PPS COMPILED SAMPLEX [PART 2 OF 5] - 652 items total with Rationale Flashcards

Question

"This is the effortless regurgitation of food, with no nausea and retching. a) Rumination b) Regurgitation c) Retching d) Restitution"

Answer 1

B "Nelson 21st p1904-1905 Regurgitation is the effortless movement of stomach contents into the esophagus and mouth. It is not associated with distress, and infants with regurgitation are often hungry immediately after an episode. Regurgitation is a result of gastroesophageal reflux through an incompetent, or, in infants, immature lower esophageal sphincter. This is often a developmental process, and regurgitation, or ""spitting"" resolves with maturity. Regurgitation should be differentiated from vomiting, which denotes an active reflex process with an extensive differential diagnosis. "

Answer 2

D "cultural sensitive - personal social intelligence - language combine motor and sensory - self help/adaptive"

Answer 3

A "Nelson 21st p1959 Encopresis is defined as voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4yr has been reached. Encopresis is not diagnosed when the behavior is exclusively the result of direct effects of a substance (e.g. laxatives) or a general medical condition (except through a mechanism involving constipation). "

Answer 4

D """Nelson 21st p134 Between 3 and 4 mo of age, the rate of growth slow to approximately 20g/day. By age 4mo, birthweight has doubled. Nelson 21st p133 Table 22.2 Emerging patterns of behavior during the first year of life 3mo Prone: Lifts head and chest with arms extended, head below the plane of body on ventral suspension Supine: Tonic head posture predominates, reaches forward and misses objects; waves at toy Sitting: Head lag partially compensated when pulled to a sitting position, early head control with bobbing motion, back rounded Reflex: Typical moro reponse has not persistence, makes defensive movements or selective withdrawal reactions 4mo Prone: Lifts head and chest, with head in approximately vertical axis, legs extended Supine: Symmetric posture predominates, hands at midline, reaches and grasps objects and brings them to mouth Sitting: No head lag when pulled to sitting position, head stedy, tipped forward, enjoys sitting with full truncal support Standing: When held erect, pushes with feet Adaptive: Sees raisin, but makes no more to reach for it Social: Laughs out loud, may show displeasure when social contact is broken, excited at sight of food 7mo Prone: Rolls over, pivots, crawls or creep-crawls Supine: Lifts head, rolls over, squirms Sitting: Sits briefly, with support of pelvis, leans forward on hands, back rounded Standing: May support most of weight, bounces actively Adaptive: Reaches out for and grasps large object, transfers object from hand to hand, grasp uses radial palm, rakes at raisin Language: Forms polysyllabic vowel sounds Social: Prefers mother, babbles, enjoys mirror, responds sto changes in emotional content of social contact """

Answer 5

A "Nelson 21st p265 Once the diagnosis of ADHD has been established, the parents and child should be educated with regard to the ways ADHD can affect learning, behavior, self-esteem, social skills, and family function. The clinician should set goals for the family to help improve the child's interpersonal relationships, develop study skills, and decreased disruptive behaviors. Parent support groups with appropriate professional consultation to such groups can be very helpful. "

Answer 6

D "Nelson 21st p130 Soon after birth, neonates are alert and ready to interact and nurse. Neonates are nearsighted, having a fixed focal length of 8-12 inches, approximately the distance from the breast to the mother's face, as well as an inborn visual preference for faces. Hearing is well-developed, and infants preferentially turn toward a female voice. "

Answer 7

C "Nelson 21st p130 Soon after birth, neonates are alert and ready to interact and nurse. Neonates are nearsighted, having a fixed focal length of 8-12 inches, approximately the distance from the breast to the mother's face, as well as an inborn visual preference for faces. Hearing is well-developed, and infants preferentially turn toward a female voice. "

Answer 8

B "Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age 24 months / 2 years Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures 30 months Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure Language: Refers to self by pronoun ""I"", knowns full name Social: Helps put things away, pretends in play 36 months / 3 years Motor: Rides tricycle, stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes, imitates construction of ""bridge"" of 3 cubes, copies circle, imitates cross Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands 48 months / 4 years Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well Adaptive: Copies bridge from model, imitates construction of ""gate"" of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines Language: Counts 4 pennies accurately, tells story Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone 60 months / 5 years Motor: Skips Adaptive: Draws triangle from copy, names heavier of 2 weights Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying "

