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138 Cards in this Set
- Front
- Back
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T/F: True allergens are proteins |
True |
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What are the 3 most common food allergies in children? |
cow's milk peanuts eggs |
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What are 6 areas you would ask about concerning a potential allergy? |
- specifics about complaint (timing, potential source) - treatment: action taken, time to resolve, previous trials of treatment - previous exposures - amount of interference w/ life - family hx - contributors: exercise? heat / cold? viral illness? |
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What would you examine for in a physical exam for potential allergies? (3) |
- existing allergic manifestations - swollen nasal mucosa, rhinitis, congestion, conjunctivitis - signs of asthma |
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T/F: Skin prick testing diagnoses allergic disease |
False! It determines presence / absence of allergen-specific IgE (presence ≠ symptomatic) |
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T/F: Routine skin prick testing with a standard panel of allergens should be done in all patients |
False! Skin prick testing should be tailored to each patient |
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What can you use intracutaneous allergy testing for? |
To test for reactions to penicillin, vaccine components, venoms NOT for food / environmental allergies |
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What is the gold standard for diagnosing food allergies? |
double-blind, placebo-controlled food challenge |
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Why is a radioallergosorbent test useful in diagnosing allergies? |
not affected by use of antihistamines |
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What is included in the treatment of allergies? (5) |
- mainly avoidance! - counselling (eg. checking labels, Epipens) - environmental control - pharmacologic treatment - immunotherapy (if fail other methods) |
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What are 2 pharmacologic options for treating allergies? |
oral antihistamines nasal corticosteroids |
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What are the clinical criteria to dx anaphylaxis? (3) |
any 1 of 3... 1) acute onset, involving skin / mucosal tissue + ≥1 of: respiratory compromise, reduced BP, signs of end-organ dysfunction 2) after likely exposure, ≥2 of: skin / mucosal symptoms, respiratory compromise, reduced BP, persistent GI symtpoms 3) after known exposure, reduced BP |
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What are clinical features of anaphylaxis? (4) |
skin & mucosa (hives, swelling, itching, rash) respiratory (wheezing, cough, chest pain) GI (nausea, vomiting, diarrhea, pain) cardiovascular (tachycardia, cyanosis, syncope) |
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T/F: anaphylaxis always occurs with hives |
False! Don't need hives to dx anaphylaxis |
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What is serum tryptase? |
a marker of anaphylaxis (may be normal in severe cases) |
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What is involved in the acute management of anaphylaxis? (5) |
- ABCs - large bore IV - Epinephrine IM - later: diphenhydramine, steroids |
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T/F: we usually use epinephrine IV for anaphylaxis treatment |
False! Usually give epinephrine IM, unless critically ill |
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What is involved in the management of anaphylaxis? (not just acute) (4) |
- stabilize (acute management) - observe for 12h - refer to allergist / immunologist - prevention (EpiPen, bracelet) |
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Compare pharmacokinetic vs pharmacodynamic drug-drug interactions |
pharmacokinetic interaction: drug B changes levels of drug A pharmacodynamic interaction: no change in drug levels |
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What is the interaction that occurs between sulfonylureas and SMX-TMP? |
affects actions of CYP2C9 more likely to be hospitalized if given SMX-TMP while on glyburide (sulfonylurea) |
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What is the interaction that occurs between codeine & paroxetine? |
paroxetine inhibits CYP2D6, which metabolizes codeine --> morphine |
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What are 3 substrates of CYP3A4? |
statins Ca channel blockers benzodiazepines |
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What are 4 inhibitors of CYP3A4? |
Ca channel blockers amiodarone antiretrovirals macrolides (except azithromycin) |
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What are 4 inducers of CYP3A4? |
tamoxifen anticonvulsants dexamethasone St John's Wort |
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What is the interaction between digoxin and clarithromycin? |
more likely for digoxin toxicity b/c of P-glycoprotein induction by clarithromycin |
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Why is there an interaction between acetaminophen and warfarin? |
- warfarin prevents recycling of vitamin K (needed for clotting) - acetaminophen inhibits enzyme that activates clotting factors |
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What are 5 drug classes that interact with warfarin? |
