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54 Cards in this Set
- Front
- Back
What is the clinical feature most effected by the age of a child
What could influence this clinical feature? |
Respiratory rate
Highest in neonates, gradually becomes slower approaching pre-adolescent/adolescent age. RR influenced by - Pulmonary/airwat infection - Non-respiratory causes of inflammation (fever, anxiety, acidosis, pain, heart failure, CNS disease, Drugs, ammonia toxin) |
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What is the condition that affects the family of an infant or child who has suffered what the parents believe is a 'close call' with death and thereafter perceived as vulnerable to serious injury or accidents?
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Vunerable Child syndrome
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During examination of an 8 m.o child, the difficulty of optimal chest auscultaion is primarily due to?
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Stanger Anxiety
Crying makes the chest physical examination almost impossible. Best conducted on the asleep, calm, nursing or feeding infant. |
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Assesment of the childs state of well being by observation mostly relies on the childs?
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Interaction with parents
Important as this is the childs "normal" environment and is free from additional factors such as stranger anxiety. |
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Based on the orientation to child development, when would you tell parents the highest risk of poisoning in children is present?
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2 years old
Self poisoning in toddlers occurs once they become ambulatory and are able to walk and climb. Plants, berries and liquids also present a risk at this age |
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What is the difference between injury control and accident prevention?
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Injuries have definable risks, are not random, and are both predictable and preventable. The term "accident" should no longer be used.
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between which periods of life do males have a higher injury rate than females?
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After the 1st/2nd years of life through to the 7th decade
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The proper age at which a child may cross a busy street alone after careful instruction is?
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10-12 yrs old
Below this age, children are unable to understand the risk and judge factors such as car speed |
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A child is in respiratory distress with stridor and cyanosis with a presumptive diagnosis of viral croup. What should you not do?
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Transport immediately in the parents car to the nearest emergency department.
No acutely ill child should be transported by parents no matter how short the distance or how long the delay for emergency services to arrive |
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Emergencies involving parents are stressful for the child, parents and emergency staff. What is useful in decreasing stress?
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- Parents presence at resuscitation
- Seperating child from other frightening sights and sounds - Communicating clearly |
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What are the causes of Pulseless Electrical Activity (PEA)
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Agents that work directly on the heart or interfere with cardiac output may produce PEA
- Toxins - PE - Pericardial Tamponade - Pneumothorax |
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What is the drug of choice for shock refractory VF?
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Amiodarone is the drug of choice for shock-resistant VT/VF
Lidocaine is second best |
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What is the normal systolic blood pressure formula for ages 1-10?
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70 + (2 x age)
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What is the one best test to determine if shock is present?
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A mixed Venous O2 Saturation Measurement
(+ possibly lactate levels) Mixed venous saturation reflects tissue oxygen extraction, which reflects oxygen delivery and oxygen consumption. If tissue oxygen consumption is greater than oxygen delivery, the mixed venous saturation declines |
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The drug pair that both stimulates the heart and relaxes the vasculature is?
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Dopamine and dobutamine
Dopamine acts on dopaminergic and beta-adrenergic receptors of the heart Dobutamine acts on beta-receptors of the heart and the peripheral arteries. |
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A 5-yr-old boy presents with petechiae, fresh bruises, low-grade
fever, dizziness, and lethargy. You admit him to the hospital and start an IV infusion. The most appropriate next step in management would be? |
Administration of Normal Saline
The dizziness and lethargy suggest poor central nervous system perfusion and hypotension. Intravenous fluid (crystalloid) resuscitation is urgently needed and should be given as soon as possible. It may need to be repeated often. In addition, intravenous antibiotics must be given rapidly, because early therapy of meningococcal sepsis with antibiotics has proven to reduce mortality. Steroids may be needed later if adrenal insufficiency is demonstrated in a patient unresponsive to fluid boluses and inotropic agents. |
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What is the normal alveolar-arterial (A-a) gradient?
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<10mmHg
Usually normal for children aged 1 month and older. Any deviation suggests V/Q mismatch, intrapulmonary shunt, cardiac left to right shunt, or rarely an alveolar diffusion defect |
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A child presents to you with respiratory distress. What is the most appropriate immediate response?
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Position child in a comfortable position, reassess the airway, provide oxygen and other supportive measures.
A mask may frighten some children, nasal cannulas are usually well tolerated. |
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Patients with severe forms of reactive airways disease (e.g. asthma) who require mechanical ventilation may benefit from what initial ventilator parameters?
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Low rates
prolonged inspiratory/expiratory times low tidal volumes (<6ml/kg) |
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What is the most important manouvre in preserving renal function in septic shock?
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Rapid restoration of the circulating volume
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What is an early morning headache a warning sign for?
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raised intracranial pressure
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What is the best investigation for blunt abdominal trauma in a paediatric patient?
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Abdominal CT with IV Contrast
Most useful for solid organs (liver, spleen, kidneys) but will also demonstrate panceatic injury, haemorrhage (free fluid), and intestinal injury |
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What age do teenagers reach adult hematologic parameters?
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Girls: 12
Boys: 14 |
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What causes galactorrhoea in a teenage girl? (6)
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1. Drug-induced (OCP, amphetamines, cocaine, marajuana, opiates, methyldopa)
2. Pregnancy-associated (post abortion or miscarriage, may continue up to 3 months) 3. Malignancy (pituitary --> very high levels of prolactin, hypothalamic craniopharyngioma) 4. Hypothyroidism 5. Chronic Renal Disease 6. Chest wall (nipple manipulation, surgery, herpes zoster) |
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Most common cause of pelvic pain in adolescents without a history of pelvic inflammatory disease?
