Edited, memorised or added to reading list

on 09-Feb-2017 (Thu)

Do you want BuboFlash to help you learning these things? Click here to log in or create user.

Flashcard 1427360058636

Tags
#9-dic-2016 #el-financiero #noticias
Question
El secretario de la Defensa Nacional, [...], señaló que urge nuevamente que se apruebe un marco legal que regule la actuación del Ejército en las calles.
Answer
Salvador Cienfuegos

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
El secretario de la Defensa Nacional, Salvador Cienfuegos, señaló que urge nuevamente que se apruebe un marco legal que regule la actuación del Ejército en las calles.

Original toplevel document

Desnaturalizan nuestra función, advierte Sedena
El secretario de la Defensa Nacional, Salvador Cienfuegos, señaló que urge nuevamente que se apruebe un marco legal que regule la actuación del Ejército en las calles. Salvador Cienfuegos, titular de Sedena, pidió que se definan tiempos y labores para las Fuerzas Armadas. (Especial) “No nos sentimos a gusto, ninguno de los qu







Flashcard 1429051411724

Tags
#sister-miriam-joseph #trivium
Question
Words are categorized by their relationship to [...] and to [...] .
Answer
being

each other

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Words are categorized by their relationship to being and to each other.

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1429109345548

Tags
#sister-miriam-joseph #trivium
Question
A speculative study is one that merely seeks to know—for example, [...].
Answer
astronomy

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
A speculative st udy is one that merely seeks to know—for example, astronomy. We can merely know about the heavenly bodies. We cannot influence their movement s

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1429153647884

Tags
#rhetoric #sister-miriam-joseph #trivium
Question
Rhetoric recognizes various levels of discourse, such as the [...] (maiden or damsel, steed), the common (girl, horse), the illiterate (gal, hoss), the slang (skirt, plug), the technical (homo sapiens, equus caballus), each with its appropriate use.
Answer
literary

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Rhetoric recognizes various levels of discourse, such as the literary (maiden or damsel, steed), the common (girl, horse), the illiterate (gal, hoss), the slang (skirt, plug), the technical (homo sapiens, equus caballus), each with its appropriate use.</s

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1429297302796

Tags
#sister-miriam-joseph #trivium
Question
the seven fine arts (architecture, [...], sculpture, painting, literature, t he drama, and the dance)
Answer
instrumental music

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
the seven fine arts (architecture, instrumental music, sculpture, painting, literature, t he drama, and the dance)

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1429303594252

Tags
#sister-miriam-joseph #trivium
Question
Arithmetic, the theory of number, and music, an application of the theory of number (the measurement of [...] quantities in motion), are the arts of [...]
Answer
discrete

discrete quantity or number.

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Arithmetic, t he theory of number, and music, an application of the theory of number (the measurement of discrete quantities in motion), are the arts of discrete quantity or number.

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1429316963596

Tags
#sister-miriam-joseph #trivium
Question
The pupil must cooperate with the teacher; he must be active, not passive. The teacher may be present either directly or indirectly. When one studies a book, the author is a teacher [...] present through the book.
Answer
indirectly

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
The pupil must cooperate with the teacher; he must be active, not passive. The teacher may be present either directly or indirectly. When one studies a book, the author is a teacher indirectly present through the book.

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1430519418124

Tags
#cfa #cfa-level-1 #economics #microeconomics #reading-13-demand-and-supply-analysis-introduction #study-session-4
Question
An example of a common value auction would be bidding on [...]. Each bidder could estimate the value; but until someone buys it, no one knows with certainty the true value.
Answer
a jar containing many coins

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
which there is some actual common value that will ultimately be revealed after the auction is settled. Prior to the auction’s settlement, however, bidders must estimate that true value. An example of a common value auction would be bidding on <span>a jar containing many coins. Each bidder could estimate the value; but until someone buys the jar and actually counts the coins, no one knows with certainty the true value.<span><body><html>

Original toplevel document

3.8. Auctions as a Way to Find Equilibrium Price
> Sometimes markets really do use auctions to arrive at equilibrium price. Auctions can be categorized into two types depending on whether the value of the item being sold is the same for each bidder or is unique to each bidder. <span>The first case is called a common value auction in which there is some actual common value that will ultimately be revealed after the auction is settled. Prior to the auction’s settlement, however, bidders must estimate that true value. An example of a common value auction would be bidding on a jar containing many coins. Each bidder could estimate the value; but until someone buys the jar and actually counts the coins, no one knows with certainty the true value. In the second case, called a private value auction , each buyer places a subjective value on the item, and in general their values differ. An example might be an auction for a unique p







Flashcard 1432424680716

Tags
#sister-miriam-joseph #trivium
Question
[...] do not add to the intrinsic worth of their possessor, nor are they desired as means, yet they may be associated with the other 2 kinds of goods.
Answer
Pleasurable goods

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
surable goods are those which are desired for their own sake because of the satisfaction they give their possessor. For instance, happiness, an honorable reputation, social prestige, flowers, and savory food are pleasurable goods. <span>They do not add to the intrinsic worth of their possessor, nor are they desired as means, yet they may be associated with valuable goods or useful goods. For instance, knowledg

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1432695475468

Tags
#italian #italian-grammar #structure
Question
Nouns referring to human beings or animals sometimes have the same [...] as their [...] , but not always.
Answer
grammatical gender

natural gender

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Nouns referring to human beings or animals sometimes have the same grammatical gender as their natural gender, but not always (see below).

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1432719854860

Tags
#italian #italian-grammar #number #structure
Question
Number Unlike gender, the grammatical concept of [...] (‘number’) causes no problem for speakers of English.
Answer
singular or plural

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Number Unlike gender, the grammatical concept of singular or plural (‘number’) causes no problem for speakers of English. Occasionally (as in English) a singular noun is used to refer to a collective entity that one might expect to be grammatically plur

Original toplevel document (pdf)

cannot see any pdfs







Flashcard 1443032337676

Tags
#cfa-level-1 #fra-introduction #study-session-7
Question

The readings in study session 7 describe the general [...], underscoring the critical role of the analysis of [...] in investment decision making.

Answer
principles of financial reporting

financial reports

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill
An Introduction
The readings in this study session describe the general principles of financial reporting, underscoring the critical role of the analysis of financial reports in investment decision making. The first reading introduces the range of information that is available







Flashcard 1471488855308

Tags
#python #sicp
Question
This pattern of binding multiple names to multiple values in a fixed-length sequence is called sequence unpacking; it is the same pattern that we see in assignment statements that [...]
Answer
bind multiple names to multiple values.

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
This pattern of binding multiple names to multiple values in a fixed-length sequence is called sequence unpacking; it is the same pattern that we see in assignment statements that bind multiple names to multiple values.

Original toplevel document

2.3 Sequences
wo names in its header will bind each name x and y to the first and second elements in each pair, respectively. >>> for x, y in pairs: if x == y: same_count = same_count + 1 >>> same_count 2 <span>This pattern of binding multiple names to multiple values in a fixed-length sequence is called sequence unpacking; it is the same pattern that we see in assignment statements that bind multiple names to multiple values. Ranges. A range is another built-in type of sequence in Python, which represents a range of integers. Ranges are created with range , which takes two integer arguments: the first







#ir #peds
Height
• At birth = 50cm (avg)
• Doubles height by 4 years
• Measure recumbent length until 2 years, then standing height
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
• At birth = 35cm (avg) o <32cm 􀃆 small head = small brain until proven otherwise • May be inaccurate at birth due to caput succedaneum, molding • 0‐3mths = +2cm/mth • 3‐6mths =+1cm/mth • 6‐12mths = +0.5cm/mth <span>Height • At birth = 50cm (avg) • Doubles height by 4 years • Measure recumbent length until 2 years, then standing height Normal Growth Velocity Growth Charts • Critical to use gender and age appropriate growth charts • In 2010, the CPS, RCFPC and the Dieticians of Can




Flashcard 1473486130444

Question
The basic idea of data abstraction is [...].
Answer
to structure programs so that they operate on abstract data

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
The basic idea of data abstraction is to structure programs so that they operate on abstract data. That is, our programs should use data in such a way as to make as few assumptions about the data as possible

Original toplevel document

2.2 Data Abstraction
we can make an abstraction that separates the way the function is used from the details of how the function is implemented. Analogously, data abstraction isolates how a compound data value is used from the details of how it is constructed. <span>The basic idea of data abstraction is to structure programs so that they operate on abstract data. That is, our programs should use data in such a way as to make as few assumptions about the data as possible. At the same time, a concrete data representation is defined as an independent part of the program. These two parts of a program, the part that operates on abstract data and the part that defines a concrete representation, are connected by a small set of functions that implement abs







Flashcard 1473657048332

Tags
#cfa-level-1 #fra-introduction #reading-22-financial-statement-analysis-intro
Question
The additional information provided may include:


An external [...] providing assurances,
Answer
auditor’s report

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
l information provided may include: A letter from the chairman of the company, A report from management discussing the results (typically called management discussion and analysis or management commentary), An <span>external auditor’s report providing assurances, A governance report describing the structure of the company’s board of directors, and a corporate responsibility report.<span><body><html>

Original toplevel document

3.1. Financial Statements and Supplementary Information
with the required financial statements, a company typically provides additional information in its financial reports. In many jurisdictions, some or all of this additional information is mandated by regulators or accounting standards boards. <span>The additional information provided may include a letter from the chairman of the company, a report from management discussing the results (typically called management discussion and analysis [MD&A] or management commentary), an external auditor’s report providing assurances, a governance report describing the structure of the company’s board of directors, and a corporate responsibility report. As part of his or her analysis, the financial analyst should read and assess this additional information along with the financial statements. The following sections describe and illustr







Flashcard 1474081459468

Tags
#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
The exposure draft identifies five content elements of a “decision-useful management commentary.” Those content elements include

1) the [...] business;

2) management’s objectives and strategies;

3) the company’s significant resources, risks, and relationships;

4) results of operations;

5) critical performance measures.
Answer
nature of the

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
The exposure draft identifies five content elements of a “decision-useful management commentary.” Those content elements include 1) the nature of the business; 2) management’s objectives and strategies; 3) the company’s significant resources, risks, and relationships; 4) results of operations; and 5)

Original toplevel document

3.1.6. Management Commentary or Management’s Discussion and Analysis
ASB) issued an exposure draft in June 2009 that proposed a framework for the preparation and presentation of management commentary. Per the exposure draft, that framework will provide guidance rather than set forth requirements in a standard. <span>The exposure draft identifies five content elements of a “decision-useful management commentary.” Those content elements include 1) the nature of the business; 2) management’s objectives and strategies; 3) the company’s significant resources, risks, and relationships; 4) results of operations; and 5) critical performance measures. In the United States, the SEC requires listed companies to provide an MD&A and specifies the content.7 Management must highlight any favorable or unfavorable trends and







Flashcard 1474124975372

Tags
#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
The standard independent [...] for a publicly traded company normally has several paragraphs under both the international and US auditing standards.
Answer
audit report

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
The standard independent audit report for a publicly traded company normally has several paragraphs under both the international and US auditing standards.

Original toplevel document

3.1.7. Auditor’s Reports
financial statements are fairly presented, meaning that there is a high probability that the audited financial statements are free from materialerror, fraud, or illegal acts that have a direct effect on the financial statements. <span>The standard independent audit report for a publicly traded company normally has several paragraphs under both the international and US auditing standards. The first or “introductory” paragraph describes the financial statements that were audited and the responsibilities of both management and the independent auditor. The second or “scope”







Flashcard 1474366147852

Tags
#cfa-level-1 #reading-22-financial-statement-analysis-intro
Question
The answer to the analytical question relies on [...]
Answer
the analyst’s interpretation of the output

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
The answer to a specific financial analysis question is rarely the numerical answer alone. Rather, the answer to the analytical question relies on the analyst’s interpretation of the output and the use of this interpreted output to support a conclusion or recommendation.

Original toplevel document

4.4. Analyze/Interpret the Processed Data
Once the data have been processed, the next step—critical to any analysis—is to interpret the output. The answer to a specific financial analysis question is seldom the numerical answer alone. Rather, the answer to the analytical question relies on the analyst’s interpretation of the output and the use of this interpreted output to support a conclusion or recommendation. The answers to the specific analytical questions may themselves achieve the underlying purpose of the analysis, but usually, a conclusion or recommendation is required. For example, an







Flashcard 1474563542284

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
For presentation purposes, assets are sometimes categorized as “[...]” or “ [...] .”
Answer
current

Non-current

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
For presentation purposes, assets are sometimes categorized as “current” or “non-current.”

Original toplevel document

3.1. Financial Statement Elements and Accounts
(e.g., rent, utilities, salaries, advertising) Depreciation and amortization Interest expense Tax expense Losses <span>For presentation purposes, assets are sometimes categorized as “current” or “non-current.” For example, Tesco (a large European retailer) presents the following major asset accounts in its 2006 financial reports: Non-current assets: In







Flashcard 1474647952652

Tags
#ir #peds
Question
A full term baby presents with an eating disorder (i.e. FTT). What is your ↑ demand DDx?
Answer
↑thyroid
resp
cardiac
infection

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, res

Original toplevel document

Growth
obstructive uropathy Ix: CBC/Fe, celiac screen (tTGT), lytes, urea, Cr, TSH, U/A, Ca 2+ , Vit ADE 14yo at 3 rd %ile weight + 10 th %ile height is not eating well. What are 3 possible causes? See above <span>A full term baby presents with an eating disorder (i.e. FTT). What is your DDx? ↓intake: non-organic , GERD, structural, CNS, genetic ↓absorption: CF, CMPA, short gut, biliary atresia, GI ↑loss: gastroenteritis ↑demand: cardiac, ↑THY, infection, respiratory Ineffective use: inborn error of metabolism Obesity 14yo ♂ with weight of 67 kg, height 150cm. Calculate BMI: 29.8 kg/m 2 4 complications of obesity: HTN, dyslipidemia, OSA, SCFE, nonEtO







Adolescent medicine (day 7)
#ir #peds
  1. ADOLESCENT MEDICINE (HEADSSS)

HEADDSSS

  • Home: How are things at home? Who lives at home, age, occupation? How does everyone get along? What do you argue about? Have there been any changes lately? Have you ever run away from home?

  • Education / Employment: Name of school, grade level, attendance pattern, amount of school missed, academic performance,favourite/least favourite courses, marks, behaviour at school, current and past jobs

  • Activities: What do you do when not at school? For fun? On weekends? Do you feel you have enough friends? Who are your bestfriends? What do you do together? Sports / exercise, extra‐curricularactivities, hobbies, social groups? Do you go out to parties a lot? Howdo you pay for things you do?

  • Drugs: Have you ever tried smoking or drinking alcohol? What did you think? What about other drugs? Have you ever tried Marijuana? Ever been drunk? Friends’ use and peer pressure? What age did you start? Frequency? Amount? What do you like/dislike? Why do you use? Use alone? Have you ever gotten into trouble because of using these substances? What would/does your family think if they knew that? What do you think about it?

  • Dieting: Do you have concerns about/have you tried to change your weight/shape (dieting/exercise)? Presence of bingeing/purging behaviours, use of diuretics/laxatives. Tell me what you eat/drink in an average day

  • Safety: Do you regularly use: seatbelts? Bike helmets? Appropriate gear when snowboarding/skateboarding? Does anyone at home own a gun? Has anyone ever hurt you or touched you in a way that was hurtful or inappropriate? Driving?

  • Sexuality: Are you interested in the same sex, opposite sex or both? (DO NOT assume heterosexuality!) Are you dating someone now? Are you having sex? What do you use for contraception/STI prevention? Number of sexual partners /age of first sexual activity/STI history / last pelvic exam in females / ever tested for STIs, HIV? History of pregnancy? Sexual abuse?

  • Suicide / Depression: Screen for depression (SIGMECAPS). Does the teen see themselves as generally happy or unhappy? Do they have difficulties with anger? When they feel sad, how do they cope with it? Have they ever thought about killing themselves? How recently? Has the teen had any prior suicide attempts?

    1. STIs

  • 14yo ♂ comes after having urethral discharge and has had 3 sexual contacts (anal but no oral sex, I think). What should you do? What should you tell the child? What are the 5 tests you would do? (choose from menu)

  • Plan: further Hx (S+S, sexual behaviours, RFs)

    • chlamydia

      • female: vag discharge, dysuria, abn vag bleed, lower abdo pain, dyspareunia, +/- fever, +/- conjunctivitis

      • male: urethral discharge, urethral pruritus, dysuria, testicular pain, +/- fever, +/- conjunctivitis

    • gonorrhea

      • female: cervicitis, PID, urethritis, inflm of lower 1/3 of vulva, vag discharge, dysuria, abn vag bleed, lower abdo pain, deep dyspareunia, +/- fever

      • male: urethritis, epididymitis, testicular pain, urethral itch, urethral discharge, +/- fever

      • both: pharyngeal inf, purulent conjunctiviti

...
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Flashcard 1475808201996

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M [...]
P Placing reflex
R Rooting
A Atonic neck reflex
G Grasp reflex
Answer
Moro

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475809774860

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P [...]
R Rooting
A Atonic neck reflex
G Grasp reflex
Answer
Placing reflex

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475811347724

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P Placing reflex
R [...]
A Atonic neck reflex
G Grasp reflex
Answer
Rooting

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475812920588

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P Placing reflex
R Rooting
A [...]
G Grasp reflex
Answer
Asymmetric tonic neck reflex

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







Flashcard 1475815542028

Tags
#ir #peds
Question
Developmental assessment
Primitive reflexes
Mnemonic: MPRAG
M Moro
P Placing reflex
R Rooting
A Atonic neck reflex
G [...]
Answer
Grasp reflex

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex

Original toplevel document

Development
n one foot to undress, so she and mom can read a story together. A Wrinkle in Time. 5 years: Skip, Tie shoes, Difference between reality/fantasy Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas <span>Developmental assessment Primitive reflexes Mnemonic: MPRAG M Moro P Placing reflex R Rooting A Atonic neck reflex G Grasp reflex Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 5







cardiology (day 8)
#has-images #ir #peds
  1. CARDIOLOGY

  • Down's + murmur, query VSD: name 3 things that would make you suspect it’s pathologic

  • Innocent: Sensitive (position, resp), Short, Single, Small (area), Soft, Sweet, Systolic

  • Pathologic: loud (>3/6), harsh, pansystolic/diastolic/late systolic/conntinuous, cannot modify with position, abnormal exam, PHx congenital heart disease, RFs (high LSB, pansystolic/diastolic, radiates to back/neck, >II, harsh, click

Congenital Heart Disease Functionally significant structural abnormalities of the heart and great vessels present at birth presented below.