5 A's - amiodarone - analgesic - antidepressants - antiplatelets - antibiotics |
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What are 3 examples of drug interactions that increase risk of hyperkalemia / sudden death? |
SMX-TMP with... - amiloride - spironolactone - ACE inhibitors / ARBs |
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Why can citalopram (SSRI) and tramadol together cause serotonin syndrome? |
tramadol also inhibits serotonin reuptake |
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What are 6 types of adverse drug reactions? |
ABCDEF... - adverse (dose related) - bizarre (non-dose related) - chronic - delayed - end of use - failure of therapy |
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What are type A drug reactions? |
adverse reactions - not host dependent - pharmacologic basis - dose dependent |
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What are examples of type A drug reactions to... - beta blockers - benzodiazepines - acetaminophen - epinephrine - anticoagulants |
beta blockers: bradycardia benzos: sedation acetaminophen: liver toxicity epinephrine: tachycardia anticoagulants: bleeding |
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What are Type B drug reactions? |
bizarre... - host dependent - pharmacologic +/- immunologic causes - uncommon but serious |
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What is anticonvulsant hypersensitivity syndrome? What type of drug reaction is it? |
Type B triad: fever, rash, internal organ involvement usually from aromatic anticonvulsants, after 1-8 weeks treatment |
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What is an example of a type B drug reaction to ticlopidine? |
febrile neutropenia / aplastic anemia |
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What are 2 possibilities when someone reports a penicillin allergy? |
maculopapular rash (mild reaction) sulfa reaction / toxic epidermal necrolysis (severe) |
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What are type C drug reactions? |
chronic, potential toxicity more with time & w/ cumulative dose |
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What type of reaction is the development of cardiotoxicity to doxorubicin 2-3 months after termination of treatment? |
type D: delayed (doxorubicin = chemo for breast cancer) |
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What is an example of a Type F drug reaction? |
failure of therapy eg. clopidogrel needs activation by CYP2C19 --> people may have low levels of CYP2C19, or PPIs can inhibit CYP2C19 |
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What is the main hormone for intrauterine growth? |
IGF-1 (insulin) |
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How large should a baby's head be at birth? At what rate does it grow after? |
35 cm @ birth increases by 12 cm in 1st year |
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How heavy should a baby be at birth? When does its weight double? triple? quadruple? |
3-3.5 kg @ birth 2x by 5 months 3x by 1 year 4x by 2 years |
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How many ounces are in a pound? |
16 oz = 1 pound |
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How tall should a baby be at birth? at 1 year old? |
50 cm @ birth 76 cm @ 1 year |
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When should a child have doubled its birth height? |
4 years old |
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What is the normal growth velocity in childhood? |
6 cm / year |
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When would you investigate short stature in a child? (4) |
- height <<< 3rd %ile - abnormal growth velocity - crossing %iles - abnormal considering parents' height |
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How would you calculate midparental height? |
MPH = (dad's height + mom's height +/-12.5cm) / 2 if male child: +12.5 if female child: -12.5 |
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What is the significance of midparental height? |
90% of their offspring should fall within 2 SDs of the MPH (ie. +/- 10cm) |
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When does female puberty begin? What is the first sign? |
onset @ 7-13 years old first sign: breast development |
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When does menarche occur relative to other pubertal changes? |
menarche when growth is almost complete |
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T/F: early puberty is rare and often pathologic in girls |
False! Early puberty is common |
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When does male puberty begin? What is the first sign? |
onset @ 9-14 years old first sign: testicular enlargement |
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T/F: voice change is a reliable index of male puberty progress |
False! |
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T/F: early puberty in males is rare and often pathologic |
True |
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What 6 areas would you ask about in history for short stature in children? |
- pregnancy course - neonatal health - nutrition - puberty onset - chronic disease, medications - family hx |
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What would be included in a physical exam for short stature in children? (4) |
- plot growth - measure proportions - vitals - dysmorphic features? thyroid? tanner stage? chronic disease |