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Endometriosis
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Techniques to increase compliance in adolescents
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Simplify regimen
Discuss potential side effects Education Enlist co-operation Work together with parents (without giving them complete control) Make the patient responsible Use praise liberally Avoid confrontation |
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HEADSS
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Home
Education Activities Drugs Sex Suicide |
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4 criteria required for the diagnosis of anorexia nervosa?
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1. Internal fear of becoming obese despite weight loss
2. Distortion of body image 3. Refusal to maintain normal BMI 4. Amenorrhoea in postmenarchal females |
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What are some hormonal features seen in anorexia nervosa?
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Amenorrhoea
Symptoms of hypothyroidism (levels of T4 normal but T3 low) Loss of diurnal variation of cortisol Diminished plasma catecholamines flattened glucose tolerance curve |
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Psychologic profile of a typical person with anorexia nervosa
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Distorted body image
Poor self-esteem Depression Over-achiever perfectionist Strong-willed Uncommunicative behaviour Distrustful Irritablility Obsessive thoughts of food/dieting |
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What causes sudden death in a person with anorexia?
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Depressed cardiovascular functions due to effects on myocardium. Bradycardia, decreased QRS amplitudes, non-specific ST changes often without underlying electrolyte changes
Increased risk of arrhythmias if electrolytes are distorted (specifically K+ from vomitting and diarrhoea) |
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How is bulimia diagnosed?
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History
High-caloric overeating and subsequent forced vomiting or other purging methods (laxatives, diuretics) often done in periods of psychological stress |
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What is the difference between Primary and secondary Amenorrhoea
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Primary: no onset of menses by
- 16 or - Within 3 years of onset of secondary sex characteristics or - Within 1 year of onset of breast/pubic hair developement Secondary No menses for 3 months after previous establishment of regular menstrual periods |
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What are some causes of primary amenorrhoea? (2 categories)
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Amenorrhoea without secondary sex characteristics
- Turner, 17a-hydroxylase deficiency - Congenital absence of uterus - Diminished gonadotrophins Amenorrhoea with secondary sex characteristics - Dysfunction of GnRH (stress, excess exercise, weight loss, PCOS, hypothyroidism) - abnormal pituitary glands - Ovarian dysfunction - Abnormalities in genital tract - Pregnancy |
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What are some Complications of Bulimia?
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- Electrolyte abnormalities
- Eosophageal reflux - Cardiomyopathy from use of Ipecac - CNS changes of perceptions of satiety - Enamel erosion, salivary gland enlargement |
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What is the PCOS triad?
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- amenorrhoea/oligomenorrhoea
- hirsutism - obesity |
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What are the normal values of the menstrual cycle?
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Most cycles last no longer than 8 days
No more or less frequent than every 21-40 days Not associated by > 80ml blood loss (ask for clotting for a more reliable guage) |
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When do boys develope the ability to reproduce?
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Spermache: 13.3 years
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What are the 4 types of substances used by teens?
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1. Experimental
2. Recreational 3. Problematic 4. Addictive |
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What is the antidote for opiod toxicity?
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Naloxone
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What are the symptoms of Nicotine withdrawal?
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onset within 2 hours of last use
Peaks at 24 hours Persist for weeks Symptoms - strong desire for nicotine - irritability - frustration/anger/depression - difficulty concentrating - increased appetite - Headache - GI disturbances |
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What are some signs of Nicotine withdrawal?
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- Decreased Heart rate
- weight gain - decreased catecholamine levels - decreased metabolic rate - Alteration of REM pattern |
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How common is gynecomastia in teenage boys?
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75% aged 12-14.5 have some breast development
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Why does gynecomastia occur in teenage boys so commonly?
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Early in puberty, oestrogen production increases relatively faster than testosterone. In obese boys, aromatase (found in higher concentrations in adipose tissue) converts testosterone to oestrogen
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What drugs are associated with gynecomastia? CHEST
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Ca-channel blockers
Hormonal medications (OCP, steroids) Experimental drugs (marijuana, heroin) pSychoactive drugs (TCA, diazepam) Testosterone antagonists (spiranolactone) |
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What is the most common solid cancer in older adolescent males?
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Testicular cancer
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Which side do varicoceles more commonly occur?
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Left
Left spermatic vein drains to the left renal vein, right spermatic vein drains to IVC. Hemodynamics favour higher left-sided pressures predisposing the left side |
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What are the risks for infants of teenage mothers?
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- low birth weight
- premature or small for gestational age - infant mortality 2-3 times higher - |
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How soon after conception will a urine pregnancy test be positive?
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hCG can be detected in the urine 1-3 weeks post conception
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What is the mechanism of the Oral contraceptive pill?
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1. Interference with hypothalamic GnRH (suppresses FSH/LH)
2. Increased Cervical mucus thickness and reduced volume 3. Atrophy of endometrium and decreased glycogen content (reduced chance of implantation) |
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What are the contraindications of OCP use? (6)
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1. History of thromboembolic disease
2. Abnormal LFT's 3. Oestrogen dependant neoplasia 4. Breast cancer 5. Undiagnosed vaginal/uterine bleed 6. Pregnancy |
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After OCP's are discontinued, how long is amenorrhoea likely to persist?
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Few months after discontinuation. If > 6 months, secondary causes should be sought.
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What is the risk to the fetus if the mother begins taking OCP's?
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Masculinization of female infants and higher bilirubin levels of the newborn.
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What oral treatments are effective for emergency postcoital contraception?
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Ethinyl Oestrodiol/norgestrel
Most effective when given 72hours of intercourse |