Answer 9

C "Nelson 21st p872 The estimated rate of heat loss in a newborn is approximately 4 times that of an adult. Under normal delivery room conditions (20-25C), these rates generally result in a cumulative loss of 2-3C in deep body temperature (corresponding to a heat loss of approximately 200kcal/kg). The heat loss occurs by 4 mechanisms 1. Convection of heat energy to the cooler surrounding air 2. Conduction of heat to the colder materials touching the infant 3. Heat radiation from the infant to nearby cooler objects 4. Evaporation from skin and lungs"

Answer 10

C """Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age 24 months / 2 years Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures 30 months Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure Language: Refers to self by pronoun """"I"""", knowns full name Social: Helps put things away, pretends in play 36 months / 3 years Motor: Rides tricycle, stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes, imitates construction of """"bridge"""" of 3 cubes, copies circle, imitates cross Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands 48 months / 4 years Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well Adaptive: Copies bridge from model, imitates construction of """"gate"""" of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines Language: Counts 4 pennies accurately, tells story Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone 60 months / 5 years Motor: Skips Adaptive: Draws triangle from copy, names heavier of 2 weights Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying """

Answer 11

C "Prev Ped 2018 p26 Breastmilk storage period 1. Room temperature (<25C) - 4 hours 2. Room temperature (>25C) - 1 hour 3. Referigerator (4C) - 8 days 4. Freezer compartment of a 1 door refrigerator - 2 weeks 5. Freezer compartment of a 2 door refrigerator - 3 months 6. Deep freezer with a constant temperature -20C - 6 months"

Answer 12

D "Prev Ped 2016 p33 Figure 3. Z score interpretation Length/Height for age - Below -2: Stunted - Below -3: Severely stunted Weight for age - Below -2: Underweight - Below -3: Severely underweight Weight for length/height - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted BMI for age - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted"

Answer 13

C "Nelson 21st p1017 Both structrual and functional brain development continue throughout adolescence. Cortical gray matter volume peaks in preadolescence then decreases because of selective pruning of rarely used synaptic connections. Cortical white matter volume increases until mid-late adolescence, reflecting increasing myelination and subsequent facilitation of integrated brain activity and more efficient transmission of information between different regions of the brain, enhancing the ""signal-to-noise"" ratio. "

Answer 14

D """Nelson 21st p1017 Both structrual and functional brain development continue throughout adolescence. Cortical gray matter volume peaks in preadolescence then decreases because of selective pruning of rarely used synaptic connections. Cortical white matter volume increases until mid-late adolescence, reflecting increasing myelination and subsequent facilitation of integrated brain activity and more efficient transmission of information between different regions of the brain, enhancing the """"signal-to-noise"""" ratio. """

Answer 15

B "Nelson 21st p1015 Table 132.1 Milestones in early, middle, and late adolescents Physical Early adolescents - Females: secondary sex characteristics (breast, pubic, axillary hair), start of growth spurt - Males: testicular enlargement, start of genital growth Middle adolescents - Females: peak growth velocity, menarche - Males: growth spurt, secondary sex characteristics, nocturnal emissions, facial and body hair, voice changes - Changes in body composition, acne Late adolescents - Physical maturation slows - Increased lean muscle mass in males Peers Early adolescents - same sex peer affiliations Middle adolescents - Intense peer group involvement, preoccupation with peer culture, conformity Late adolescents - peer group and values recede in importance "

Answer 16

C "Nelson 21st p133 Table 22.2 Emerging patterns of behavior during the first year of life 7mo Prone: Rolls over, pivots, crawls or creep-crawls Supine: Lifts head, rolls over, squirms Sitting: Sits briefly, with support of pelvis, leans forward on hands, back rounded Standing: May support most of weight, bounces actively Adaptive: Reaches out for and grasps large object, transfers object from hand to hand, grasp uses radial palm, rakes at raisin Language: Forms polysyllabic vowel sounds Social: Prefers mother, babbles, enjoys mirror, responds sto changes in emotional content of social contact 10mo Sitting: Sits up alone and indefinitly without support Standing: Pulls to sttanding position, cruises or walks holding on to furniture Motor: Creeps or crawls Adaptive: Graps objects with thumb and forefinger, pokes at things with forefinger, picks up pellet with assisted pincer movement, uncovers hidden toy, attempts to retrieve dropped object, releases object grasped by another person Language: Repetitive consonant sounds (mama, dada) Social: Responds to the sound of name, plays peek-a-boo or pat-a-cake, waves bye bye 1 yr Motor: Walks with one hand held, rises independently, takes several steps Adaptive: Picks up rasin with unassisted pincer movement of forefinger and thumb, releases object to other person on request or gesture Language: Says a few words besides mama and dada Social: Plays simple ball game, makes postural adjustment to dressing"