Ebstein’s anomaly – opening of tricuspid valve is displaced towards the apex of the right ventricle = “atrialization” of the right ventricle. * CHD with cyanosis/tachypnea in first hours of life: TGA, Ebstein’s, Pulmonary atresia ^ CHD with CHF (excess pulm. flow): large VSD, AVSD, PDA, coarctation of the aorta # CHD with shock/catastrophy: critical coarctation or AS, interrupted aortic arch, Hypoplastic left heart5 most common types of Cyanotic Congenital Heart Defects (Five T’s)

• Tetralogy of Fallot (TOF): PA stenosis, RV hypertrophy, VSD,
overriding aorta
• Truncus arteriosus: A single trunk gives rise to the aortic arch,
pulmonary arteries and coronary arteries
• Transposition of Great Arteries (TGA): RV to aorta, LV to PA – the
pulmonary and systemic circulations are in parallel rather than in
series
• Tricuspid Atresia: Absence of the tricuspid valve forces all of the
systemic venous return across an ASD to mix with the pulmonary
venous return, often associated with pulmonary stenosis or atresia
• Total anomalous pulmonary venous connections (TAPVC): PV not
connected to LA
Note: Clinical presentations of these lesions usually differ markedly and may not
present with apparent cyanosis.

Ventricular Septal Defect
Defect in the formation of the intraventricular septum (varies in
size/location: muscular, perimembranous, or trabecular)
Clinical Findings
• Murmur: Holosystolic (soft or harsh):
o Soft murmur suggests the right sided pressures are high
o Harsh murmur suggests right sided pressures are relatively low
o Best heard at LLSB 􀃆 at >1 week old (when pulmonary vascular
resistance decreases enough for shunting L􀃆R)
• Heart sounds: loss of splitting of the second heart sound and a loud P2
suggests pulmonary hypertension
• CHF symptoms: respiratory distress, difficulty feeding (+diaphoresis),
FTT
Pathophysiology
Left to right shunt 􀃆 increased blood flow to lungs 􀃆 increased PV return
with LV overload and dysfunction, and later right heart dysfunction +/‐
pulmonary hypertension
Management
• For CHF symptoms: Diuretics and nutritional support
• If defect shows signs of closing, then monitor closely for any signs of
pulmonary hypertension
• Surgical correction of VSD if significant clinical symptoms not managed
medically (to avoid pulmonary vascular disease)

Atrial Septal Defect
Defect in the formation of the interatrial septum (varies in size/location:
ostium secundum, ostium primum, sinus venosus). Patent foramen ovale
does not ordinarily produce intracardiac shunts.
Clinical Findings
• Murmur: Systolic ejection murmur at pulmonic valve:
o Pressure gradient between atria is relatively small so shunt occurs
throughout cardiac cycle, the left‐to‐right shunt is silent.
o Murmur originates from pulmonary valve due to increased blood
flow producing a relative stenosis of the pulmonary valve (2‐3/6)
• Heart sounds: widely, fixed split S2
...
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




dermatology (day 8)
#ir #peds
  1. DERMATOLOGY

    1. Dermatitis

  • Atopic dermatitis: what is Tx?

  • MCQ: emollients and topical GCs for 10 d

  • Child with itchy, erythematous, crusty eruption. DDx and 4 Tx?

  • DDx: atopic dermatitis, nummular dermatitis, allergic contact dermatitis, scabies, psoriasis, tinea, drug eruption

  • Tx (atopic dermatitis): avoid triggers, emollients, topical GCs, calcineurin inhibitors

  • "Pruritic eruption" over child's finger web space, axilla, and neck web; sister has the same thing, but parents asymptomatic. What is the Dx (1 mark), 3 DDx (3 marks), the lab Ix that will definitively establish the Dx (1 mark), and most popular/standard Tx (1mark)?

  • Dx: scabies Ix: microscopy (mites, ova feces)

  • DDx: Urticaria Contact dermatitis Scabies Chicken pox Atopic dermatitis Bites

  • Tx: permethrin 5% cream, 2 x 1wk apart for even asymptomatic family members

  • A child presents to you with a diaper rash or is it? What else could it be?

  • DDx: diaper candidiasis, irritant contact dermatitis, infantile psoriasis, others

    1. Rash/Exanthems

  • A young ♂ with asthma gets a rash on his arms: itchy, red, and found on flexural surfaces. What are 2 possibilities?

  • DDx: topic dermatitis, scabies, Pastia’s lines

  • Rosy cheeks + lacy rash: give the Dx, causative organism, 1 complication, and Tx.

  • Dx: erythema infectiosum (fifth disease) Causative agent: parvovirus B19

  • Tx: NSAIDs (symptomatic arthropathy), otherwise none

  • Complications: STAR (sore throat, arthritis, rash), glove and sock, aplastic crisis (sickle cell patients), fetal infection (anemia, fetal hydrops)

  • Fever + erythematous rash: most likely Dx?

  • MCQ: child is UTD on all immunizations, which eliminates 3 choices right away and narrows it down to either MRSA or GAS, take your pick ;-)

  • Child with high fever x 4 days goes to walk-in clinic and gets amoxicillin. On the following day, he breaks out into generalized maculopapular rash.

  • DDx (2 marks): Kawasaki disease, roseola, scarlet fever, drug reaction, etc.

  • Tx (2 marks): depends on etiology

Definitions
MACULE
‐ Flat, circumscribed area of colour change
‐ Large (>1 cm) macule: patch
‐ E.g. vitiligo, port‐wine stain, café au lait
PAPULE
‐ Elevated, palpable lesion
‐ Large (>1cm) papule: plaque
‐ E.g. wart, mollusca
VESICLE
‐ Fluid‐filled elevation (pus, sanguinous)
‐ Large (>1 cm) vesicle: bulla
‐ E.g. impetigo
PUSTULE ‐ Circumscribed elevation of skin containing purulent exudate
‐ E.g. herpes simplex, varicella zoster
NODULE
‐ Palpable solid lesion
‐ Large (>1 cm) nodule: tumour
‐ E.g. dermatofibroma...
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




endo (day 8)
#has-images #ir #peds
  1. ENDOCRINOLOGY

    1. Diabetes mellitus

  • Best marker for insulin resistance?

  • MCQ: acanthosis nigricans

    1. Puberty

  • 13yo ♀, no onset of menarche. What questions would you ask on Hx (6)? What would you do O/E? When and how would you investigate?

  • Hx: Breast development, weight loss, pubic hair development, short stature, FHx, athlete, medical illness, high performance athlete

  • O/E: assess nutritional status, dysmorphism, evidence of chronic disease, signs of abuse or neglect, sexual development (“boobs→pubes→grow→flow”)

  • Ix (if no menarche >16 or pubertal >12): always (bone age, CBC/lytes, CRP, FSH/LH, EST/TEST, TSH/T4, IGF, U/A), consider (IBD panel, Celiac panel, etc.)

  • Precocious puberty in ♀: when are you worried and which tests would you order?

Ix (if bone age > height age, <6, OR psychological issues): always (bone age, FSH/LH, EST/TEST, DHEAs/17-hydroxyPRO, TSH/T4), consider (pelvic U/S, MRI head, β-hCG, GnRH/ACTH stimulation)

Hypoglycemia (Infants and Children)
Definition
Plasma glucose (PG) ≤2.8 mmol/L
Etiology
• Endocrine causes: Ketotic hypoglycemia, GH deficiency,
panhypopituitarism, ACTH deficiency, Addisons disease, excess
exogenous insulin
• Nonendocrine
causes: Sepsis/shock, liver disease, ingestion (e.g.
ethanol, salicylates, beta‐blockers), inborn error of metabolism
Clinical Presentation
• Autonomic symptoms: Sweating, weakness, tachycardia, tremor,
feelings of nervousness and/or hunger
• Neuroglycopenic symptoms: Lethargy, irritability, confusion, unusual
behaviour, hypothermia, seizure and coma
Investigations
Send critical labs (prior to initiating treatment) if PG ≤2.8 mmol/L:
Serum glucose, blood gas, electrolytes, insulin, GH, cortisol, free fatty acids,
ß‐hydroxybutyrate, acylcarnitines, total and free carnitine, serum amino
acids, NH4, lactate, urine organic acids, c‐peptide, urine sample for glucose,
ketones and reducing substances
Management
• Treat if PG <3.3 mmol/L and neurologic symptoms (confusion, seizure)
or PG ≤ 2.8 mmol/L
• Initial bolus of dextrose (5 mL/kg of D10W or 2 mL/kg of D25W),
then continuous dextrose infusion to maintain PG
• If no IV access, give glucagon IM or SC. Children <20 kg = 0.03 mg/kg,
max 0.5 mg/dose. Children >20 kg = 1 mg/dose. May repeat q20
minutes as needed

Diabetes Mellitus
Introduction
• Type 1 DM (DM1) accounts for 5‐10% of all diabetes
• Most commonly presents in childhood
o Age of onset has bimodal distribution: peaks at 4‐6 and 10‐14 yrs
o Family history a significant risk factor (5% for first‐degree
relatives)
• Incidence varies with geographical location
• Major Emergencies
o Diabetic ketoacidosis (DKA) ‐ initial presentation in 15‐67%
- Risk for DKA increases if age < 6 yrs or low SES
o Intercurrent illness
o Hypoglycemia
Pathophysiology
Genetic susceptibility + environmental trigger 􀃆 autoimmune β‐cell
destruction 􀃆 progressive insulin deficiency
Differential Diagnosis
• Type 2 Diabetes Mellitus (DM2)
o Disorder of insulin resistance
o Typically presents after puberty
o Associated symptoms: metabolic syndrome, obesity, PCOS,
acanthosis nigracans
• Genetic defects in β‐cell function
• Medications: atypical anti‐psychotics, immunosuppressants...
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




#ir #peds
ID
Age, sex with a history of (non‐active/chronic issues) admitted with (list
active/acute issues for why the patient is admitted). Could also include a
list of recent events that occurred since the most recent note.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
SUBJECTIVE
• How was patient overnight, how they feel that day, any new concerns
from the patient/parent
• What has changed since the previous note? Does the patient have any
new symptoms? Any pain? How is the patient coping with the active
symptoms, progression, better/worse.
• Ask the parents and patient’s nurse: behaviour, activity, sleep,
appetite, in and outs.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. <span>SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the pat

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
OBJECTIVE
Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain
I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid
balance
General: what the patient is doing, appearance, behaviour, cognition,
cooperation, disposition
P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it
is common for hospitalized patients to develop problems in these regions.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
oes the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. <span>OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
INVESTIGATIONS
New lab results, imaging or diagnostic tests/ interventions and relevant
results still pending
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
atient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. <span>INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new fin

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
MEDS
Reviewed daily regarding changes such as new/held/discontinued/
restarted (e.g. Ampicillin day 2/10)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
volved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending <span>MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ co

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
IMPRESSION/ASSESSMENT (IMP)
Summarize what the new findings mean, what progress is being made.
Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/
consult? Differential diagnosis if anything has been ruled in/out?
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
ESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) <span>IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan&#13

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
PLAN (P)
1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day
course required, await urine C&S)
2. Issue (2) 􀃆 plan
3. Issue (3) 􀃆 plan
4. Disposition – plans for home, transfer
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
ION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? <span>PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer<span><body><html>

Original toplevel document

Documentation
egular medications (may not need all; e.g., no need for previous PO antibiotics if starting IV) o Present: what does patient need now o Future: anticipate what patient may need; e.g., fever, nausea, pain, stools <span>Progress Note (Template) (Service) Progress Note Date, Time ID Age, sex with a history of (non‐active/chronic issues) admitted with (list active/acute issues for why the patient is admitted). Could also include a list of recent events that occurred since the most recent note. SUBJECTIVE • How was patient overnight, how they feel that day, any new concerns from the patient/parent • What has changed since the previous note? Does the patient have any new symptoms? Any pain? How is the patient coping with the active symptoms, progression, better/worse. • Ask the parents and patient’s nurse: behaviour, activity, sleep, appetite, in and outs. OBJECTIVE Vitals: HR, BP, RR, SaO2, Temp, daily weight, pain I/O: Inputs (Diet, IVF), Output (U/O, BM/Diarrhea, Vx, Drains), fluid balance General: what the patient is doing, appearance, behaviour, cognition, cooperation, disposition P/E: focused physical exam of system involved plus CVS, RESP, ABDO as it is common for hospitalized patients to develop problems in these regions. INVESTIGATIONS New lab results, imaging or diagnostic tests/ interventions and relevant results still pending MEDS Reviewed daily regarding changes such as new/held/discontinued/ restarted (e.g. Ampicillin day 2/10) IMPRESSION/ASSESSMENT (IMP) Summarize what the new findings mean, what progress is being made. Stable vs. Unstable? Improved vs. Worsened? Waiting investigations/ consult? Differential diagnosis if anything has been ruled in/out? PLAN (P) 1. Issue (1) 􀃆 plan (e.g., UTI on Day 2 of Empiric Abx, likely 14 day course required, await urine C&S) 2. Issue (2) 􀃆 plan 3. Issue (3) 􀃆 plan 4. Disposition – plans for home, transfer Discharge Summary (Template) Check patient’s name, medical record number, date of birth, date of admission, date of discharge, most responsible physician (MRP), ref




#ir #peds
Irritability may be the only way that a young child can express pain or discomfort from any source
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
Irritability may be the only way that a young child can express pain or discomfort from any source, including: Meningeal irritation Headache from intracranial irritation Simple exhaustion

Original toplevel document

CLIPP 11 - Kawasaki
11. 5-year-old with fever and adenopathy - Jason January 27, 2017 2:09:56 PM EST Knowledge Irritability in a Child Irritability may be the only way that a young child can express pain or discomfort from any source, including: Meningeal irritation Headache from intracranial irritation Simple exhaustion Pediatric Vital Signs As a child gets older, the normal ranges for vital signs change, making it important to look at ageappropriate reference values. The normal hea




Flashcard 1475880291596

Tags
#peds
Question
Rashes in children are usually related to [...]
Answer
infections

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill






#ir #peds
Enterovirus
Usually erythematous and maculopapular, and may involve the palms and
soles. Infrequently, it can be petechial.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
h Fever (Part 1) Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/15 <span>Enterovirus Usually erythematous and maculopapular, and may involve the palms and soles. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer a

Original toplevel document

CLIPP 11 - Kawasaki
; Pediatric Vital Signs As a child gets older, the normal ranges for vital signs change, making it important to look at ageappropriate reference values. The normal heart rate for a 5-year-old is 80 to 100 beats per minute. <span>Rashes Associated with Fever (Part 1) Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/15 Enterovirus Usually erythematous and maculopapular, and may involve the palms and soles. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100




#ir #peds
Hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
and photos of rashes associated with fever. Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/15 Enterovirus Usually erythematous and maculopapular, and may involve the palms and soles. Infrequently, it can be petechial. <span>In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
; Pediatric Vital Signs As a child gets older, the normal ranges for vital signs change, making it important to look at ageappropriate reference values. The normal heart rate for a 5-year-old is 80 to 100 beats per minute. <span>Rashes Associated with Fever (Part 1) Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/15 Enterovirus Usually erythematous and maculopapular, and may involve the palms and soles. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100




#ir #peds
Usually seen in late summer and early fall.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
opapular, and may involve the palms and soles. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. <span>Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
; Pediatric Vital Signs As a child gets older, the normal ranges for vital signs change, making it important to look at ageappropriate reference values. The normal heart rate for a 5-year-old is 80 to 100 beats per minute. <span>Rashes Associated with Fever (Part 1) Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/15 Enterovirus Usually erythematous and maculopapular, and may involve the palms and soles. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100




#ir #peds
While the fever associated with enteroviruses may be high, it usually lasts only
a few days.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
s. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. <span>While the fever associated with enteroviruses may be high, it usually lasts only a few days.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
; Pediatric Vital Signs As a child gets older, the normal ranges for vital signs change, making it important to look at ageappropriate reference values. The normal heart rate for a 5-year-old is 80 to 100 beats per minute. <span>Rashes Associated with Fever (Part 1) Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Cho Sooyoung - sooyoung.cho@mail.utoronto.ca 1/15 Enterovirus Usually erythematous and maculopapular, and may involve the palms and soles. Infrequently, it can be petechial. In hand-foot-and-mouth disease (caused by Coxsackie virus), presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100




#ir #peds
Erythema
infectiosum
Also called fifth disease, this is caused by parvovirus B19.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash star

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
There is frequently an associated low-grade fever (37.8-38.3 degrees C, or
100-101 degrees F), with a rash appearing seven to ten days later.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
fferent kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. <span>There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Cent

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
The characteristic rash starts as facial erythema-the "slapped cheek"
appearance.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
ma infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. <span>The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the e

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
This can spread to the trunk and have an erythematous macular
appearance
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. <span>This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with f

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
Central clearing of the rash appears, giving a lacy appearance.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
01 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. <span>Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints&#

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
The rash often lasts longest on the extremities, where it has a lacy, reticular
appearance.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
e characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. <span>The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed t

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
People with fifth disease can also develop pain and swelling in their joints
(polyarthropathy syndrome).
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
n spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. <span>People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
Individuals with underlying immune deficiencies who are exposed to this virus
are at risk for developing aplastic anemia.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
g a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). <span>Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
presents as a vesicular rash on the hands and feet and with ulcers in the mouth. Usually seen in late summer and early fall. While the fever associated with enteroviruses may be high, it usually lasts only a few days. <span>Erythema infectiosum Also called fifth disease, this is caused by parvovirus B19. There is frequently an associated low-grade fever (37.8-38.3 degrees C, or 100-101 degrees F), with a rash appearing seven to ten days later. The characteristic rash starts as facial erythema-the "slapped cheek" appearance. This can spread to the trunk and have an erythematous macular appearance. Central clearing of the rash appears, giving a lacy appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance. People with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along




#ir #peds
Measles
After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and
conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and
along the hairline.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. The rash spreads downward, reaching the feet in two or three days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (kno