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What are 4 important questions to address when investigating short stature in children? |
- IUGR? - proportionate? - growth velocity? - bone age? |
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What should you investigate if a child with short stature also had IUGR? |
consider maternal, fetal, placental factors |
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How does disproportionate measurements affect your diagnosis of a child with short stature? |
disproportionate = more likely to be a bony cause |
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What are possible diagnoses for a child with short stature and normal growth velocity? |
familial short stature constitutional delay |
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Compare familial short stature & constitutional delay (birth weight, family hx, puberty onset, males vs females, bone age) |
familial short stature: normal birth weight, short in FHx, normal puberty onset, #males = #females, bone age = constitutional age constitutional delay: normal birth weight, FHx near target, late puberty, #males > #females, bone age < constitutional age |
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How would a slow growth velocity in a child with short stature affect your diagnosis? |
slow growth velocity associated w/ pathological state eg. malnutrition |
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How does a delayed bone age affect your diagnosis of a child with short stature? |
rules out familial short stature --> only familial short stature has normal bone age |
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What investigation should you do in all short stature girls? |
karyotype! |
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What are WHO guidelines for breastfeeding for infants? |
- exclusive breastfeeding for 1st 6 months - breastfeeding + solids for 6 months - 1 year old |
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What are 5 reasons to breastfeed? |
- optimal balance of nutrients (except vit D) - protects against allergies, infections - maternal benefits - lower SIDS risk - prevents obesity |
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What is the composition of breastmilk? (3) |
colostrum: first 24-48 hrs, thick, sticky, high proteins & minerals & Igs foremilk: mostly carbs, proteins, water hindmilk: mostly fat |
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What vitamin is not contained in breastmilk? |
vitamin D!!! |
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What are 5 contraindications for breastfeeding? |
maternal: active TB, HIV+, illegal drug use, certain medications baby: galactosemia (rare) |
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What are 3 forms of infant formula? Compare their preparation methods |
powder (1 scoop:2 ounces water) liquid concentrate (1:1 ratio) ready to feed (no mixing) |
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How many kcal/ml should formula be mixed to? |
0.67 kcal/ml |
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What are 4 components of infant formula? |
protein (cow milk, soy based, hydrolyzed) carbs (lactose or lactose-free) fat (essential FAs) iron! |
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What are 5 types of formula & their indications? |
cow's milk based: healthy babies cow's milk - thickened: happy spitters cow's milk - lactose free: lactose intolerant soy based: vegetarians / galactosemia therapeutic / specialized: food allergies or errors of metabolism |
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What are energy and fluid requirements for 0-6 month old infants? 6-12 month old infants? |
0-6 months: 100 kcal/kg/day, 150 cc/kg/day 6-12 months: 80 kcal/kg/day, 120 cc/kg/day |
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How do frequency of feeds differ between a newborn and a 7-12 month old infant? |
newborn: very frequent (b/c low volume) 7-12 months: 3-4 feeds/day |
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When can children have homo milk? skim milk? soy milk? |
homo milk: start at 9-12 months, until 2 years old skim milk & soy milk: >2 years old |
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How much milk should children drink? |
maximum 16 oz / day or else iron deficiency anemia |
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How much juice should children drink? |
120ml or 4oz / day |
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How can you prevent dental caries in kids? (5) |
- fluoride - don't dip pacifier in sugar / honey - no bottle in bed - wean - brush & dentist |
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What are recommendations about dietary iron in infants? |
need alternate iron source by 6 months old (b/c stores have been depleted by growth) |
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What are 4 risk factors for iron deficiency? |
- breast fed - low / delayed intake of iron rich foods - low vitamin C - high milk intake |
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T/F: iron deficiency in early childhood can lead to irreversible adverse cognitive effects |
True |
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What affects a baby's vitamin D status? (4) |
- maternal vit D status in pregnancy - gestational age - sunlight exposure - diet |
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What are supplementation recommendations for vitamin D in infants? |