Answer 17

B """""""Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age 24 months / 2 years Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures 30 months Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure Language: Refers to self by pronoun """"""""I"""""""", knowns full name Social: Helps put things away, pretends in play 36 months / 3 years Motor: Rides tricycle, stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes, imitates construction of """"""""bridge"""""""" of 3 cubes, copies circle, imitates cross Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands 48 months / 4 years Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well Adaptive: Copies bridge from model, imitates construction of """"""""gate"""""""" of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines Language: Counts 4 pennies accurately, tells story Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone 60 months / 5 years Motor: Skips Adaptive: Draws triangle from copy, names heavier of 2 weights Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying """""""

Answer 18

A "Fundamentals of Pediatrics vol 1 p273-274 Table 14-2 Benefits of breastfeeding for the mother and the family 1. Breastfeeding improves postpartum health - prevents prolonged bleeding from placental stimulation, prevents further anemia 2. Breastfeeding hastens postpartum weight loss - larger reductions in weight and hip circumference in mothers who breastfeed compared to those who bottle feed 3. Breastfeeding helps optimum child spacing - lactation amenorrhea 4. Breastfeeding is affordable and convenient 5. Breastfeeding prevents mothers from developing cancer - women who breastfeed have lower risks for breast and ovarian cancer 6. Breastfeeing protects against bone and rheumatologic problems - protective against osteoporosis and rheumatoid arthritis "

Answer 19

C "Nelson 21st p2828 The congenital undescended testis should be treated surgically by 9-15 mo of age. With anesthesia by a pediatric anesthesiologist, surgical correction at 6 mo is appropriate, because spontaneous descent of the testis will not occur after 4 mo of age. Most testes can be brought down to the scrotum with an orchiopexy, which involves an inguinal incision, mobilization of the testis and spermatic cord, and correction of an indirect inguinal hernia."

Answer 20

C "Nelson 21st p1014 In males the first visible sign of puberty and the hallmark of SMR 2 is testicular enlargement, beginning as early as 9.5yr, followed by the development of pubic hair. This is followed by penile growth during SMR 3. Peak growth occurs when testes volumes reach approximately 9-10cm3 during SMR 4. In females, typically the first visible sign of puberty and the hallmark of SMR 2 is the appearance of breast buds (thelarche) between 7 and 12 yr of age. A significant minority of females develops pubic hair (pubarche) prior to thelarche. Menses typically begin within 3 yr of thelarche during SMR 3-4 (average age 12.5yr, normal range 9-15yr). Females attain a peak height velocity of 8-9cm/yr at SMR 2-3, approximately 6mo before menarche. Males typically begin their growth acceleration at a later SMR stage, achieve a peak height velocity of 9-10cm later in the course of puberty (SMR 3-4), and continue their linear growth for approximately 2-3yr after females have stopped growing. "

Answer 21

Parents should not use food as a reward .... increase physical activity with children, parents should be involved "Nelson 21st p357 Table 60.8 Proposed suggestions for preventing obesity Family - Eat meals aas a family in a fixed place and time - Do not skip meals, especially breakfast - Do not allow television during meals - Use small plates, keep serving dishes away from the table - Avoid unnecessary sweet or fatty foods and sugar-sweetened drinks - Remove televisions from children's bedrooms, restrict times for TV viewing and video games - Do not use food as a reward"

Answer 22

B "Nelson 21st p283 Intellectual disability refers to a group of disorders that all include significant impairment in general intellectual function (reasoning, learning, problem solving), social skills, and adaptive behavior. Consistent among these definitions is onset of symptoms before age 18yr or adulthood Significant impairment in general intellectual function refers to performance on an individually administered test of intelligence that is approximately 2 SD below the mean. Intelligence quotient (IQ) scores <70 would meet these criteria. Significant impairment in adaptive behavior reflects the degree that the cognitive dysfunction impairs daily function. Adaptive behavior refers to the skills required for people to function in their everyday lives, addressing three broad sets of skills: conceptual, social, and practical. "