Original toplevel document

CLIPP 11 - Kawasaki
le with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. <span>Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. The rash spreads downward, reaching the feet in two or three days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention. Immunization is very effective in preventing this infection. All photos in this case showing disease manifestations are courtesy of Gary Williams, MD, and the University of Wisconsin teaching file. Hyperlink "hands "




#ir #peds
The rash spreads downward, reaching the feet in two or three days.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
hotos of rashes associated with fever. Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. <span>The rash spreads downward, reaching the feet in two or three days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time

Original toplevel document

CLIPP 11 - Kawasaki
le with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. <span>Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. The rash spreads downward, reaching the feet in two or three days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention. Immunization is very effective in preventing this infection. All photos in this case showing disease manifestations are courtesy of Gary Williams, MD, and the University of Wisconsin teaching file. Hyperlink "hands "




#ir #peds
The initial rash appears on the buccal mucosa as red lesions with bluish white
spots in the center (known as Koplik spots). These have frequently
disappeared by the time the patient presents to medical attention.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
e of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. The rash spreads downward, reaching the feet in two or three days. <span>The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention. Immunization is very effective in preventing this infection.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
le with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. <span>Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. The rash spreads downward, reaching the feet in two or three days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention. Immunization is very effective in preventing this infection. All photos in this case showing disease manifestations are courtesy of Gary Williams, MD, and the University of Wisconsin teaching file. Hyperlink "hands "




#ir #peds
Immunization is very effective in preventing this infection.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
ree days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention. <span>Immunization is very effective in preventing this infection.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
le with fifth disease can also develop pain and swelling in their joints (polyarthropathy syndrome). Individuals with underlying immune deficiencies who are exposed to this virus are at risk for developing aplastic anemia. <span>Measles After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline. The rash spreads downward, reaching the feet in two or three days. The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention. Immunization is very effective in preventing this infection. All photos in this case showing disease manifestations are courtesy of Gary Williams, MD, and the University of Wisconsin teaching file. Hyperlink "hands "




#ir #peds
Scarlet fever
This rash, caused by infection with group A Streptococcus, consists of
very fine papules, often described as feeling like sandpaper.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
Children get many different kinds of rashes-many, though not all, related to infections. Below are descriptions and photos of rashes associated with fever. Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, la

Original toplevel document

CLIPP 11 - Kawasaki
s and neck. There is usually less involvement of the face and legs. The rash is preceded by three or four days of high fevers, which end as the rash appears. Usually seen in children less than two years old. 3/15 <span>Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever. Varicella The rash, also known as chicken pox, starts on the trunk and spreads to the extremities and head. Each lesion progresses from an erythematous macule to pap




#ir #peds
It is erythematous, but blanches.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
ns. Below are descriptions and photos of rashes associated with fever. Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. <span>It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It i

Original toplevel document

CLIPP 11 - Kawasaki
s and neck. There is usually less involvement of the face and legs. The rash is preceded by three or four days of high fevers, which end as the rash appears. Usually seen in children less than two years old. 3/15 <span>Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever. Varicella The rash, also known as chicken pox, starts on the trunk and spreads to the extremities and head. Each lesion progresses from an erythematous macule to pap




#ir #peds
The rash starts in the groin, axillae, and neck, but rapidly spreads.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
tos of rashes associated with fever. Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. <span>The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative compl

Original toplevel document

CLIPP 11 - Kawasaki
s and neck. There is usually less involvement of the face and legs. The rash is preceded by three or four days of high fevers, which end as the rash appears. Usually seen in children less than two years old. 3/15 <span>Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever. Varicella The rash, also known as chicken pox, starts on the trunk and spreads to the extremities and head. Each lesion progresses from an erythematous macule to pap




#ir #peds
The fever can be high, and the disease is usually self-limited, lasting
less than 10 days.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
sed by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. <span>The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
s and neck. There is usually less involvement of the face and legs. The rash is preceded by three or four days of high fevers, which end as the rash appears. Usually seen in children less than two years old. 3/15 <span>Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever. Varicella The rash, also known as chicken pox, starts on the trunk and spreads to the extremities and head. Each lesion progresses from an erythematous macule to pap




#ir #peds
It is important to treat with antibiotics to prevent non-suppurative
complications of strep, including rheumatic fever.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on


Parent (intermediate) annotation

Open it
eeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. <span>It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever.<span><body><html>

Original toplevel document

CLIPP 11 - Kawasaki
s and neck. There is usually less involvement of the face and legs. The rash is preceded by three or four days of high fevers, which end as the rash appears. Usually seen in children less than two years old. 3/15 <span>Scarlet fever This rash, caused by infection with group A Streptococcus, consists of very fine papules, often described as feeling like sandpaper. It is erythematous, but blanches. The rash starts in the groin, axillae, and neck, but rapidly spreads. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. It is important to treat with antibiotics to prevent non-suppurative complications of strep, including rheumatic fever. Varicella The rash, also known as chicken pox, starts on the trunk and spreads to the extremities and head. Each lesion progresses from an erythematous macule to pap




#ir #peds
When you enter the examination room, introduce yourself to the teenager first and shake hands before addressing the parent (if present).
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
ocial information that is important for maintaining a teenager's well-being. BUILDING RAPPORT The opening vignette underscores the importance of the following measures in establishing rapport with a teenager: •<span>When you enter the examination room, introduce yourself to the teenager first and shake hands before addressing the parent (if present). •Take the history while the teenager is dressed and ask him to disrobe only for the examination. •Face the adolescent and maintain eye contact as much as possible




#ir #peds
When the parent has a laundry list of concerns, make sure to interject occasionally and politely ask the adolescent whether he shares those concerns, which can be addressed one-on-one with the teenager later in the visit.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
and maintain eye contact as much as possible while listening to the parent. If the teenager perceives that he is the central person in the doctor- patient relationship, he will feel respected and will be more likely to trust you. •<span>When the parent has a laundry list of concerns, make sure to interject occasionally and politely ask the adolescent whether he shares those concerns, which can be addressed one-on-one with the teenager later in the visit. With a new patient and family, I find it invaluable to discuss confidentiality up front. I usually say, "At this office, we encourage teens be honest with their doctor.




#ir #peds
With a new patient and family, I find it invaluable to discuss confidentiality up front. I usually say, "At this office, we encourage teens be honest with their doctor. It helps ensure that health concerns and questions are addressed. It also helps teens prepare for a rapidly approaching adulthood, when they will have to know how to discuss health concerns with their physician. Occasionally, we discuss sensitive issues such as sexuality and drugs and, for the most part, we agree to keep these conversations private. We expect teens to ask questions that will ultimately keep them healthy and safe."
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
3; •When the parent has a laundry list of concerns, make sure to interject occasionally and politely ask the adolescent whether he shares those concerns, which can be addressed one-on-one with the teenager later in the visit. <span>With a new patient and family, I find it invaluable to discuss confidentiality up front. I usually say, "At this office, we encourage teens be honest with their doctor. It helps ensure that health concerns and questions are addressed. It also helps teens prepare for a rapidly approaching adulthood, when they will have to know how to discuss health concerns with their physician. Occasionally, we discuss sensitive issues such as sexuality and drugs and, for the most part, we agree to keep these conversations private. We expect teens to ask questions that will ultimately keep them healthy and safe." I also discuss the contingencies of when confidentiality must be broken. Specifically, I explain that when there are issues that may put the teen's (or someone else's) life o




#ir #peds
I also discuss the contingencies of when confidentiality must be broken. Specifically, I explain that when there are issues that may put the teen's (or someone else's) life or health at risk, confidentiality must be broken and adults must be brought in who can help keep him/her safe. I tell the adolescent that I never break confidentiality without telling him first. The teen always has the option to decide how he would like the parent to find out.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
an. Occasionally, we discuss sensitive issues such as sexuality and drugs and, for the most part, we agree to keep these conversations private. We expect teens to ask questions that will ultimately keep them healthy and safe." <span>I also discuss the contingencies of when confidentiality must be broken. Specifically, I explain that when there are issues that may put the teen's (or someone else's) life or health at risk, confidentiality must be broken and adults must be brought in who can help keep him/her safe. I tell the adolescent that I never break confidentiality without telling him first. The teen always has the option to decide how he would like the parent to find out. THE "HEADDS" SCREENING TOOL The "HEADDS" mnemonic reminds clinicians about the psychosocial factors that influence the physical and emotional w




#ir #peds
Home

•Try to get a general picture . . . Who lives with the patient? Does the family live in a house? Cramped quarters? Does the adolescent have any privacy?

•Do the parents live together? If not, is the out-of-house parent involved with the patient--and to what extent?

•Have there been recent changes in the family dynamic--a new sibling, the death of a close grandparent, a parental separation or divorce? Is a family member sick? If so, how is this affecting the patient?

•How many siblings live at home and where in the birth order is the patient? In some large families, the responsibilities for younger children may fall on the oldest child. This level of responsibility may seem appropriate or it may overwhelm the teen.

These questions are best asked when the parent is present so that objective information (that can be discussed with the teen alone) can be obtained.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
"HEADDS" mnemonic reminds clinicians about the psychosocial factors that influence the physical and emotional well-being of teenagers. This is a helpful screening tool for identifying potential problems and risk factors. <span>Home •Try to get a general picture . . . Who lives with the patient? Does the family live in a house? Cramped quarters? Does the adolescent have any privacy? •Do the parents live together? If not, is the out-of-house parent involved with the patient--and to what extent? •Have there been recent changes in the family dynamic--a new sibling, the death of a close grandparent, a parental separation or divorce? Is a family member sick? If so, how is this affecting the patient? •How many siblings live at home and where in the birth order is the patient? In some large families, the responsibilities for younger children may fall on the oldest child. This level of responsibility may seem appropriate or it may overwhelm the teen. These questions are best asked when the parent is present so that objective information (that can be discussed with the teen alone) can be obtained. Education Many busy practitioners hesitate to explore issues about education because they believe that this is outside their domain. I would argue that avoiding a




#ir #peds
School is the adolescent's primary job, and almost all teens want to succeed. When things are going poorly in school, I see this as a manifestation of some other process that is inhibiting success. Such processes frequently include ADHD, learning disabilities, depression, anxiety, bullying, or school phobia.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
oners hesitate to explore issues about education because they believe that this is outside their domain. I would argue that avoiding a discussion about school performance prevents a real understanding of any underlying issues facing the teen. <span>School is the adolescent's primary job, and almost all teens want to succeed. When things are going poorly in school, I see this as a manifestation of some other process that is inhibiting success. Such processes frequently include ADHD, learning disabilities, depression, anxiety, bullying, or school phobia. It can be immensely helpful to ask the teen how well school is going while the parent is in the room. Teens often report that everything is "fine"; parents may coun




#ir #peds
It can be immensely helpful to ask the teen how well school is going while the parent is in the room. Teens often report that everything is "fine"; parents may counter that the adolescent has been skipping classes or is earning poor grades.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
When things are going poorly in school, I see this as a manifestation of some other process that is inhibiting success. Such processes frequently include ADHD, learning disabilities, depression, anxiety, bullying, or school phobia. <span>It can be immensely helpful to ask the teen how well school is going while the parent is in the room. Teens often report that everything is "fine"; parents may counter that the adolescent has been skipping classes or is earning poor grades. Some other key issues to inquire about: •Have there been any changes (for better or worse) in the teen's academic progress during the past year? •If the




#ir #peds
Some other key issues to inquire about:

•Have there been any changes (for better or worse) in the teen's academic progress during the past year?

•If the teen is doing poorly, find out why. Does he have difficulty paying attention in class or during homework time? Do homework assignments take forever to complete? Positive answers suggest the possibility of ADHD.

•Have teachers mentioned any problems with the student's ability to learn, digest, and understand information? Positive answers suggest possible learning disabilities. In this situation, the student might benefit from psychoeducational testing and/or the development of an individualized education plan.

•Is the student skipping classes? Has he joined a new peer group? Do the parents suspect any drug or alcohol use? Any significant mood changes recently? Could there be an underlying mood disorder (depression, anxiety) that prevents the student from focusing?

•Is the student having trouble waking up to get to school on time? Is he falling asleep in class? Are homework assignments incomplete because the student sleeps for hours each afternoon or early evening? The duration and quality of sleep can profoundly influence an adolescent's academic performance and should be addressed whenever academic concerns arise.

•What are the student's life plans and goals? Younger teenagers may simply want to be a "pro basketball player," a developmentally appropriate goal. By high school, there should be some discussions about the teen's post-high school plans. If the student is planning on going to college, is he pursuing the academics and activities necessary to meet this goal?
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
helpful to ask the teen how well school is going while the parent is in the room. Teens often report that everything is "fine"; parents may counter that the adolescent has been skipping classes or is earning poor grades. <span>Some other key issues to inquire about: •Have there been any changes (for better or worse) in the teen's academic progress during the past year? •If the teen is doing poorly, find out why. Does he have difficulty paying attention in class or during homework time? Do homework assignments take forever to complete? Positive answers suggest the possibility of ADHD. •Have teachers mentioned any problems with the student's ability to learn, digest, and understand information? Positive answers suggest possible learning disabilities. In this situation, the student might benefit from psychoeducational testing and/or the development of an individualized education plan. •Is the student skipping classes? Has he joined a new peer group? Do the parents suspect any drug or alcohol use? Any significant mood changes recently? Could there be an underlying mood disorder (depression, anxiety) that prevents the student from focusing? •Is the student having trouble waking up to get to school on time? Is he falling asleep in class? Are homework assignments incomplete because the student sleeps for hours each afternoon or early evening? The duration and quality of sleep can profoundly influence an adolescent's academic performance and should be addressed whenever academic concerns arise. •What are the student's life plans and goals? Younger teenagers may simply want to be a "pro basketball player," a developmentally appropriate goal. By high school, there should be some discussions about the teen's post-high school plans. If the student is planning on going to college, is he pursuing the academics and activities necessary to meet this goal? Be on the lookout for the adolescent with strong cognitive abilities who is faltering academically. An evaluation for mood disorders, substance abuse, ADHD, or learning disab




#ir #peds
Activities

After-school activities (or lack thereof) can profoundly affect an adolescent's physical well-being. I generally obtain this history without the parent in the room because the teen usually answers more honestly. If the history suggests participation in an activity that could be detrimental to the patient's health, this may warrant a private or a 3-way discussion with the parent.

Other key points to ask about:

•What activities does the teen participate in after school? Most adolescents need to be involved with some activity in addition to academics. Watching TV or Internet chatting all afternoon does not count as a healthy activity. The American Academy of Pediatrics recommends no more than 1 to 2 hours each day of "screen time."

•Simple "chilling" and "hanging out" generally spell trouble. With whom does the adolescent spend time? Is he home alone with a girlfriend or out on the street with peers? If an adolescent spends afternoons alone every day, some investigation of possible mood disorder or social issues is warranted.

The adolescent who naps for 2 to 3 hours every afternoon may require an evaluation for depression, substance use, or sleep cycle disorders.

Overactivity also needs to be identified. Teenagers (like everyone else) need time to relax and have fun. Some teens (or their parents) may require a friendly "prescription" from the doctor instructing them to incorporate this into their busy schedules.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
meet this goal? Be on the lookout for the adolescent with strong cognitive abilities who is faltering academically. An evaluation for mood disorders, substance abuse, ADHD, or learning disabilities is usually warranted. <span>Activities After-school activities (or lack thereof) can profoundly affect an adolescent's physical well-being. I generally obtain this history without the parent in the room because the teen usually answers more honestly. If the history suggests participation in an activity that could be detrimental to the patient's health, this may warrant a private or a 3-way discussion with the parent. Other key points to ask about: •What activities does the teen participate in after school? Most adolescents need to be involved with some activity in addition to academics. Watching TV or Internet chatting all afternoon does not count as a healthy activity. The American Academy of Pediatrics recommends no more than 1 to 2 hours each day of "screen time." •Simple "chilling" and "hanging out" generally spell trouble. With whom does the adolescent spend time? Is he home alone with a girlfriend or out on the street with peers? If an adolescent spends afternoons alone every day, some investigation of possible mood disorder or social issues is warranted. The adolescent who naps for 2 to 3 hours every afternoon may require an evaluation for depression, substance use, or sleep cycle disorders. Overactivity also needs to be identified. Teenagers (like everyone else) need time to relax and have fun. Some teens (or their parents) may require a friendly "prescription" from the doctor instructing them to incorporate this into their busy schedules. Drugs and Drinking There is no one "right" way to approach the topic, but the following tactics can be helpful: •Start with a generalized conv




#ir #peds
Drugs and Drinking

There is no one "right" way to approach the topic, but the following tactics can be helpful:

•Start with a generalized conversation and open-ended questions: eg, "Many of my teenage patients tell me their friends sometimes try drugs and alcohol. What kinds of things have your friends talked about trying?"

•As the adolescent answers, start bringing the conversation closer to home. "It must be a challenge for you to be at a party where your friends are drinking and getting drunk. How do you deal with it when they offer you (or pressure you with) something to drink?"

•Congratulate the teen who continually insists that he has never indulged in any of these substances for making good, mature decisions for his health.

•If the teen admits to trying various substances, be careful not to sound judgmental. Explore the benefits (and consequences) the teen gets from the substance use, how it makes him feel the next day, how often he is using the substance.

•When you identify a substance use problem, encourage a follow-up appointment. Let the teen know that you can see why he is attracted to the substance, but that you have concerns for his safety.