if breastfed or use formula: 400 IUs in Northern Canada in winter: 800 IUs |
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When should a child reach these milestones... - holds bottle - finger feeds - uses cup and spoon - eats with hands - eats with knife and fork |
hold bottle @ 6-9 months finger feeds @ 9-12 months cup & spoon @ 12-18 months eats w/ hands @ 18-24 months knife & fork @ 4-5 years |
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How often should you offer solid foods when transitioning to solid foods? |
≥2 times daily |
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How can you approach a discussion about obesity in a pediatric setting? (5) |
5 A's - ask permission - assess (BMI, complications, barriers) - advise - agree - assist |
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What determines if a patient is capable? (2) |
- can understand info about the options - can appreciate foreseeable consequences |
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What are 3 ddx for chronic abdominal pain in the older child? |
organic GI disorder organic non-GI disorder functional GI disorder |
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What are 4 categories of functional GI disorders? |
- functional dyspepsia - IBD - abdominal migraine - childhood functional abdominal pain |
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What are red flags in a child with chronic abdominal pain? (5) |
***EXAM*** - GI symptoms: oral ulcers, dysphagia, bilious emesis, hematemesis, melena, hematochezia, occult GI blood loss, unexplained diarrhea, acute abdomen, anal skin tags / fissures - liver & kidney symptoms: jaundice, flank pain, dysuria, hematuria - hematologic symptoms: hypoalbuminemia, anemia, leukocytosis - other symptoms: joint pain, rashes, fevers, nocturnal symptoms, weight loss, delayed puberty - family hx |
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What is irritable bowel syndrome? |
abdominal pain with ≥2 of the following, 25% of the time: - improvement w/ defecation - changes in frequency of stool - changes in form of stool |
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What is functional dyspepsia? |
persistent upper abdo pain - no improvement with defecation - no changes in stool |
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What is an abdominal migraine? |
intense, paroxysmal pain for >1h associated with 2 of: - anorexia - nausea - vomiting - headache - photophobia - pallor |
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What is functional abdominal pain vs. functional abdominal pain syndrome? |
functional abdo pain: abdo pain with insufficient criteria for other GI disorders functional abdo pain syndrome: meets criteria for functional abdo pain, 25% time, with disrupted daily living or other somatic symptoms |
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When is the peak incidence of functional abdominal pain? |
10-12 years old |
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What are 4 clinical features of functional abdominal pain? |
- periumbilical - self limited, not related to meals / activities - doesn't wake from sleep - normal growth, normal physical exam |
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T/F: Diagnosis of functional abdominal pain can be confirmed with a abdominal CT scan |
False! There is no confirmatory diagnostic tool for functional abdominal pain --> hx & physical exam are essential |
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What is crucial in the management of functional abdominal pain? |
reassurance & education! also: social history, acknowledge pain, encourage continued activities |
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T/F: Most children with functional abdominal pain persist into adulthood |
False! Only ~1/3 persist |
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What are 4 patterns of headaches? |
acute acute recurrent chronic progressive chronic non-progressive |
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What are red flags for 2º headache in children? |
***EXAM*** - <3 years old - headache characteristics: progressive, more with straining / coughing, explosive / sudden onset, new / different headache - neurologic symptoms - systemic symptoms - sleep related - 2º risk factors: immunocompromised, hypercoagulable, cancer, neurocutaneous disorder |
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What are 5 characteristics of a migraine? |
- +/- aura - lasts 30min - 72hrs - unilateral or bilateral, pulsating - nausea, photo / phonophobia - positive family hx |
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What are 6 common triggers of a migraine? |
stress fatigue poor sleep illness fasting dehydration |
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What are symptoms associated with a basilar migraine? (7) |
vertigo, tinnitus ataxia nystagmus, diplopia dysarthria occipital headache |
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What are symptoms of a confusional migraine? (3) |
altered mental status aphasia headache |
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What are 4 symptoms of a hemiplegic migraine? |
hemiplegia numbness aphasia confusion |
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What are 3 characteristics of a tension headache? |
bilateral, pressure / tightening quality +/- photo / phonophobia triggered by stress (no nausea, not worse with physical activity) |