•Suspected habitual substance use by a teenager who will not follow up with you constitutes a safety issue that requires breaking confidentiality.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
entified. Teenagers (like everyone else) need time to relax and have fun. Some teens (or their parents) may require a friendly "prescription" from the doctor instructing them to incorporate this into their busy schedules. <span>Drugs and Drinking There is no one "right" way to approach the topic, but the following tactics can be helpful: •Start with a generalized conversation and open-ended questions: eg, "Many of my teenage patients tell me their friends sometimes try drugs and alcohol. What kinds of things have your friends talked about trying?" •As the adolescent answers, start bringing the conversation closer to home. "It must be a challenge for you to be at a party where your friends are drinking and getting drunk. How do you deal with it when they offer you (or pressure you with) something to drink?" •Congratulate the teen who continually insists that he has never indulged in any of these substances for making good, mature decisions for his health. •If the teen admits to trying various substances, be careful not to sound judgmental. Explore the benefits (and consequences) the teen gets from the substance use, how it makes him feel the next day, how often he is using the substance. •When you identify a substance use problem, encourage a follow-up appointment. Let the teen know that you can see why he is attracted to the substance, but that you have concerns for his safety. •Suspected habitual substance use by a teenager who will not follow up with you constitutes a safety issue that requires breaking confidentiality. Sex and Sexuality Addressing sexual development can help prevent unplanned pregnancies, sexually transmitted infections, and HIV/AIDS. Data consistently indicate t




#ir #peds
"I see lots of teenagers, and we frequently talk about sex. Some like girls, some like guys, some like both, and some are just not sure. When you think about dating or having sex, do you think about guys, girls, or both?"
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
attractions or experiences. Many adolescents who are unsure of their sexual orientation tend to avoid labels such as "gay," "lesbian," or "bisexual." A good way to broach this topic with a male teenager might be: <span>"I see lots of teenagers, and we frequently talk about sex. Some like girls, some like guys, some like both, and some are just not sure. When you think about dating or having sex, do you think about guys, girls, or both?" •Patients frequently use slang to describe genitalia or different kinds of sexual activity. If you are unsure, ask for clarification. •Teens hate lectures. Rather




#ir #peds
Teens hate lectures. Rather than lecturing on safer sex, involve the teen in a discussion on how he would approach various situations. For example, ask a female patient how she would negotiate not having sex with a partner who did not have a condom. Ask a teenage boy how he might behave if he was about to have intercourse and his girlfriend changed her mind.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
you think about dating or having sex, do you think about guys, girls, or both?" •Patients frequently use slang to describe genitalia or different kinds of sexual activity. If you are unsure, ask for clarification. •<span>Teens hate lectures. Rather than lecturing on safer sex, involve the teen in a discussion on how he would approach various situations. For example, ask a female patient how she would negotiate not having sex with a partner who did not have a condom. Ask a teenage boy how he might behave if he was about to have intercourse and his girlfriend changed her mind. Suicidality and Mental Health The following approach can help you quickly assess the patient's mood and mental health status: •Explain that many teenage




#ir #peds
Inquire about persistent irritability--a presenting symptom of depression in teens.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

&quot;HEADDS&quot; Up on Talking With Teenagers
emotions during adolescence that can sometimes make them feel "out of control." •Ask about mood-related symptoms. Does the teen feel "down" more often than his friends do? How many days a week is he happy? Sad? <span>Inquire about persistent irritability--a presenting symptom of depression in teens. •Ask about fatigue and/or inability to fall asleep. Does the patient wake early in the morning, unable to get back to sleep? Has his appetite changed recently? •Do




#ir #peds
MALTREATMENT: phys/emo/sex/neglect/exploitationàactual/potential harm to child’s health/survival/development/dignity within relationship of responsibility/trust/power
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
MALTREATMENT: phys/emo/sex/neglect/exploitationàactual/potential harm to child’s health/survival/development/dignity within relationship of responsibility/trust/power Child isn't walking, but XR shows spiral fracture in femur. What's next? MCQ : full body XR Suspected child abuse: when are you suspicious, what t




#ir #peds
  • Child isn't walking, but XR shows spiral fracture in femur. What's next?
  • MCQ: full body XR
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
MALTREATMENT: phys/emo/sex/neglect/exploitationàactual/potential harm to child’s health/survival/development/dignity within relationship of responsibility/trust/power Child isn't walking, but XR shows spiral fracture in femur. What's next? MCQ : full body XR Suspected child abuse: when are you suspicious, what to ask on Hx, and what is Tx? Red Flags: inj inconsistent w/ hx (mechanism, force, age/developmental stag




#ir #peds
Red Flags: inj inconsistent w/ hx (mechanism, force, age/developmental stage), hx inconsistent/changes, medical attn delay, multiple inj, different age inj, bruises (non-amb bruises, well-cushioned, patterned), # (non-amb, different ages, location)
  • Fractures: metaphyseal/ribs/scapula/vertebrae/sternum/mult skull #s
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
ity/trust/power Child isn't walking, but XR shows spiral fracture in femur. What's next? MCQ : full body XR Suspected child abuse: when are you suspicious, what to ask on Hx, and what is Tx? <span>Red Flags: inj inconsistent w/ hx (mechanism, force, age/developmental stage), hx inconsistent/changes, medical attn delay, multiple inj, different age inj, bruises (non-amb bruises, well-cushioned, patterned), # (non-amb, different ages, location) Fractures: metaphyseal/ribs/scapula/vertebrae/sternum/mult skull #s Hx: events leading up to injury Location & time, who present, detailed events, child’s response, caregiver’s response, other children at risk, rel




#ir #peds
Hx: events leading up to injury
  • Location & time, who present, detailed events, child’s response, caregiver’s response, other children at risk, relevant PHx
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
cal attn delay, multiple inj, different age inj, bruises (non-amb bruises, well-cushioned, patterned), # (non-amb, different ages, location) Fractures: metaphyseal/ribs/scapula/vertebrae/sternum/mult skull #s <span>Hx: events leading up to injury Location & time, who present, detailed events, child’s response, caregiver’s response, other children at risk, relevant PHx Thorough O/E (completely undress): head, skin (ears, genitalia, buttocks), neuro (fontanelle, HC, fundi), mouth (frenulum), abdo, msk (swelling, pain), g/u (by specialized team




#ir #peds
Thorough O/E (completely undress): head, skin (ears, genitalia, buttocks), neuro (fontanelle, HC, fundi), mouth (frenulum), abdo, msk (swelling, pain), g/u (by specialized team)
  • Palpate everywhere
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
scapula/vertebrae/sternum/mult skull #s Hx: events leading up to injury Location & time, who present, detailed events, child’s response, caregiver’s response, other children at risk, relevant PHx <span>Thorough O/E (completely undress): head, skin (ears, genitalia, buttocks), neuro (fontanelle, HC, fundi), mouth (frenulum), abdo, msk (swelling, pain), g/u (by specialized team) Palpate everywhere Document all injuries on a body diagram: type, location, size, shape, colour, pattern Photography of skin injuries is ideal (police or hospital camera) Ix (suspected non-accide




#ir #peds
Document all injuries on a body diagram: type, location, size, shape, colour, pattern
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
at risk, relevant PHx Thorough O/E (completely undress): head, skin (ears, genitalia, buttocks), neuro (fontanelle, HC, fundi), mouth (frenulum), abdo, msk (swelling, pain), g/u (by specialized team) Palpate everywhere <span>Document all injuries on a body diagram: type, location, size, shape, colour, pattern Photography of skin injuries is ideal (police or hospital camera) Ix (suspected non-accidental in non-ambulating children/infants): skeletal survey (all <2yo if NAI suspected), CT h




#ir #peds
Ix (suspected non-accidental in non-ambulating children/infants): skeletal survey (all <2yo if NAI suspected), CT head, direct ophthalmoscopy, labs for occult trauma (AST, ALT, lipase, UA)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
), abdo, msk (swelling, pain), g/u (by specialized team) Palpate everywhere Document all injuries on a body diagram: type, location, size, shape, colour, pattern Photography of skin injuries is ideal (police or hospital camera) <span>Ix (suspected non-accidental in non-ambulating children/infants): skeletal survey (all <2yo if NAI suspected), CT head, direct ophthalmoscopy, labs for occult trauma (AST, ALT, lipase, UA) Fractures: bone density on XR, Ca 2+ , Mg 2+ , Phos, ALP, PTH, VIT D Ddx: accidental inj, osteogenesis imperfecta, Menkes dz, osteopenia (rickets, prematurity, meds), os




#ir #peds
Fractures: bone density on XR, Ca2+, Mg2+, Phos, ALP, PTH, VIT D
  • Ddx: accidental inj, osteogenesis imperfecta, Menkes dz, osteopenia (rickets, prematurity, meds), osteomyelitis, bone tumours
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
uries is ideal (police or hospital camera) Ix (suspected non-accidental in non-ambulating children/infants): skeletal survey (all <2yo if NAI suspected), CT head, direct ophthalmoscopy, labs for occult trauma (AST, ALT, lipase, UA) <span>Fractures: bone density on XR, Ca 2+ , Mg 2+ , Phos, ALP, PTH, VIT D Ddx: accidental inj, osteogenesis imperfecta, Menkes dz, osteopenia (rickets, prematurity, meds), osteomyelitis, bone tumours Bruising: CBC, diff, smear, INR, PTT, von Willebrand, clotting factors VII, IX, X, XIII. Ddx: accidental inj, bleeding d/o (ITP, thrombocytopenia, hemophilia),




#ir #peds
Bruising: CBC, diff, smear, INR, PTT, von Willebrand, clotting factors VII, IX, X, XIII.
  • Ddx: accidental inj, bleeding d/o (ITP, thrombocytopenia, hemophilia), connective tissue d/o (Ehlers Danlos), Mongolian spots, folk healing practices, phytophotodermatitis, ink/paint
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
T, lipase, UA) Fractures: bone density on XR, Ca 2+ , Mg 2+ , Phos, ALP, PTH, VIT D Ddx: accidental inj, osteogenesis imperfecta, Menkes dz, osteopenia (rickets, prematurity, meds), osteomyelitis, bone tumours <span>Bruising: CBC, diff, smear, INR, PTT, von Willebrand, clotting factors VII, IX, X, XIII. Ddx: accidental inj, bleeding d/o (ITP, thrombocytopenia, hemophilia), connective tissue d/o (Ehlers Danlos), Mongolian spots, folk healing practices, phytophotodermatitis, ink/paint Intracranial bleed: bruising workup + urine organic acids head trauma often missed b/c: non-specific sx’s (vomiting, crying, irritable) Sexual abuse: STIs r/o o




#ir #peds
Intracranial bleed: bruising workup + urine organic acids
  • head trauma often missed b/c: non-specific sx’s (vomiting, crying, irritable)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
llebrand, clotting factors VII, IX, X, XIII. Ddx: accidental inj, bleeding d/o (ITP, thrombocytopenia, hemophilia), connective tissue d/o (Ehlers Danlos), Mongolian spots, folk healing practices, phytophotodermatitis, ink/paint <span>Intracranial bleed: bruising workup + urine organic acids head trauma often missed b/c: non-specific sx’s (vomiting, crying, irritable) Sexual abuse: STIs r/o other causes (ddx) CAS duties: 1) report (reasonable grounds to suspect needs protection) 2) ongoing report (additional reasonable grounds) 3) no delega




#ir #peds
CAS duties: 1) report (reasonable grounds to suspect needs protection) 2) ongoing report (additional reasonable grounds) 3) no delegation
  • àinvestigation (CAS (safety) + police (criminal charges))
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
ctices, phytophotodermatitis, ink/paint Intracranial bleed: bruising workup + urine organic acids head trauma often missed b/c: non-specific sx’s (vomiting, crying, irritable) Sexual abuse: STIs r/o other causes (ddx) <span>CAS duties: 1) report (reasonable grounds to suspect needs protection) 2) ongoing report (additional reasonable grounds) 3) no delegation àinvestigation (CAS (safety) + police (criminal charges)) How to report Provide basis for suspicion, address, religion, relationship w/ offender, other children A father is known to hit his son for disciplin




#ir #peds
How to report
  • Provide basis for suspicion, address, religion, relationship w/ offender, other children
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
: STIs r/o other causes (ddx) CAS duties: 1) report (reasonable grounds to suspect needs protection) 2) ongoing report (additional reasonable grounds) 3) no delegation àinvestigation (CAS (safety) + police (criminal charges)) <span>How to report Provide basis for suspicion, address, religion, relationship w/ offender, other children A father is known to hit his son for discipline. The child says his dad hits him with a ruler. Father says he hits his son only with a hand. How can you tell O/E




#ir #peds
  • A father is known to hit his son for discipline. The child says his dad hits him with a ruler. Father says he hits his son only with a hand. How can you tell O/E how the child was hit? Is this discipline or child abuse?
  • O/E: shape of imprint/bruise, type of injury
  • Abuse: potentially meets definition (depends on injury)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 2 - maltx
l reasonable grounds) 3) no delegation àinvestigation (CAS (safety) + police (criminal charges)) How to report Provide basis for suspicion, address, religion, relationship w/ offender, other children <span>A father is known to hit his son for discipline. The child says his dad hits him with a ruler. Father says he hits his son only with a hand. How can you tell O/E how the child was hit? Is this discipline or child abuse? O/E: shape of imprint/bruise, type of injury Abuse: potentially meets definition (depends on injury) Child abuse (2 MCQ questions, what tests would you do; can't remember scenario) (See above) You "see bruises on infant" and also that t




#ir #peds
2DTaP-IPV-HibPneu-C-13Rot-1
4DTaP-IPV-HibPneu-C-13Rot-1
6DTaP-IPV-Hib
12Men-C-CPneu-C-13MMR
15 Var
18DTaP-IPV-Hib
4-6Tdap-IPV MMRV
Gr 7Men-C-ACYWHPV-4HB
14-16Tdap
Yr Infl
Live (MMR + V)àSC
Td q10y >24, Pneu q5y, shingles >65
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 3 - imm
2 DTaP-IPV-Hib Pneu-C-13 Rot-1 4 DTaP-IPV-Hib Pneu-C-13 Rot-1 6 DTaP-IPV-Hib 12 Men-C-C Pneu-C-13 MMR 15 Var 18 DTaP-IPV-Hib 4-6 Tdap-IPV MMRV Gr 7 Men-C-ACYW HPV-4 HB 14-16 Tdap Yr Infl Live (MMR + V)àSC Td q10y >24, Pneu q5y, shingles >65 HEALTH SUPERVISION IMMUNIZATIONS ( know Ontario immunization schedule) All IM excl MMR & V (SC) & Rota (oral)




#ir #peds
IMMUNIZATIONS (know Ontario immunization schedule)
  1. All IM excl MMR & V (SC) & Rota (oral)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 3 - imm
MMR 15 Var 18 DTaP-IPV-Hib 4-6 Tdap-IPV MMRV Gr 7 Men-C-ACYW HPV-4 HB 14-16 Tdap Yr Infl Live (MMR + V)àSC Td q10y >24, Pneu q5y, shingles >65 HEALTH SUPERVISION <span>IMMUNIZATIONS ( know Ontario immunization schedule) All IM excl MMR & V (SC) & Rota (oral) “Do vaccines cause ASD?” How do you advise the parents? Discuss how you would calm mom's fear of autism in a child receiving MMR. Unders




#ir #peds
  • “Do vaccines cause ASD?” How do you advise the parents? Discuss
    how you would calm mom's fear of autism in a child receiving MMR.
  • Understand concern: worries, understanding of dz risks &
Vaccine benefits & risks, validate why may have belief
  • if concerned re: ASD, discuss how original info was fraud &
no evidence to support link; give anecdotes of children
affected by vaccine-preventable dz’s
  • stick to msg: vaccines are safe & effective & serious dz can
be prevented w/ imm
  • vaccine benefits & risks, herd protection not 100% (tetanus from soil), ‘wait and see’ not good b/c many need mult doses & take time to protect
  • vaccine safety system: held to higher safety standard than drugs, usually approved in Canada after use in other countries
  • address pain assc w/ imm
  • don’t dismiss from practice if parents refuse: majority of parents accept when concerns addressed
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 3 - imm
y >24, Pneu q5y, shingles >65 HEALTH SUPERVISION IMMUNIZATIONS ( know Ontario immunization schedule) All IM excl MMR & V (SC) & Rota (oral) <span>“Do vaccines cause ASD?” How do you advise the parents? Discuss how you would calm mom's fear of autism in a child receiving MMR. Understand concern: worries, understanding of dz risks & Vaccine benefits & risks, validate why may have belief if concerned re: ASD, discuss how original info was fraud & no evidence to support link; give anecdotes of children affected by vaccine-preventable dz’s stick to msg: vaccines are safe & effective & serious dz can be prevented w/ imm vaccine benefits & risks, herd protection not 100% (tetanus from soil), ‘wait and see’ not good b/c many need mult doses & take time to protect vaccine safety system: held to higher safety standard than drugs, usually approved in Canada after use in other countries address pain assc w/ imm don’t dismiss from practice if parents refuse: majority of parents accept when concerns addressed Adverse reaction of MMR vaccine? (give 3) MMR: measles rash (7-14d), ITP, parotitis, febrile seizure Local : induration, tenderness, redness, swe




#ir #peds
  • Adverse reaction of MMR vaccine? (give 3)
  • MMR: measles rash (7-14d), ITP, parotitis, febrile seizure
    • Local: induration, tenderness, redness, swelling
    • Allergic: urticaria, rhinitis, anaphylaxis
    • Systemic: ↑T, rash, irritability, lymphadenopathy, arthr/myalgia, arthritis
    • CIs: moderate/severe illness ± fever (not mild URTI), component allergy
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 3 - imm
stem: held to higher safety standard than drugs, usually approved in Canada after use in other countries address pain assc w/ imm don’t dismiss from practice if parents refuse: majority of parents accept when concerns addressed <span>Adverse reaction of MMR vaccine? (give 3) MMR: measles rash (7-14d), ITP, parotitis, febrile seizure Local : induration, tenderness, redness, swelling Allergic : urticaria, rhinitis, anaphylaxis Systemic : ↑T, rash, irritability, lymphadenopathy, arthr/myalgia, arthritis CIs: moderate/severe illness ± fever (not mild URTI) , component allergy During a 6mo ♀ wellness visit, which diseases is the child being inoculated against (3 marks; there are five diseases, which opens up the possibility that I am wron




#ir #peds
AEs of DTaP-IPV-Hib: serious s/e rare. Mild pain, swelling, redness x few days at site. Some get fever/rash/lose appetite/fussy/drowsy x1-2d after shot (acetaminophen to prevent pain & fever).
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 3 - imm
against (3 marks; there are five diseases, which opens up the possibility that I am wrong)? Name the AEs of such a vaccine (3 marks). Diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type B (Hib) <span>AEs: serious s/e rare. Mild pain, swelling, redness x few days at site. Some get fever/rash/lose appetite/fussy/drowsy x1-2d after shot (acetaminophen to prevent pain & fever). Mother being counselled about HPV vaccine. Which of the following are correct? protects against genital warts




#ir #peds
  • Mother being counselled about HPV vaccine. Which of the following are correct?
  • protects against genital warts T (not 100%)
  • HPV causes cervical and anal cancer T (HPV 16,18)
  • most of us will get the infection and clear it on our own F (10% incidence)
  • injection at 0, 2, 6 months T (0, 1-2, 6)
  • side effects are common F
  • protects against four high-risk subtypes F (not HPV 6,11)
  • doesn’t require yearly paps T (q3y)
  • average time from acquiring high-risk genotype to cancer is 30-40 y F (15y)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Highlight doc Day 3 - imm
ugh), polio, Haemophilus influenzae type B (Hib) AEs: serious s/e rare. Mild pain, swelling, redness x few days at site. Some get fever/rash/lose appetite/fussy/drowsy x1-2d after shot (acetaminophen to prevent pain & fever). <span>Mother being counselled about HPV vaccine. Which of the following are correct? protects against genital warts T (not 100%) HPV causes cervical and anal cancer T (HPV 16,18) most of us will get the infection and clear it on our own F (10% incidence) injection at 0, 2, 6 months T (0, 1-2, 6) side effects are common F protects against four high-risk subtypes F (not HPV 6,11) doesn’t require yearly paps T (q3y) average time from acquiring high-risk genotype to cancer is 30-40 y F (15y) Which vaccination should an 11yo ♀ get before leaving for summer school? I answered DTaP booster. Hepatitis B, and meningococcal C 15mo well-baby




#ir #peds
Growth monitoring should be performed at primary care visits for
children and youth ages 17 and younger
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
se • Provide education about age‐appropriate foods, mealtime scheduling and behaviour • Caloric fortification of food • May need referral to dietitian, social work Overweight and Obesity Introduction • <span>Growth monitoring should be performed at primary care visits for children and youth ages 17 and younger • BMI = mass (kg) / height (m2) o WHO Growth Charts for Canada are recommended which have different cutpoints for the definition of overweight and obesity than the U




#ir #peds
BMI = mass (kg) / height (m2)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
fication of food • May need referral to dietitian, social work Overweight and Obesity Introduction • Growth monitoring should be performed at primary care visits for children and youth ages 17 and younger • <span>BMI = mass (kg) / height (m2) o WHO Growth Charts for Canada are recommended which have different cutpoints for the definition of overweight and obesity than the US‐based CDC charts • Cut‐off poi




#ir #peds
Birth to 2 years
‐ Risk of overweight – Weight for length > 85th
‐ Overweight – Weight for length > 97th
‐ Obese – Weight for length > 99.9th
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
WHO Growth Charts for Canada are recommended which have different cutpoints for the definition of overweight and obesity than the US‐based CDC charts • Cut‐off points for overweight and obese depend on age and BMI (WHO) o <span>Birth to 2 years ‐ Risk of overweight – Weight for length > 85th ‐ Overweight – Weight for length > 97th ‐ Obese – Weight for length > 99.9th o 2 to 5 years ‐ Risk of overweight – BMI > 85th ‐ Overweight – BMI > 97th ‐ Obese – BMI > 99.9th o 5 to 19 years ‐ Overweight – BMI > 85th&#13




#ir #peds
2 to 5 years
‐ Risk of overweight – BMI > 85th
‐ Overweight – BMI > 97th
‐ Obese – BMI > 99.9th
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
ff points for overweight and obese depend on age and BMI (WHO) o Birth to 2 years ‐ Risk of overweight – Weight for length > 85th ‐ Overweight – Weight for length > 97th ‐ Obese – Weight for length > 99.9th o <span>2 to 5 years ‐ Risk of overweight – BMI > 85th ‐ Overweight – BMI > 97th ‐ Obese – BMI > 99.9th o 5 to 19 years ‐ Overweight – BMI > 85th ‐ Obese – BMI > 97th ‐ Severely obese – BMI > 99.9th • Over 60% of overweight children will have at least one




#ir #peds
5 to 19 years
‐ Overweight – BMI > 85th
‐ Obese – BMI > 97th
‐ Severely obese – BMI > 99.9th
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
ength > 85th ‐ Overweight – Weight for length > 97th ‐ Obese – Weight for length > 99.9th o 2 to 5 years ‐ Risk of overweight – BMI > 85th ‐ Overweight – BMI > 97th ‐ Obese – BMI > 99.9th o <span>5 to 19 years ‐ Overweight – BMI > 85th ‐ Obese – BMI > 97th ‐ Severely obese – BMI > 99.9th • Over 60% of overweight children will have at least one CV risk factor History • What concerns, if any, do you have about your child’s weight? When did weight




#ir #peds
Over 60% of overweight children will have at least one CV risk factor
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
ears ‐ Risk of overweight – BMI > 85th ‐ Overweight – BMI > 97th ‐ Obese – BMI > 99.9th o 5 to 19 years ‐ Overweight – BMI > 85th ‐ Obese – BMI > 97th ‐ Severely obese – BMI > 99.9th • <span>Over 60% of overweight children will have at least one CV risk factor History • What concerns, if any, do you have about your child’s weight? When did weight gain start? Has gain been slow over time or sudden? • What, if any, pas




#ir #peds
History
• What concerns, if any, do you have about your child’s weight? When
did weight gain start? Has gain been slow over time or sudden?
• What, if any, past attempts at weight loss have been made?
• Review of systems for comorbidities and etiologies of obesity:
o Headaches, blurred vision (hypertension, intracranial
hypertension)
o Breathing pauses when sleeping, snoring, daytime sleepiness (OSA)
o Joint pain (slipped femoral capital epiphysis, blount disease)
o Menstrual history, hirsutism, acne (hyperandrogenism, PCOS)
o Polyuria, nocturia (T2DM)
o Increased fatigue, cold intolerance, constipation, dry skin
(hypothyroidism)
o Stunted growth, striae (Cushing’s)
• Family History
o Identify obesity in first degree relatives
o Evaluate history of cardiovascular disease, type 2 DM, cancer in
first degree or second‐degree relatives
• Diet
o Identify caretakers who feed the child
o Identify foods high in calories and low in nutritional value that can
be reduced, eliminated, or replaced
o Assess eating patterns (e.g. timing, content, location of meals and
snacks)
o Estimate the type and quantity of beverage intake (sugar
sweetened beverages, juice, pop)
o Frequency of dining out
• Activity
o Identify barriers to walking or riding a bike to school
o Evaluate time spent in play
o Evaluate school recess and physical education (frequency, duration
and intensity)
o Assess after‐school and weekend activities
o Assess screen time (television, computer, movies, video games)
• Assess psychological impact of weight on child (bullying, depression,
anxiety, social isolation etc.)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
#13; ‐ Obese – BMI > 99.9th o 5 to 19 years ‐ Overweight – BMI > 85th ‐ Obese – BMI > 97th ‐ Severely obese – BMI > 99.9th • Over 60% of overweight children will have at least one CV risk factor <span>History • What concerns, if any, do you have about your child’s weight? When did weight gain start? Has gain been slow over time or sudden? • What, if any, past attempts at weight loss have been made? • Review of systems for comorbidities and etiologies of obesity: o Headaches, blurred vision (hypertension, intracranial hypertension) o Breathing pauses when sleeping, snoring, daytime sleepiness (OSA) o Joint pain (slipped femoral capital epiphysis, blount disease) o Menstrual history, hirsutism, acne (hyperandrogenism, PCOS) o Polyuria, nocturia (T2DM) o Increased fatigue, cold intolerance, constipation, dry skin (hypothyroidism) o Stunted growth, striae (Cushing’s) • Family History o Identify obesity in first degree relatives o Evaluate history of cardiovascular disease, type 2 DM, cancer in first degree or second‐degree relatives • Diet o Identify caretakers who feed the child o Identify foods high in calories and low in nutritional value that can be reduced, eliminated, or replaced o Assess eating patterns (e.g. timing, content, location of meals and snacks) o Estimate the type and quantity of beverage intake (sugar sweetened beverages, juice, pop) o Frequency of dining out • Activity o Identify barriers to walking or riding a bike to school o Evaluate time spent in play o Evaluate school recess and physical education (frequency, duration and intensity) o Assess after‐school and weekend activities o Assess screen time (television, computer, movies, video games) • Assess psychological impact of weight on child (bullying, depression, anxiety, social isolation etc.) Physical Exam • Obtain and plot weight, height, BMI on WHO Growth Charts for Canada Complete physical exam • Findings to look for o Hypertension o En




#ir #peds
Physical Exam
• Obtain and plot weight, height, BMI on WHO Growth Charts for Canada
Complete physical exam
• Findings to look for
o Hypertension
o Enlarged thyroid
o Acanthosis nigricans (insulin resistance)
o Striae
o Hepatomegaly
o Hirsutism
o Hip/knee pain or decreased ROM (Blounts, SCFE)
o Sexual maturity rating
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
3; o Assess after‐school and weekend activities o Assess screen time (television, computer, movies, video games) • Assess psychological impact of weight on child (bullying, depression, anxiety, social isolation etc.) <span>Physical Exam • Obtain and plot weight, height, BMI on WHO Growth Charts for Canada Complete physical exam • Findings to look for o Hypertension o Enlarged thyroid o Acanthosis nigricans (insulin resistance) o Striae o Hepatomegaly o Hirsutism o Hip/knee pain or decreased ROM (Blounts, SCFE) o Sexual maturity rating Investigations • Investigations can be performed for children who meet cut‐off point for obesity • Lipid profile, glucose, HbA1C • Liver enzymes (specific




#ir #peds
Investigations
• Investigations can be performed for children who meet cut‐off point
for obesity
• Lipid profile, glucose, HbA1C
• Liver enzymes (specifically ALT) every 2 years
• Consider ultrasound of liver if liver enzymes are abnormal
• Fasting lipid profile every 2 years
• Fasting plasma glucose, HbA1C every 2 years, if severe obesity
(consider 2 h OGTT (1.75 mg/kg upto max 75 g)
• Sleep study if symptoms present
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
for o Hypertension o Enlarged thyroid o Acanthosis nigricans (insulin resistance) o Striae o Hepatomegaly o Hirsutism o Hip/knee pain or decreased ROM (Blounts, SCFE) o Sexual maturity rating <span>Investigations • Investigations can be performed for children who meet cut‐off point for obesity • Lipid profile, glucose, HbA1C • Liver enzymes (specifically ALT) every 2 years • Consider ultrasound of liver if liver enzymes are abnormal • Fasting lipid profile every 2 years • Fasting plasma glucose, HbA1C every 2 years, if severe obesity (consider 2 h OGTT (1.75 mg/kg upto max 75 g) • Sleep study if symptoms present Management • Structured behavior programs should not be offered to children/youth who are at a healthy weight to prevent obesity • The subject of talking about




#ir #peds
Structured behavior programs should not be offered to children/youth
who are at a healthy weight to prevent obesity
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
e abnormal • Fasting lipid profile every 2 years • Fasting plasma glucose, HbA1C every 2 years, if severe obesity (consider 2 h OGTT (1.75 mg/kg upto max 75 g) • Sleep study if symptoms present Management • <span>Structured behavior programs should not be offered to children/youth who are at a healthy weight to prevent obesity • The subject of talking about a patient’s weight can often be a very sensitive topic. o Ask for permission to discuss weight o Assess obesity related risk and poten




#ir #peds
o Ask for permission to discuss weight
o Assess obesity related risk and potential ‘root causes’of weight gain
o Advice on obesity risks, discuss treatment benefits and options
o Agree on a realistic SMART plan to achieve health behavior
outcomes
o Assist in addressing drivers and barriers, offer education and
resources, refer as necessary and arrange follow‐up
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
; Management • Structured behavior programs should not be offered to children/youth who are at a healthy weight to prevent obesity • The subject of talking about a patient’s weight can often be a very sensitive topic. <span>o Ask for permission to discuss weight o Assess obesity related risk and potential ‘root causes’of weight gain o Advice on obesity risks, discuss treatment benefits and options o Agree on a realistic SMART plan to achieve health behavior outcomes o Assist in addressing drivers and barriers, offer education and resources, refer as necessary and arrange follow‐up • Stress the importance of achieving behavioural and health‐related improvements rather than focusing primarily on numbers on a scale. • Behaviour modification – can prod




#ir #peds
Stress the importance of achieving behavioural and health‐related
improvements rather than focusing primarily on numbers on a scale.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
eatment benefits and options o Agree on a realistic SMART plan to achieve health behavior outcomes o Assist in addressing drivers and barriers, offer education and resources, refer as necessary and arrange follow‐up • <span>Stress the importance of achieving behavioural and health‐related improvements rather than focusing primarily on numbers on a scale. • Behaviour modification – can produce weight loss of 5‐20% over 3‐6 months • Lifestyle modification strategies can be broadly categorized as: o Controlling the envi




#ir #peds
Behaviour modification – can produce weight loss of 5‐20% over 3‐6
months
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
and barriers, offer education and resources, refer as necessary and arrange follow‐up • Stress the importance of achieving behavioural and health‐related improvements rather than focusing primarily on numbers on a scale. • <span>Behaviour modification – can produce weight loss of 5‐20% over 3‐6 months • Lifestyle modification strategies can be broadly categorized as: o Controlling the environment – include the entire family in healthy changes rather than child alone&#1




#ir #peds
Lifestyle modification strategies can be broadly categorized as:
o Controlling the environment – include the entire family in healthy
changes rather than child alone
o Monitoring behavior
o Assessing motivation
o Setting realistic goals
o Rewarding successful changes in behavior
o Arrange short‐term follow‐up to review progress
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
w‐up • Stress the importance of achieving behavioural and health‐related improvements rather than focusing primarily on numbers on a scale. • Behaviour modification – can produce weight loss of 5‐20% over 3‐6 months • <span>Lifestyle modification strategies can be broadly categorized as: o Controlling the environment – include the entire family in healthy changes rather than child alone o Monitoring behavior o Assessing motivation o Setting realistic goals o Rewarding successful changes in behavior o Arrange short‐term follow‐up to review progress • Involve a multidisciplinary team (dietitian, exercise therapist, social worker, psychologist) • There is no role of medications (such as orlistat) for healthy weight&#1




#ir #peds
• Involve a multidisciplinary team (dietitian, exercise therapist, social
worker, psychologist)
• There is no role of medications (such as orlistat) for healthy weight
management in children 2‐11 years old or for routine use in youth 12‐
17
• Surgical management can be offered in a select group of adolescents –
there is no role for routine referral for surgical management for
overweight/obesity
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
in healthy changes rather than child alone o Monitoring behavior o Assessing motivation o Setting realistic goals o Rewarding successful changes in behavior o Arrange short‐term follow‐up to review progress <span>• Involve a multidisciplinary team (dietitian, exercise therapist, social worker, psychologist) • There is no role of medications (such as orlistat) for healthy weight management in children 2‐11 years old or for routine use in youth 12‐ 17 • Surgical management can be offered in a select group of adolescents – there is no role for routine referral for surgical management for overweight/obesity Healthy Active Living Syllabus: Lipnowski et al. Healthy Active Living: Physical activity guidelines for children and adolescents . Paediatr Child Health. 2012;17(4




#ir #peds
‘Healthy living’ is described by Health Canada as making choices that
enhance physical, mental, social and spiritual health
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
r overweight/obesity Healthy Active Living Syllabus: Lipnowski et al. Healthy Active Living: Physical activity guidelines for children and adolescents . Paediatr Child Health. 2012;17(4):209. Introduction • <span>‘Healthy living’ is described by Health Canada as making choices that enhance physical, mental, social and spiritual health • Health care professionals should be promoting physical activity and reducing sedentary time in children and adolescents Canadian guidelines for physical activity




#has-images #ir #peds
Canadian guidelines for physical activity and sedentary behavior
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
by Health Canada as making choices that enhance physical, mental, social and spiritual health • Health care professionals should be promoting physical activity and reducing sedentary time in children and adolescents <span>Canadian guidelines for physical activity and sedentary behavior Short stature: differential ABCDEFG : A lone (neglected infant) B one dysplasias (rickets, scoliosis, mucopolysaccharidoses) C hromosomal (Turner's




#ir #peds
Short stature: differential ABCDEFG:
Alone (neglected infant)
Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses)
Chromosomal (Turner's, Down's)
Delayed growth
Endocrine (low growth hormone, Cushing's, hypothyroid)
Familial
GI malabsorption (celiac, Crohn's)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Growth
spiritual health • Health care professionals should be promoting physical activity and reducing sedentary time in children and adolescents Canadian guidelines for physical activity and sedentary behavior <span>Short stature: differential ABCDEFG : A lone (neglected infant) B one dysplasias (rickets, scoliosis, mucopolysaccharidoses) C hromosomal (Turner's, Down's) D elayed growth E ndocrine (low growth hormone, Cushing's, hypothyroid) F amilial G I malabsorption (celiac, Crohn's) <span><body><html>




#ir #peds
Symptoms of bacterial pneumonia frequently overlap those present with viral infections or reactive airway disease.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
Abstract Although immunization has decreased the incidence of bacterial pneumonia in vaccinated children, pneumonia remains common in healthy children. Symptoms of bacterial pneumonia frequently overlap those present with viral infections or reactive airway disease. Optimally, the diagnosis of bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials. Factors such as age, vital signs and other measures of illness




#ir #peds
Optimally, the diagnosis of bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
zation has decreased the incidence of bacterial pneumonia in vaccinated children, pneumonia remains common in healthy children. Symptoms of bacterial pneumonia frequently overlap those present with viral infections or reactive airway disease. <span>Optimally, the diagnosis of bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials. Factors such as age, vital signs and other measures of illness severity are critical when deciding whether to admit a patient to hospital. Because Streptococcus pneumoniae continues to




#ir #peds
Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
f bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials. Factors such as age, vital signs and other measures of illness severity are critical when deciding whether to admit a patient to hospital. Because <span>Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia .If improvement does not occur, consideration should be giv




#ir #peds
Because Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
gnosis of bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials. Factors such as age, vital signs and other measures of illness severity are critical when deciding whether to admit a patient to hospital. <span>Because Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia .If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess). Routine chest radiographs at the end of therapy are not recommend




#ir #peds
If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
hospital. Because Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia .<span>If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess). Routine chest radiographs at the end of therapy are not recommended unless clinically indicated. Key Words: Antimicrobial therapy; Bacterial pneumonia; Viral pneumonia &#




#ir #peds
Routine chest radiographs at the end of therapy are not recommended unless clinically indicated.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
escribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia .If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess). <span>Routine chest radiographs at the end of therapy are not recommended unless clinically indicated. Key Words: Antimicrobial therapy; Bacterial pneumonia; Viral pneumonia Most physicians who care for children and youth have had experience with managing acute




Antimicrobial therapy (lecture)
#ir #peds
Classification of bacteria
• Gram stain
▫Gram positive vs. gram negative
▫Don’t stain (acid fast organisms – mycobacteria, no cell wall – mycoplasma)
•Other factors to considerCan the antibiotic(s) get to the site of infection?
Will the antibiotic(s) be active at the site of infection?
Is the drug bactericidal or bacteristatic?
Are there any potential drug interactions?
▫Oxygen requirements (anaerobic, aerobic)
▫Motility
▫Spore production

Gram positive bacteria
Cocci
>>pairs & chains (S pneumoniae, S pyogenes, Grp B strep, Viridans Strep, enterococci)
>>clusters
>>>>>coagulase + (S aureus)
>>>>>coagulase - (seen more in neonates)
Bacilli
>>aerobic or facultative anaerobes (Listeria spp)
>>anaerobes
>>branching

Gram negative bacteria
Bacilli
>>Enterobacteriaceae (E. coli, Klebsiella spp., Enterobacter spp., Salmonella spp., Shigella spp.)
>>Various (respiratory ones) (Haemophilus influenzae, Bordetella pertussis)
>>non-fermenters (pseudomonas spp)
>>anaerobes
Cocci
>>Neisseria gonorrhoeae (commonly in babies w/ conjunctivitis), Neisseria meningitidis, Moraxella catarrhalis

Principles of antibiotic use and spectrum of activity
Selecting the correct antibiotic - Think bug, drug, host
>>Bug - What are the likely pathogens? What is the likelihood of antibiotic resistance?
>>Drug - Can the antibiotic(s) get to the site of infection? Will the antibiotic(s) be active at the site of infection? Is the drug bactericidal or bacteristatic? (eg meningitis vs UTI) Are there any potential drug interactions?
>>Host - Are there any underlying medical or surgical conditions? (eg renal failure, liver dysfn) Is the host immunologically normal? Are there any foreign bodies in place? Does the patient have any drug allergies? How expensive will the treatment course be?