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What are recommended investigations for a child with a recurrent headache and normal neuro exam? |
history and physical neuroimaging, LP, EEG is not recommended (if normal neuro exam) |
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When is neuroimaging recommended for recurrent headaches? (5) |
- red flags in hx / physical - abnormal neuro exam - with seizures - change in type of headache - recent onset of severe headache |
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What are 6 principles of management for recurrent headaches? |
- reassurance - headache diary - avoid triggers - exercise - address comorbidities - good follow-up |
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What are 3 medications that can be used for recurrent headaches? |
acetaminophen / ibuprofen @ onset nasal sumatriptan (adolescents) anti-nausea agents |
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T/F: Someone with recurrent headaches can take ibuprofen or acetaminophen every day to relieve headaches. |
False! Can get medication rebound / overuse headache should limit use to 2-3 days / week |
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When is ADHD most prevalent? |
children <12 years old |
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What are 5 factors associated with ADHD? |
- single parent family - low parental educational attainment - low family income - low birth weight - developmental problems |
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What is the etiology of ADHD? |
multifactorial... inherited (polygenic, dopamine genes) environmental - perinatal (eg. LBW, prenatal smoking) - postnatal (eg. head injury, infection, autoimmune) - epigenetics |
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T/F: Children with ADHD have deficits in basic cognitive processes and executive function |
False. They only have deficits in executive function |
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What is different about the brain development in a child with ADHD? |
- slower development - smaller volume (total cerebral, right cerebral, right caudate, splenium, cerebellum, frontal regions) |
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What are diagnostic criteria for ADHD? |
- developmentally inappropriate - functionally impairing - in ≥2 settings - present since childhood - ≥6 symptoms of hyperactivity & inattention |
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What are 3 subtypes of ADHD? |
primarily hyperactive primarily inattentive combined |
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T/F: behaviour modification can be as effective as pharmacologic treatment for ADHD |
True |
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What are 5 side effects from ADHD medication? |
- insomnia - loss of appetite - emotional (after school) - anxiety (if pre-disposed) - growth suppression (?) |
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What should you be aware of when prescribing stimulants for ADHD? (2) |
- high diversion potential! (ie. abuse) - multiple dosing = poor compliance |
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What are 4 drug handling processes that affect pharmacokinetics of a drug? |
drug compliance absorption distribution elimination |
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What are 3 risk factors for non-compliance? |
polypharmacy chronic treatment adolescence |
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How is drug absorption different in neonates? (2) |
- unpredictable peristalsis - short intestinal transit time |
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What affects drug absorption in neonates? (3) |
fever diarrhea vomiting |
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How does drug distribution differ in neonates? (4) |
- higher concentration of unbound drug - more extracellular fluid - less intracellular fluid - more total body water |
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How does drug elimination differ in neonates & children? |
neonates: less clearance per kg children: more clearance per kg |
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Caffeine has a longer half-life and slower clearance in neonates. How does this affect the loading dose & maintenance dose? |
same loading dose smaller maintenance dose |
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Gentamicin has slower clearance, longer half-life, and larger apparent volume of distribution in neonates. How would this affect dosing? |
slower clearance = less often larger volume of distribution = more drug |
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T/F: If a child is half the average adult weight, their drug dosages can be calculated by dividing the adult dose in half |
FALSE!!! DO NOT!!! |
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What is a potential side effect of tetracycline (in children)? |
teeth discolouration (up to 8 years old) |
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What is a potential side effect of valproic acid (in children)? |
liver failure |
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What is a potential side effect of ethanol (in children)? |
hypoglycemia |
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What is a potential side effect of sulfonamides (in children)? |
kernicterus |
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What is a potential side effect of aspirin (in children)? |
Reye syndrome |