Non-antibiotic considerations
>>Source control – consider the role of surgery (eg need to drain abscess first before abx use)
>>Anatomic and tissue related factors
▫Blood brain barrier
▫Osteomyelitis, sequestrum
▫Vegetations or necrotic tissue (devascularized tissue)
>>Ability of antibiotic to act at site of infection
▫Hard to eradicate organisms from foreign-body material
▫Abscess fluid
Many antibiotics do not penetrate well
Some antibiotics inactive in acid pH (e.g. aminoglycosides)

Cidal versus static
>>Bactericidal antibiotics kill bacteria (Cidal antibiotics preferred for serious life-threatening conditions)
▫Cell wall active agents (beta-lactams, vancomycin)
▫Daptomycin, quinolones, metronidazole, co-trimoxazole
>>Bacteristatic antibiotics inhibit bacterial growth and reproduction without killing them
▫Inhibitors of protein synthesis (macrolides, tetracyclines, clindamycin, chloramphenicol)
▫Sulfonamides, trimethoprim

Penicillin: spectrum of activity
>>Gram positive cocci (streptococci or any relatives/similar ones)
▫Group A, B, C, G streptococci, S. pneumoniae, S. bovis, viridans streptococci, enterococci
>>Gram negative cocci and rods
▫Neisseria gonorrhoeae & N. meningitidis, Pasteurella multocida
>>Other
▫Oral anaerobes (non-β-lactamase producing; fusobacteria, peptostreptococcus, prevotella spp., Bacteroides fragilis)
▫Syphilis
▫Selected gram positive bacilli including Clostridium spp., Actinomyces spp., Bacillus spp., C. diphtheriae
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Penicillin class antibiotics
#peds
Penicillin class antibiotics (Antibiotic & Spectrum and advantage over penicillin)
>>Aminopenicillins (amoxi PO or ampi IV) - a bit more GN coverage, esp respiratory. same as penicillin + non-β lactamase producing H. influenzae, some gram negative enterics (E. coli, K. pneumoniae, Salmonella), Listeria (ampi is drug of choice), enterococci
>>β-lactamase stable (ie cloxacillin) - Methicillin sensitive S. aureus (basically S aureus abx) & coagulase negative staphylococci, streptococci
>>Ureidopenicillins (ie pipracillin) - Improved gram negative coverage including enterobacteriaceae (much expanded GN coverage, incl pseudomonas), P. aeruginosa
>>β-lactamase inhibitor combo’s (eg pip-tazo) - Improved activity against β lactamase producing gram positive (most common mechanism of resistance, so get very broad coverage, overcoming lots of GNs & anaerobes), gram negative and anaerobic organisms
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Cephalosporins: activity spectrum
#peds
Antibiotic class - Antibiotics - Spectrum of activity and comments
>>1st generation (usually GP but some GN coverage for simple inf's) - IV: cefazolin, PO: cephalexin - Gram +ve organisms (streptococci, staphylococci), Variable coverage against enteric gram negatives
that cause UTI (E. coli, K. pneumoniae)
>>2nd generation - IV: Cefuroxime, PO: Cefuroxime, Cefprozil - Gram +ve organisms (streptococci, staphylococci), H. influenzae, M. catarrhalis
>>3rd generation (covers streptococci well, which is why use for meningitis) - IV: Ceftriaxone, Cefotaxime, PO: Cefixime - Gram −ve organisms except P. aeruginosa. Streptococci including S. pneumoniae, group A
strep, group B strep (cefixime less so)
>>>>IV: Ceftazidime - Gram −ve organisms including P. aeruginosa, Poor gram positive coverage
**Enterococci are resistant to all current cephalosporins**
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Carbapenems
#peds
•Meropenem, ertapenem
•Broad spectrum coverage of gram positives, gram negative and anaerobes
•Spectrum of activity DOES NOT include (if drug of choice doesn't work, carbapenems likely won't either):
▫Methicillin resistant S. aureus & coagulase negative staph.
▫Ampicillin resistant enterococci
▫Occasional highly resistant gram negatives (enterics, pseudomonas)
▫Highly penicillin resistant S. pneumoniae may have reduced susceptibility
▫Stenotrophomonas maltophilia
▫Atypical organisms (mycoplasma, chlamydia, rickettsia, mycobacteria)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
1) Previously healthy 7 year old boy with fever, sore throat and rash for 2 days
Differential diagnosis
>>Viruses
▫Epstein-Barr virus (commonly seen in teens)
▫Herpes simplex virus
▫Adenovirus, influenza, (parainfluenza, RSV, coronavirus)
▫Enteroviruses (coxsackie)
>>Bacteria (rarely see these)
▫Corynebacterium diphtheriae
▫Archanobacterium hemolyticum
▫(Neisseria gonorrheae)

Management
>>Diagnosis
▫Rapid antigen detection test has high specificity, but limited sensitivity (if clinically likely, take culture even if test neg)
▫Throat swab for culture should always be taken prior to initiating antibiotics
>>Treatment (betalactams are drug of choice)
▫Penicillin V x 10 days (amoxicillin is an alternative)
▫Macrolides for penicillin allergic (macrolide resistance rates among S. pyogenes isolates in Canada 10-15%)
>>>>azithromycin (type of macrolide) acts quickly & tastes good, but increased resistance & long t1/2

2) Generally healthy 2 year old girl with fever (39.3o C) and ear ache x 24 hours
•What else do you want to know?
>>hx abx of use, recurrence of otitis, exposure/contact w/ sick pts, vaccinations
>>>>if get otitis after full vaccinations, more likely has resistant strain
•What are the likely pathogens?
>>h influenza, s pneumoniae, moraxella - top 3 to rmb
•What empiric therapy would you give (if any)?
>>can wait & see x48h - based on pain, T, age, background hx
>>amoxicillin - drug of choice - for now recommendation is high dose
•No prior episodes of AOM
•Immunizations up-to-date (including Prevnar)
•No recent antibiotics
•Two older siblings (4, 5 years old), both healthy
•Attending daycare
•Many children in day care with URTIs

Pathogens of acute otitis media
•Bacteria
▫Streptococcus pneumoniae (25% to 40%)
▫Non-typeable Haemophilus influenzae (10% to 30%)
▫Moraxella catarrhalis (5% to 15%)
▫Other less commonly seen pathogens include group A Streptococcus, S. aureus (3% to 5%)
•Viruses account for up to 20% of acute otitis media cases (bacterial cultures negative)

Natural history
>>Approximately 80% resolve without specific therapy
▫S. pneumoniae (least likely to resolve, which is why target with amoxi)
▫Non-typeable Haemophilus influenzae
▫Moraxella catarrhalis
>>Factors associated with lack of spontaneous resolution
▫Age < 2 years of age
▫Recurrent otitis media
▫Severe disease
▫Malnutrition or other immunocompromised states

Antibiotic therapy
>>First line (high dose amoxi) - Amoxicillin 75-90 mg/kg/day divided BID
>>Second line - Cefprozil, Cefuroxime, Ceftriaxone, Azithromycin, Clarithromycin
>>Treatment failure - if no sx improvement after 2-3d of initial therapy (Amoxicillin-clavulanate 90 mg/kg/day (amoxil component) divided BID x 10 days)
>>>>if no response to amoxi-clavu (Ceftriaxone 50 mg/kg/day for 3 doses) - consider need for tympanocentesis

Mother calls after 48 hours; still febrile, still having ear pain
•Why has she not responded? (Haven’t taken the antibiotics, Inadequate dose prescribed, Alternate diagnosis, Resistant S. pneumoniae , Haemophilis influenzae …)
•What will you do now?
>>Treatment options
▫Amoxicillin-clavulanate, with high dose amoxicillin component (80-90 mg/kg/d)
▫Cefuroxime (or cefprozil)
▫IM ceftriaxone x3 days
▫Macrolide may be OK but resistance relatively common

Watchful waiting criteria
>>Child is older than 6 months
>>No underlying conditions of concern
▫Immunodeficiency
▫Chronic cardiac or pulmonary disease
▫Anatomic abnormalities of head/neck
▫History of complicated otitis media
▫Down syndrome
>>Non-severe illness
▫Otalgia appe...
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
Previously healthy 4-year-old boy with fever and lethargy x 24 hours
•On examination reduced level of consciousness, nuchal rigidity (+ve Kernig, Brudzinsky)
•CSF findings
▫WBC 265 WBC x106/L (70% polymorphs)
▫RBC 2 x106/L
▫Glucose 0.2 mmol/L

•What are the most common pathogens? (s pneumo, n meningitidis - for meningitis)
•What empiric antibiotic therapy should be administered and why?
▫Suspected organisms
▫Potential for antibiotic resistance
▫CSF penetration
>>Ceftriaxone (or cefotaxime) + vancomycin

Acute bacterial meningitis
>>Infant (much harder to assess nuchal rigidity)
•Symptoms
▫Fever, poor feeding, vomiting, irritability, lethargy, inconsolable crying
•Signs
▫Bulging anterior fontanelle (absence doesn't rule out)
▫Diminished activity
▫Septic appearance
▫Petechial rash
•Typically non-specific
>>Child (> 2 years)
•Symptoms
▫Fever, headache, vomiting, back/neck pain, photophobia, confusion, disorientation
•Signs
▫Neck stiffness
▫Kernig & Brudzinski signs
▫Focal neurological signs
▫Petechial rash

CSF findings (normal - abnormal)
>>WBC (x106/L) - neo (0-30), >1m (<5) - bact (50-50000), viral (20-2000), TB (100-500)
>>% PMN - neo (<60), >1m (0) - bact (95), viral (<30), TB (<30)

Acute bacterial meningitis - Empiric antibiotic therapy
>>neonate - Group B streptococcus, Gram negative bacilli (E. coli), Listeria spp. - Ampicillin + cefotaxime (ampi mainly needed for listeria b/c cefo won't cover)
>>1-3 mo. - Overlap of “neonatal” organisms or those seen in older children - Ampicillin + cefotaxime ± vancomycin
>>. >3 mo. - Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b - Ceftriaxone + vancomycin
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
Lobar Pneumonia
>>4 most likely causes: #1 = s pneumo, h influ, GAS (s pyogenes), s aureus (not common but important to think about)

Tx - most commonly s pneumo so send home on amoxi
>>even if admit b/c vomiting, give ampi because still targeting s pneumo

Acute bacterial pneumonia
>>other possible causes: Mycobacterium tuberculosis, RSV, Influenza A/B, adenovirus, etc

Microbiologic diagnosis
>>Blood cultures are insensitive (positive in < 20%)
>>Sputum culture (hard to get & usually contaminated with mouth bugs)
>>pleural fluid PCR - can specifically ask for s pneumo, or do pan-analysis for multiple

Empiric therapy for hospitalized children with uncomplicated pneumonia
>>Non-life threatening - ampicillin
>>Respiratory failure or septic shock - Ceftriaxone ± vancomycin (broader coverage)
-Main pathogen being targeted is S. pneumoniae
-Ceftriaxone offers better coverage against β-lactamase+ H. influenzae & possibly for S. pneumoniae with high level resistance to penicillin
-vanco for s aureus coverage (tend to be much sicker, tend to have abscesses)
-If influenza virus detected, strongly consider oseltamivir or zanamavir
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
atypical pneumonia (bilateral, interstitial, not particularly sick, older child/adult)
-most common bug = m pneumoniae
>>mainly target m pneumoniae & c pneumoniae for practical purposes
>>other possible organisms: c psittaci (usually from birds), l pneumophilla (hospitals/contaminated water), c burnetii (birthing of certain mammals)

Antibiotics for “atypical pneumonia”
>>Macrolides
▫Erythromycin, clarithromycin, azithromycin
>>Quinolones
▫Ciprofoxicin
▫Respiratory quinolones (levofloxacin, moxifloxacin)
>>Tetracyclines
▫Tetracycline, doxycycline
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
Impetigo
>>s aureus, GAS (s pyogenes) most common
>>topical therapy (mupirocin, fucidin)
>>systemic therapy (cloxacillin, cephalexin - 1st gen ceph) - cloxacillin doesn't taste good so cephalexin does better with kids

Antibiotics for resistant gram positive infections
>>Organisms
Methicillin resistant S. aureus
▫Penicillin resistant S. pneumoniae & viridans streptococci
▫Ampicillin resistant enterococci
>>Potential antibiotics
▫Vancomycin (for kids being admitted)
▫Linezolid
▫Daptomycin, Clindamycin (used more often), TMP SMX
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
Urinary tract infection
>>Common pathogens
▫E. coli (80-90%)
▫Klebsiella pneumoniae
▫Other enteric gram –ve’s (Proteus spp., Enterobacter spp., Citrobacter spp., Pseudomonoas aeruginosa)
▫Enterococcus faecalis, E. faecium

Febrile urinary tract infection - Diagnosis
>>Sterile urine specimen is essential
▫Suprapubic aspiration
▫Transurethral catheterization
▫Clean catch
>>Bag specimens are notoriously unreliable
▫Good negative predictive value (can rule out UTI)
▫High false positive rate (85%) - get cleaner urine (catheter) if +ve, don't send bag for culture
>>Presumptive diagnosis (urinalysis, microscopy)
▫Microscopy (presence of bacteria, WBC)
▫Urinalysis (leukocyte esterase, nitrites)

Radiologic investigations
>>Renal and bladder ultrasound recommended after first UTI in all children to check for structural abnormalities

Management
>>Complicated UTI (criteria for admission)
▫Acutely ill, young (< 2-3 mo.), vomiting, immunocompromised
▫Admit for hydration, IV antibiotics
▫Ampicillin plus gentamicin
>>Uncomplicated UTI (kids that go home)
▫Well child
▫Oral antibiotic therapy (options include amoxicillin-clavulanate, cephalexin, TMP-SMX, cefixime…)
>>Antibiotic therapy should be given for 7-10 days
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Approach to suspected bacterial infections in children
#peds
Common sepsis pathogens
>>Community-acquired, otherwise healthy
•Staphylococcus aureus
Neisseria meningitidis (#1)
•Streptococcus pneumoniae
•Streptococcus pyogenes
>>Hospital-acquired, immunocompromised

Empiric coverage for septic shock (> 3 months of age)
>>Previously well - ceftriaxone plus vancomycin - penicillin allergy (ciprofloxacin plus vancomycin)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
>>Most have minor self-resolving viral infections
>>The key is to identify those with a serious infectious or non-infectious entity
>>Factors to consider in your approach
▫What is the age of the patient?
▫Is the child a normal host?
▫What exposures have occurred?
▫Is there an identifiable focus of infection?
▫How sick does the child look?

definitions:
•Fever without a source
▫Acute febrile illness in which the etiology of the fever is not apparent after careful history & physical examination
•Serious bacterial infection
▫Meningitis, sepsis, bone & joint infections, urinary tract infections, pneumonia, enteritis
•Toxic appearance
▫Clinical picture consistent with the sepsis syndrome (lethargy, poor perfusion, marked hypoventilation or hyperventilation, cyanosis etc.)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
Common life-threatening infections acquired perinatally
•Group B streptococcus
•Escherichia coli (and other gram negative enterics)
•Listeria monocytogenes
•Herpes simplex virus (↑ LFTs: 200-300) - important to know b/c treatable
•Enteroviruses

Important bacterial pathogens in toxic appearing infants (age in days - freq - pathogens)
>>0-28 - most common - GBS, e coli
>>>>less common - listeria monocyotogenes, s aureus, GAS, k pneumoniae
>>29-90 - most common - GBS, e coli
>>>>less common - s pneumo, n meningitidis, l monocytogenes, s aureus, GAS
>> 91+ - most common - s pneumo
>>>>less common - s aureus, GAS, n meningitidis
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
Investigating the toxic appearing infant
•Full septic workup
•Includes
▫CBC and blood culture
▫Urinalysis and urine culture
▫Lumbar puncture for CSF analysis and culture
▫CXR in presence of respiratory symptoms/signs
▫Stool microscopy and culture in presence of gastrointestinal symptoms/signs (diarrhea)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
Approach to the well-appearing febrile infant ≤ 28 days old
•Full septic workup
▫CBC with differential and blood culture
▫CSF for WBC & diff., protein, glucose, gram stain, culture
▫Urine microscopy/urinalysis and culture
▫Stool culture (if diarrhea present)
▫Chest x-ray (if respiratory symptoms/signs)
•Empiric therapy
▫Ampicillin and gentamicin if no evidence of meningitis
▫Ampicillin and cefotaxime with meningitis
▫Acyclovir added if risk factors or clinical finding suggestive of HSV

statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
Approach to the febrile infant 29-90 days
>>Low risk criteria - just observe w/o abx (outpt) - If clinical deterioration occurs: admit; FSWU; empiric antibiotics
  • Previously healthy term infant
  • Non-toxic clinical appearance
  • No focal infection (except otitis media)
  • Peripheral leukocyte count 5.0 – 15.0 x109/L (normal CBC)
  • Absolute band count ≤ 1.5 x109/L
  • Urine: ≤ 10 WBC per high field (x40)
  • Stool (if diarrhea): ≤ 5 WBC per high field (x40)
>>high risk - Admit to hospital - FSWU + IV abx
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
Approach to fever without a source in children 3-24 months old
(usually can just tx symptomatically)
>>Temperature ≥ 39.0C
OPTION 1:
1. Urinalysis & urine culture: males ≤ 6 mo’s of age, females ≤ 12 mo’s of age
2. Consider CBC & blood culture for unimmunized children if temp ≥ 39.0oC
3. Chest x-ray if clinical evidence of possible pneumonia
4. Acetaminophen
5. Return if fever persists >48 hours or condition deteriorates
OPTION 2:
1. No diagnostic tests or antibiotics
2. Acetaminophen
3. Return if fever persists >48 hours or condition deteriorates
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




Fever without source in children less than 2 years of age
#peds
Antibiotic selection for toxic appearing infants
Age group - Meningitis - Empiric antibiotics
0-28 days - No - Ampicillin + gentamicin or cefotaxime
Yes - Ampicillin + cefotaxime
29-90 days - No - Ampicillin + cefotaxime
Yes - Ampicillin + cefotaxime ± vancomycin
3-36 months - No - Cefuroxime or cefotaxime
Yes - Cefotaxime + vancomycin
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




#peds
S. pneumoniae most common cause of acute otitis media, pneumonia and meningitis after 3 months of age
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




#peds
Approach to the well appearing infant
Age - Approach
0-28 days - FSWU; empiric antibiotic therapy
29-90 days - Clinical and laboratory screening; assess “risk”; manage according to risk
3-24 months - Vast majority have viral illnesses; clinical follow-up ± selected tests
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




#peds
Toxic appearing infants - full septic workup, empiric antibiotic therapy pending cultures
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on




#ir #peds
Pneumonia is an acute inflammation of the parenchyma of the lower respiratory tract caused by a microbial pathogen. Bacterial infections are usually primary but, occasionally, viral respiratory tract infections such as influenza are followed by bacterial pneumonias.[5] Uncomplicated pneumonias may be accompanied by small parapneumonic effusions. Evidence of empyema (pus in the pleural space), a lung abscess or a necrotic portion of lung parenchyma implies the development of a complicated pneumonia.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
y, because these pneumonias may be caused by different pathogens or require more extensive investigation. The present practice point replaces a previous document published in 2011.[4] Definition and host risk factors <span>Pneumonia is an acute inflammation of the parenchyma of the lower respiratory tract caused by a microbial pathogen. Bacterial infections are usually primary but, occasionally, viral respiratory tract infections such as influenza are followed by bacterial pneumonias.[5] Uncomplicated pneumonias may be accompanied by small parapneumonic effusions. Evidence of empyema (pus in the pleural space), a lung abscess or a necrotic portion of lung parenchyma implies the development of a complicated pneumonia. Etiology The most common causes of pneumonia in infants and preschool children are viruses that usually, but not exclusively, circulate in winter (eg, respirat




#ir #peds
The most common causes of pneumonia in infants and preschool children are viruses that usually, but not exclusively, circulate in winter (eg, respiratory syncytial virus, influenza, parainfluenza virus and human metapneumovirus). Viruses as a sole cause of pneumonia are less common in older children, with the exception of influenza.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
ay be accompanied by small parapneumonic effusions. Evidence of empyema (pus in the pleural space), a lung abscess or a necrotic portion of lung parenchyma implies the development of a complicated pneumonia. Etiology <span>The most common causes of pneumonia in infants and preschool children are viruses that usually, but not exclusively, circulate in winter (eg, respiratory syncytial virus, influenza, parainfluenza virus and human metapneumovirus). Viruses as a sole cause of pneumonia are less common in older children, with the exception of influenza. Among bacteria, Streptococcus pneumoniae continues to be the most common bacterial pathogen causing pneumonia in children of all ages. Group A streptococcal pneumonia is mu




#ir #peds
Among bacteria, Streptococcus pneumoniae continues to be the most common bacterial pathogen causing pneumonia in children of all ages. Group A streptococcal pneumonia is much less common. Although Staphylococcus aureus is not a common cause of paediatric pneumonia, it has been increasingly encountered in communities where methicillin-resistant S aureus (MRSA) is prevalent. Haemophilus influenzae type b has almost disappeared because of vaccination. Mycoplasma pneumoniae and Chlamydophila pneumoniae are more common causes of pneumonia among school-age children, but they occasionally cause pneumonia in younger children
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
xclusively, circulate in winter (eg, respiratory syncytial virus, influenza, parainfluenza virus and human metapneumovirus). Viruses as a sole cause of pneumonia are less common in older children, with the exception of influenza. <span>Among bacteria, Streptococcus pneumoniae continues to be the most common bacterial pathogen causing pneumonia in children of all ages. Group A streptococcal pneumonia is much less common. Although Staphylococcus aureus is not a common cause of paediatric pneumonia, it has been increasingly encountered in communities where methicillin-resistant S aureus (MRSA) is prevalent. Haemophilus influenzae type b has almost disappeared because of vaccination. Mycoplasma pneumoniae and Chlamydophila pneumoniae are more common causes of pneumonia among school-age children, but they occasionally cause pneumonia in younger children.[6] Symptoms and signs of acute pneumonia The symptoms of pneumonia may be nonspecific, especially in infants and younger children. Acute onset of fever, cough




#ir #peds
The symptoms of pneumonia may be nonspecific, especially in infants and younger children.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
n. Mycoplasma pneumoniae and Chlamydophila pneumoniae are more common causes of pneumonia among school-age children, but they occasionally cause pneumonia in younger children.[6] Symptoms and signs of acute pneumonia <span>The symptoms of pneumonia may be nonspecific, especially in infants and younger children. Acute onset of fever, cough, difficulty breathing, poor feeding or vomiting, and lack of interest in normal activities are common symptoms. Chest or abdominal pain may also be prominent




#ir #peds
Acute onset of fever, cough, difficulty breathing, poor feeding or vomiting, and lack of interest in normal activities are common symptoms
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
among school-age children, but they occasionally cause pneumonia in younger children.[6] Symptoms and signs of acute pneumonia The symptoms of pneumonia may be nonspecific, especially in infants and younger children. <span>Acute onset of fever, cough, difficulty breathing, poor feeding or vomiting, and lack of interest in normal activities are common symptoms. Chest or abdominal pain may also be prominent features. Abrupt onset of rigors favours a bacterial cause. M pneumoniae is typically characterized by malaise and headache for seven to 1




#ir #peds
Chest or abdominal pain may also be prominent features.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
The symptoms of pneumonia may be nonspecific, especially in infants and younger children. Acute onset of fever, cough, difficulty breathing, poor feeding or vomiting, and lack of interest in normal activities are common symptoms. <span>Chest or abdominal pain may also be prominent features. Abrupt onset of rigors favours a bacterial cause. M pneumoniae is typically characterized by malaise and headache for seven to 10 days before the onset of fever and cough, which then pr




#ir #peds
Abrupt onset of rigors favours a bacterial cause
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
c, especially in infants and younger children. Acute onset of fever, cough, difficulty breathing, poor feeding or vomiting, and lack of interest in normal activities are common symptoms. Chest or abdominal pain may also be prominent features. <span>Abrupt onset of rigors favours a bacterial cause. M pneumoniae is typically characterized by malaise and headache for seven to 10 days before the onset of fever and cough, which then predominate. During annual influenza season, influe




#ir #peds
M pneumoniae is typically characterized by malaise and headache for seven to 10 days before the onset of fever and cough, which then predominate
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
te onset of fever, cough, difficulty breathing, poor feeding or vomiting, and lack of interest in normal activities are common symptoms. Chest or abdominal pain may also be prominent features. Abrupt onset of rigors favours a bacterial cause. <span>M pneumoniae is typically characterized by malaise and headache for seven to 10 days before the onset of fever and cough, which then predominate. During annual influenza season, influenza (with or without a secondary bacterial infection) as a cause of pneumonia should be strongly considered. Influenza infections may be heralded




#ir #peds
During annual influenza season, influenza (with or without a secondary bacterial infection) as a cause of pneumonia should be strongly considered. Influenza infections may be heralded by the sudden onset of systemic symptoms such as diffuse myalgias and fever, which are then followed by cough, sore throat or other respiratory symptoms
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
abdominal pain may also be prominent features. Abrupt onset of rigors favours a bacterial cause. M pneumoniae is typically characterized by malaise and headache for seven to 10 days before the onset of fever and cough, which then predominate. <span>During annual influenza season, influenza (with or without a secondary bacterial infection) as a cause of pneumonia should be strongly considered. Influenza infections may be heralded by the sudden onset of systemic symptoms such as diffuse myalgias and fever, which are then followed by cough, sore throat or other respiratory symptoms. Children typically experience fever and tachypnea (determined by counting the respiratory rate for 60 s in a calm state) (Table 1). Indrawing, retractions and/or a trachea




#ir #peds
Measurement of oxygen saturation with pulse oximetry is indicated in all patients presenting to a hospital or with significant illness because hypoxemia may not be clinically apparent and cyanosis is only associated with severe hypoxemia. However, a normal oxygen saturation does not exclude the possibility of pneumonia.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
y symptoms. Children typically experience fever and tachypnea (determined by counting the respiratory rate for 60 s in a calm state) (Table 1). Indrawing, retractions and/or a tracheal tug indicate respiratory distress (dyspnea). <span>Measurement of oxygen saturation with pulse oximetry is indicated in all patients presenting to a hospital or with significant illness because hypoxemia may not be clinically apparent and cyanosis is only associated with severe hypoxemia. However, a normal oxygen saturation does not exclude the possibility of pneumonia. Physical signs suggesting pneumonic consolidation include dullness to percussion, increased tactile fremitus, reduced normal vesicular breath sounds and increased bronchial




#ir #peds
The predominance of wheezing and hypoxia should suggest the possibility of bronchiolitis or mucous plugging from asthma, rather than pneumonia
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
cal signs suggesting pneumonic consolidation include dullness to percussion, increased tactile fremitus, reduced normal vesicular breath sounds and increased bronchial breath sounds – all of which may be difficult to detect in young children. <span>The predominance of wheezing and hypoxia should suggest the possibility of bronchiolitis or mucous plugging from asthma, rather than pneumonia. Signs of an effusion include dullness to percussion, decreased tactile fremitus, and decreased or absent breath sounds. There may be associated signs of dehydration and/or sepsis. &#13




#ir #peds
Age-specific criteria for tachypnea
Age Approximate normal respiratory rates Upper limit that should be used to define tachypnea
<2 months 34–50 60
2–12 months 25–40 50
1–5 years 20–30 40
>5 years 15–25 30
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
gging from asthma, rather than pneumonia. Signs of an effusion include dullness to percussion, decreased tactile fremitus, and decreased or absent breath sounds. There may be associated signs of dehydration and/or sepsis. TABLE 1 <span>Age-specific criteria for tachypnea Age Approximate normal respiratory rates Upper limit that should be used to define tachypnea <2 months 34–50 60 2–12 months 25–40 50 1–5 years 20–30 40 >5 years 15–25 30 Data presented as breaths/min Investigations Imaging Radiographs are not indicated for children experiencing wheezing with a typical presentation




#ir #peds
Radiographs are not indicated for children experiencing wheezing with a typical presentation of bronchiolitis or asthma because bacterial pneumonia is very unlikely.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
spiratory rates Upper limit that should be used to define tachypnea <2 months 34–50 60 2–12 months 25–40 50 1–5 years 20–30 40 >5 years 15–25 30 Data presented as breaths/min Investigations Imaging <span>Radiographs are not indicated for children experiencing wheezing with a typical presentation of bronchiolitis or asthma because bacterial pneumonia is very unlikely. When bacterial pneumonia is suspected clinically (a febrile child with acute respiratory symptoms and physical findings compatible with consolidation or pleural effusion), a chest radio




#ir #peds
When bacterial pneumonia is suspected clinically (a febrile child with acute respiratory symptoms and physical findings compatible with consolidation or pleural effusion), a chest radiograph (both postero-anterior and lateral) should usually be obtained.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
as breaths/min Investigations Imaging Radiographs are not indicated for children experiencing wheezing with a typical presentation of bronchiolitis or asthma because bacterial pneumonia is very unlikely. <span>When bacterial pneumonia is suspected clinically (a febrile child with acute respiratory symptoms and physical findings compatible with consolidation or pleural effusion), a chest radiograph (both postero-anterior and lateral) should usually be obtained. The reason for imaging is that the clinical features of other conditions overlap with bacterial pneumonia, and antibiotics may be avoided if the chest radiograph does not s




#ir #peds
in cases where the diagnosis of bacterial pneumonia is highly suspected from history, combined with typical clinical and physical findings and the child is not sufficiently ill to require hospitalization, a chest radiograph is not essential
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
ally be obtained. The reason for imaging is that the clinical features of other conditions overlap with bacterial pneumonia, and antibiotics may be avoided if the chest radiograph does not suggest bacterial pneumonia.[7] However, <span>in cases where the diagnosis of bacterial pneumonia is highly suspected from history, combined with typical clinical and physical findings and the child is not sufficiently ill to require hospitalization, a chest radiograph is not essential. All hospitalized children should have a chest radiograph performed to assess the extent of pneumonia and determine the presence of pleural effusion or abscess. The promine




#ir #peds
All hospitalized children should have a chest radiograph performed to assess the extent of pneumonia and determine the presence of pleural effusion or abscess.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
in cases where the diagnosis of bacterial pneumonia is highly suspected from history, combined with typical clinical and physical findings and the child is not sufficiently ill to require hospitalization, a chest radiograph is not essential. <span>All hospitalized children should have a chest radiograph performed to assess the extent of pneumonia and determine the presence of pleural effusion or abscess. The prominent radiographic pattern in bacterial pneumonia is alveolar/airspace disease that is seen as consolidations. Classically, these present as lobar consolidations wi




#ir #peds
The prominent radiographic pattern in bacterial pneumonia is alveolar/airspace disease that is seen as consolidations. Classically, these present as lobar consolidations with air bronchograms; however, airspace disease may also take the form of subsegmental or nodular opacities (eg, round pneumonia) or infiltrates. Clinical correlation is always important, especially when considering other, rarer causes of similar radiographic patterns.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
ill to require hospitalization, a chest radiograph is not essential. All hospitalized children should have a chest radiograph performed to assess the extent of pneumonia and determine the presence of pleural effusion or abscess. <span>The prominent radiographic pattern in bacterial pneumonia is alveolar/airspace disease that is seen as consolidations. Classically, these present as lobar consolidations with air bronchograms; however, airspace disease may also take the form of subsegmental or nodular opacities (eg, round pneumonia) or infiltrates. Clinical correlation is always important, especially when considering other, rarer causes of similar radiographic patterns. Poorly defined patches of infiltrates or atelectasis are more indicative of a viral etiology.[8] The ‘atypical’ pathogens, M pneumoniae or C pneumoniae, classically produce




#ir #peds
Poorly defined patches of infiltrates or atelectasis are more indicative of a viral etiology
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
disease may also take the form of subsegmental or nodular opacities (eg, round pneumonia) or infiltrates. Clinical correlation is always important, especially when considering other, rarer causes of similar radiographic patterns. <span>Poorly defined patches of infiltrates or atelectasis are more indicative of a viral etiology.[8] The ‘atypical’ pathogens, M pneumoniae or C pneumoniae, classically produce bilateral focal or interstitial infiltrates that appear to be more extensive relative to the milder but p




#ir #peds
Viral testing of nasopharyngeal secretions is usually not indicated for outpatients with suspected pneumonia. However, such testing should be strongly considered in children admitted during influenza season with possible viral pneumonia because antivirals are likely to be of benefit for influenza pneumonia, particularly in moderately to severely ill children
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
a is difficult in children. Most cases are not bacteremic at the time of diagnosis. If sputum is available (usually only in children >10 years of age), it should be sent for Gram staining and, if considered adequate, cultured. <span>Viral testing of nasopharyngeal secretions is usually not indicated for outpatients with suspected pneumonia. However, such testing should be strongly considered in children admitted during influenza season with possible viral pneumonia because antivirals are likely to be of benefit for influenza pneumonia, particularly in moderately to severely ill children.[11][12] Children (usually school age) with subacute, nonsevere pneumonia, presenting with features such as prominent cough, minimal leukocytosis and a nonlobar infiltrate, may have pne




#ir #peds
A complete blood count with differential testing and blood cultures (before starting antimicrobial therapy, if possible) are indicated for children who are hospitalized
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
a positive result may indicate remote infection. Bloodwork Typical bacterial pneumonias usually present with higher peripheral white blood cell counts than ‘atypical’ bacterial or viral pneumonias (eg, M pneumoniae). <span>A complete blood count with differential testing and blood cultures (before starting antimicrobial therapy, if possible) are indicated for children who are hospitalized. Even though the yield from blood cultures is low, a positive result is helpful, especially if the child subsequently experiences a complicated course. Furthermore, it is an important p




#ir #peds
Most children with pneumonia can be managed as outpatients
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
inimum volume of blood cultured should be at least 1 mL to 2 mL in infants, 4 mL to 5 mL in children <10 years of age and 10 mL to 20 mL in older children. Guidelines for referral to hospital or hospital admission <span>Most children with pneumonia can be managed as outpatients. Specific paediatric criteria for admission are not available. Hospitalization is generally indicated if a child has inadequate oral intake, is intolerant of oral therapy, has severe il




#ir #peds
Hospitalization is generally indicated if a child has inadequate oral intake, is intolerant of oral therapy, has severe illness or respiratory compromise (eg, grunting, nasal flaring, apnea, hypoxemia), or if the pneumonia is complicated
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
nd 10 mL to 20 mL in older children. Guidelines for referral to hospital or hospital admission Most children with pneumonia can be managed as outpatients. Specific paediatric criteria for admission are not available. <span>Hospitalization is generally indicated if a child has inadequate oral intake, is intolerant of oral therapy, has severe illness or respiratory compromise (eg, grunting, nasal flaring, apnea, hypoxemia), or if the pneumonia is complicated. There should be a lower threshold for admitting infants younger than six months of age to hospital because they may need more supportive care and monitoring, and it can be difficult to




#ir #peds
If influenza is detected or suspected, strong consideration should be given to prompt treatment with neuraminidase inhibitors (oseltamivir, zanamivir). Treatment with antivirals has been shown to provide benefit and may prevent secondary bacterial infections, particularly in hospitalized or moderately to severely ill children.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
r threshold for admitting infants younger than six months of age to hospital because they may need more supportive care and monitoring, and it can be difficult to recognize subtle deterioration clinically. Management <span>If influenza is detected or suspected, strong consideration should be given to prompt treatment with neuraminidase inhibitors (oseltamivir, zanamivir). Treatment with antivirals has been shown to provide benefit and may prevent secondary bacterial infections, particularly in hospitalized or moderately to severely ill children.[12]-[14] When other viruses are detected in a nasopharyngeal sample and/or the chest radiograph is most compatible with viral pneumonia (ie, without consolidations), manage with support




#ir #peds
When other viruses are detected in a nasopharyngeal sample and/or the chest radiograph is most compatible with viral pneumonia (ie, without consolidations), manage with supportive care (ie, oxygen and rehydration if required) without antibiotics, unless there is convincing evidence of a secondary bacterial pneumonia
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
with neuraminidase inhibitors (oseltamivir, zanamivir). Treatment with antivirals has been shown to provide benefit and may prevent secondary bacterial infections, particularly in hospitalized or moderately to severely ill children.[12]-[14] <span>When other viruses are detected in a nasopharyngeal sample and/or the chest radiograph is most compatible with viral pneumonia (ie, without consolidations), manage with supportive care (ie, oxygen and rehydration if required) without antibiotics, unless there is convincing evidence of a secondary bacterial pneumonia. The primary goal of antimicrobial therapy, for the vast majority of uncomplicated community-acquired pneumonias, is to provide good coverage for S pneumoniae, because mole




#ir #peds
The primary goal of antimicrobial therapy, for the vast majority of uncomplicated community-acquired pneumonias, is to provide good coverage for S pneumoniae, because molecular-based techniques have shown this to be the predominant bacterial pathogen
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
most compatible with viral pneumonia (ie, without consolidations), manage with supportive care (ie, oxygen and rehydration if required) without antibiotics, unless there is convincing evidence of a secondary bacterial pneumonia. <span>The primary goal of antimicrobial therapy, for the vast majority of uncomplicated community-acquired pneumonias, is to provide good coverage for S pneumoniae, because molecular-based techniques have shown this to be the predominant bacterial pathogen.[15]-[17] Therefore, outpatients with lobar or broncho-pneumonia should usually be treated with oral amoxicillin. Patients who require hospitalization but do not have a life-threatening




#ir #peds
Therefore, outpatients with lobar or broncho-pneumonia should usually be treated with oral amoxicillin
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
f antimicrobial therapy, for the vast majority of uncomplicated community-acquired pneumonias, is to provide good coverage for S pneumoniae, because molecular-based techniques have shown this to be the predominant bacterial pathogen.[15]-[17] <span>Therefore, outpatients with lobar or broncho-pneumonia should usually be treated with oral amoxicillin. Patients who require hospitalization but do not have a life-threatening illness should usually be started empirically on intravenous ampicillin. There is recent data demonstrating that




#ir #peds
Patients who require hospitalization but do not have a life-threatening illness should usually be started empirically on intravenous ampicillin. There is recent data demonstrating that ampicillin alone leads to a good clinical outcome in almost all cases of community-acquired pneumonia, including cases that require hospitalization
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
vide good coverage for S pneumoniae, because molecular-based techniques have shown this to be the predominant bacterial pathogen.[15]-[17] Therefore, outpatients with lobar or broncho-pneumonia should usually be treated with oral amoxicillin. <span>Patients who require hospitalization but do not have a life-threatening illness should usually be started empirically on intravenous ampicillin. There is recent data demonstrating that ampicillin alone leads to a good clinical outcome in almost all cases of community-acquired pneumonia, including cases that require hospitalization.[18]-[20] Children who experience respiratory failure or septic shock associated with pneumonia should receive empiric therapy with a third-generation cephalosporin because




#ir #peds
Children who experience respiratory failure or septic shock associated with pneumonia should receive empiric therapy with a third-generation cephalosporin because it offers broader coverage. Ceftriaxone or cefotaxime offer better coverage than amoxicillin or ampicillin for beta-lactamase-producing H influenzae and may be more efficacious against high-level penicillin-resistant pneumococcus – and possibly provide empirical coverage for the rare methicillin-susceptible S aureus (a rare cause of pneumonia).
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
ally on intravenous ampicillin. There is recent data demonstrating that ampicillin alone leads to a good clinical outcome in almost all cases of community-acquired pneumonia, including cases that require hospitalization.[18]-[20] <span>Children who experience respiratory failure or septic shock associated with pneumonia should receive empiric therapy with a third-generation cephalosporin because it offers broader coverage. Ceftriaxone or cefotaxime offer better coverage than amoxicillin or ampicillin for beta-lactamase-producing H influenzae and may be more efficacious against high-level penicillin-resistant pneumococcus – and possibly provide empirical coverage for the rare methicillin-susceptible S aureus (a rare cause of pneumonia).[21] However, when there is rapidly progressing multilobar disease or pneumatoceles, the addition of vancomycin is suggested empirically to provide extra coverage for MRSA until culture




#ir #peds
However, when there is rapidly progressing multilobar disease or pneumatoceles, the addition of vancomycin is suggested empirically to provide extra coverage for MRSA until culture results are available. If results of microbiological investigations in these patients do not reveal a pathogen, transitioning to ampicillin with subsequent oral amoxicillin is reasonable
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
or beta-lactamase-producing H influenzae and may be more efficacious against high-level penicillin-resistant pneumococcus – and possibly provide empirical coverage for the rare methicillin-susceptible S aureus (a rare cause of pneumonia).[21] <span>However, when there is rapidly progressing multilobar disease or pneumatoceles, the addition of vancomycin is suggested empirically to provide extra coverage for MRSA until culture results are available. If results of microbiological investigations in these patients do not reveal a pathogen, transitioning to ampicillin with subsequent oral amoxicillin is reasonable. The antimicrobial management of patients with suspected empyema is similar to that of patients without empyema because there is a predominance of S pneumoniae being the et




#ir #peds
continue here
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

Uncomplicated Pneumonia
or penicillin is recommended, followed by oral therapy with amoxicillin. If another pathogen is detected in pleural fluid or blood, modifications to the antimicrobial regimen should be made based on antimicrobial susceptibility. T<span>he role of antimicrobials in treating both M pneumoniae and C pneumoniae is unknown because most children resolve infection without macrolides. However, treatment may be appropriate to hasten recovery in chil




Article 1476203515148

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
#cfa-level-1 #reading-23-financial-reporting-mechanics

The main section of this reading presented a basic accounting system represented as a spreadsheet. An alternative system that underlies most manual and electronic accounting systems uses debits and credits. Both a spreadsheet and a debit/credit system are based on the basic accounting equation: Assets = Liabilities + Owners’ equity Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided the use of negative numbers (which could lead to errors in recording). The system can be illustrated with T-accounts for every account involved in recording transactions. The T-account is so named for its shape: T-Account Debit Credit The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.” The names should not be construed as denoting value. A debit is not better than a credit and vice versa. Debit simply means the left side of the T-account, and credit simply means t



#cfa-level-1 #reading-23-financial-reporting-mechanics
An alternative system that underlies most manual and electronic accounting systems uses debits and credits.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
The main section of this reading presented a basic accounting system represented as a spreadsheet. An alternative system that underlies most manual and electronic accounting systems uses debits and credits. Both a spreadsheet and a debit/credit system are based on the basic accounting equation: Assets = Liabilities + Owners’ equity Early generations of accountants




Flashcard 1476205874444

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
An alternative system that underlies most manual and electronic accounting systems uses [...]
Answer
debits and credits.

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
An alternative system that underlies most manual and electronic accounting systems uses debits and credits.

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
The main section of this reading presented a basic accounting system represented as a spreadsheet. An alternative system that underlies most manual and electronic accounting systems uses debits and credits. Both a spreadsheet and a debit/credit system are based on the basic accounting equation: Assets = Liabilities + Owners’ equity Early generations of accountants







Flashcard 1476207447308

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Are debits / credit system and spreadsheet based on what equation?
Answer

Assets = Liabilities + Owners’ equity


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill
APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
ad> The main section of this reading presented a basic accounting system represented as a spreadsheet. An alternative system that underlies most manual and electronic accounting systems uses debits and credits. Both a spreadsheet and a debit/credit system are based on the basic accounting equation: Assets = Liabilities + Owners’ equity Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided the use of negative numbers







#cfa-level-1 #reading-23-financial-reporting-mechanics
Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided the use of negative numbers (which could lead to errors in recording).
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
tem that underlies most manual and electronic accounting systems uses debits and credits. Both a spreadsheet and a debit/credit system are based on the basic accounting equation: Assets = Liabilities + Owners’ equity <span>Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided the use of negative numbers (which could lead to errors in recording). The system can be illustrated with T-accounts for every account involved in recording transactions. The T-account is so named for its shape: T-Account Debit Credit &#




Flashcard 1476210855180

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided [...]
Answer
the use of negative numbers (which could lead to errors in recording).

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided the use of negative numbers (which could lead to errors in recording).

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
tem that underlies most manual and electronic accounting systems uses debits and credits. Both a spreadsheet and a debit/credit system are based on the basic accounting equation: Assets = Liabilities + Owners’ equity <span>Early generations of accountants desired a system for recording transactions that maintained the balance of the accounting equation and avoided the use of negative numbers (which could lead to errors in recording). The system can be illustrated with T-accounts for every account involved in recording transactions. The T-account is so named for its shape: T-Account Debit Credit &#







#cfa-level-1 #reading-23-financial-reporting-mechanics
The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.”
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
e numbers (which could lead to errors in recording). The system can be illustrated with T-accounts for every account involved in recording transactions. The T-account is so named for its shape: T-Account Debit Credit <span>The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.” The names should not be construed as denoting value. A debit is not better than a credit and vice versa. Debit simply means the left side of the T-account, and credit simply means the r




Flashcard 1476213476620

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
The left-hand side of the T-account is called a “[...],” and the right-hand side is termed a “ [...].”
Answer
debit

credit

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.”

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
e numbers (which could lead to errors in recording). The system can be illustrated with T-accounts for every account involved in recording transactions. The T-account is so named for its shape: T-Account Debit Credit <span>The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.” The names should not be construed as denoting value. A debit is not better than a credit and vice versa. Debit simply means the left side of the T-account, and credit simply means the r







#cfa-level-1 #reading-23-financial-reporting-mechanics
A debit is not better than a credit and vice versa. Debit simply means the left side of the T-account, and credit simply means the right side.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
T-account is so named for its shape: T-Account Debit Credit The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.” The names should not be construed as denoting value. <span>A debit is not better than a credit and vice versa. Debit simply means the left side of the T-account, and credit simply means the right side. Traditionally, debit is abbreviated as “DR,” whereas credit is abbreviated “CR.” The T-account is also related to the balance sheet and accounting equation as follows: Bala




Flashcard 1476217408780

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Which is better a debit or a credit?
Answer
A debit is not better than a credit and vice versa.

Debit simply means the left side of the T-account, and credit simply means the right side

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill
APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
T-account is so named for its shape: T-Account Debit Credit The left-hand side of the T-account is called a “debit,” and the right-hand side is termed a “credit.” The names should not be construed as denoting value. <span>A debit is not better than a credit and vice versa. Debit simply means the left side of the T-account, and credit simply means the right side. Traditionally, debit is abbreviated as “DR,” whereas credit is abbreviated “CR.” The T-account is also related to the balance sheet and accounting equation as follows: Bal







#cfa-level-1 #reading-23-financial-reporting-mechanics
Assets are referred to as the left side of the T-account. Assets are, therefore, recorded with a debit balance
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
raditionally, debit is abbreviated as “DR,” whereas credit is abbreviated “CR.” The T-account is also related to the balance sheet and accounting equation as follows: Balance Sheet Assets Liabilities Owners’ Equity <span>Assets are referred to as the left side of the balance sheet (and accounting equation) and hence are on the left side of the T-account. Assets are, therefore, recorded with a debit balance. In other words, to record an increase in an asset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabiliti




Flashcard 1476221603084

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Assets are referred to as the left side of the T-account. Assets are, therefore, recorded with a [...] balance
Answer
debit

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Assets are referred to as the left side of the T-account. Assets are, therefore, recorded with a debit balance

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
raditionally, debit is abbreviated as “DR,” whereas credit is abbreviated “CR.” The T-account is also related to the balance sheet and accounting equation as follows: Balance Sheet Assets Liabilities Owners’ Equity <span>Assets are referred to as the left side of the balance sheet (and accounting equation) and hence are on the left side of the T-account. Assets are, therefore, recorded with a debit balance. In other words, to record an increase in an asset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabiliti







#cfa-level-1 #reading-23-financial-reporting-mechanics
to record an increase in an asset, an entry is made to the left-hand side of a T-account.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
lities Owners’ Equity Assets are referred to as the left side of the balance sheet (and accounting equation) and hence are on the left side of the T-account. Assets are, therefore, recorded with a debit balance. In other words, <span>to record an increase in an asset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). Inc




Flashcard 1476224224524

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
to record an increase in an asset, an entry is made to the [...] side of a T-account.
Answer
left-hand

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
to record an increase in an asset, an entry is made to the left-hand side of a T-account.

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
lities Owners’ Equity Assets are referred to as the left side of the balance sheet (and accounting equation) and hence are on the left side of the T-account. Assets are, therefore, recorded with a debit balance. In other words, <span>to record an increase in an asset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). Inc







#cfa-level-1 #reading-23-financial-reporting-mechanics
A decrease to an asset is recorded on the right side of a T-account.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
e sheet (and accounting equation) and hence are on the left side of the T-account. Assets are, therefore, recorded with a debit balance. In other words, to record an increase in an asset, an entry is made to the left-hand side of a T-account. <span>A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right si




Flashcard 1476226845964

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
[...] to an asset is recorded on the right side of a T-account.
Answer
A decrease

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
A decrease to an asset is recorded on the right side of a T-account.

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
e sheet (and accounting equation) and hence are on the left side of the T-account. Assets are, therefore, recorded with a debit balance. In other words, to record an increase in an asset, an entry is made to the left-hand side of a T-account. <span>A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right si







#cfa-level-1 #reading-23-financial-reporting-mechanics
Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
he T-account. Assets are, therefore, recorded with a debit balance. In other words, to record an increase in an asset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. <span>Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. At an




Flashcard 1476231040268

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
[...] are referred to as the right side of the balance sheet (and accounting equation)
Answer
Liabilities and owners’ equity

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation)

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
he T-account. Assets are, therefore, recorded with a debit balance. In other words, to record an increase in an asset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. <span>Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. At an







#cfa-level-1 #reading-23-financial-reporting-mechanics
Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
sset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). <span>Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the a




Flashcard 1476233661708

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
[...] to liabilities and owners’ equity are recorded on the right side of a T-account.
Answer
Increases

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side.

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
sset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). <span>Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the a







#cfa-level-1 #reading-23-financial-reporting-mechanics

At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance.

statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. <span>At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. A T-account is created for each asset account, liability account, and owners’ equity account. The collection of these T-accounts at the beginning of the year for a fictitio




Flashcard 1476237069580

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
Decreases to liabilities and owners’ equity are recorded on the [...] side.
Answer
left side

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side.

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
sset, an entry is made to the left-hand side of a T-account. A decrease to an asset is recorded on the right side of a T-account. Liabilities and owners’ equity are referred to as the right side of the balance sheet (and accounting equation). <span>Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the a







Flashcard 1476239428876

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question

At any point in time, the balance in a T account is determined by [...] , [...] , and [...].

Answer
Adding the amounts on the left side
Adding the amounts on the right side


calculating the difference

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a debit balance equal to the difference. If t

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. <span>At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. A T-account is created for each asset account, liability account, and owners’ equity account. The collection of these T-accounts at the beginning of the year for a fictitio







Flashcard 1476241788172

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question

If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a [...].

Answer
debit balance equal to the difference

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
he account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a <span>debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. <span><

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. <span>At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. A T-account is created for each asset account, liability account, and owners’ equity account. The collection of these T-accounts at the beginning of the year for a fictitio







Flashcard 1476244147468

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question

If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a [...]

Answer
credit balance.

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
of amounts on the right side of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a <span>credit balance. <span><body><html>

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
the right side of the balance sheet (and accounting equation). Increases to liabilities and owners’ equity are recorded on the right side of a T-account; decreases to liabilities and owners’ equity are recorded on the left side. <span>At any point in time, the balance in an account is determined by summing all the amounts on the left side of the account, summing all the amounts on the right side of the account, and calculating the difference. If the sum of amounts on the left side of the account is greater than the sum of amounts on the right side of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. A T-account is created for each asset account, liability account, and owners’ equity account. The collection of these T-accounts at the beginning of the year for a fictitio







#cfa-level-1 #reading-23-financial-reporting-mechanics
A T-account is created for each asset account, liability account, and owners’ equity account.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. <span>A T-account is created for each asset account, liability account, and owners’ equity account. The collection of these T-accounts at the beginning of the year for a fictitious company, Investment Advisers, Ltd. (IAL), is presented in Exhibit 1. Each balance sheet T-account is ter




Flashcard 1476247555340

Tags
#cfa-level-1 #reading-23-financial-reporting-mechanics
Question
A T-account is created for each [.3.] account.
Answer
asset account, liability account, and owners’ equity

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
A T-account is created for each asset account, liability account, and owners’ equity account.

Original toplevel document

APPENDIX 23: A DEBIT/CREDIT ACCOUNTING SYSTEM
of the account, the account has a debit balance equal to the difference. If the sum of amounts on the right side of the account is greater than the sum of amounts on the left side of the account, the account has a credit balance. <span>A T-account is created for each asset account, liability account, and owners’ equity account. The collection of these T-accounts at the beginning of the year for a fictitious company, Investment Advisers, Ltd. (IAL), is presented in Exhibit 1. Each balance sheet T-account is ter