Answer 23

>50% are achievers "Nelson 21st p262 ADHD is the most common neurobehavioral disorder of childhood and among the most prevalent chronic health conditions affecting school-aged children. ADHD is characterized by inattention, including increased distractability and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capability; and motor overactivity and motor restlessness. Affected children usually experience academic underachievement, problems with interpersonal relationships with family members and peers, and low self-esteem. "

Answer 24

A "Nelson 21st p281-282 Developmental stuttering is a childhood speech disorder that is not associated with stroke, traumatic brain injury, or other possible medical conditions and that interrupts the normal flow of speech through repeated or prolonged sounds, syllables, or single syllable words. DSM-5 refers to this disorder as childhood onset fluency disorder, and impact on functional behavior is a component of the psychiatric diagnosis of this condition. If there is a positive family history for stuttering, if symptoms are present for >4wk, and if the dysfluencies are impacting a child's social, behavioral, and emotional functioning, referral is warranted. Although there is no cure for stuttering, behavioral therapies are available that are developed and implemented by speech and language pathologists. Treatment in preschool age-children has been shown to improve stuttering. For school-age children, treatment includes not only improving fluency but also concommittants of the condition. This includes recognizing and accepting stuttering and appreciating others' reaction to the child when stuttering, managing secondary behaviors, and addressing avoidance behaviors. "

Answer 25

C "Prev Ped 2016 p33 Figure 3. Z score interpretation Length/Height for age - Below -2: Stunted - Below -3: Severely stunted Weight for age - Below -2: Underweight - Below -3: Severely underweight Weight for length/height - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted BMI for age - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted"

Answer 26

A "Nelson 21st p267 The term dyslexia means an unexpected difficulty in reading for an individual who has the intelligence to be a much better reader, most commonly caused by a difficulty in the phonological processing (the appreciation of individual sounds of spoken language), which affects the ability of an individual to speak, read, and spell. "

Answer 27

A "Nelson 21st p143 Handedness is usually established by the 3rd yr. Fustration may result from attempts to change childrens's hand preference. Variations in fine motor development reflect both individual proclivities and different opportunities for learning. Children who are restricted from drawing with crayons, for example, develop a mature pencil grasp later. "

Answer 28

A "Nelson 21st p145 Control is a central issue. They are also prone to lose internal control, that is, to have temper tantrums. Fear, overtiredness, hunger, inconsistent expectations, or physical discomfort can also evoke tantrums. Tantrums normally appear toward the end of the 1st year of life and peak in prevalence between 2 and 4yr of age. Tantrums lasting more than 15min or regularly occuring more than 3x/day may reflect underlying medical, emotional, developmental, or social problems Nelson 21st p241 The first key to office management of temper tantrums and breath holding spells is to help parents intervene before the child is highly distressed. The parent can be instructed to calmly remind the child of the expected behavior and the potential consequence if the expected behavior does not occur. If the child does not comply, he or she should be placed in time-out for a period approximating 1min for each year of age. Time out can be effectively used in children up to age 10 yr. Parents should also be advised to be mindful of their own reactions to the child's tantrum behavior, to avoid an escalation of the child's behavior caused by an angry parental response. "

Answer 29

C "Nelson 21st p136 Colic is characterized by the rule of 3. It occurs in a healthy, thriving infant beginning in the 2nd or 3rd week of life, lasts about 3 hr/day, occurs 3 days/wk, lasts more than 3wk, and resolved by 3 or 4 mo of age. There is no specific treatment for colic, but practitioners should provide advice and reassurance to parents. Parents must be counseled about the problem, the importance of implementing a series of calm, systematic steps to soothe the infant, and having a plan for stress relief, such as time-out for parents and substitute caregivers. Parents can be advised that colic is self-limited and has no adverse effects on the child. The cause of colic is not known, and no medical intervention has been consistently effeective. "

Answer 30

D "Answer should be all of the above Nelson p1060 Table 142.4 Laboratory tests to evaluate patients with abnormal uterine bleeding - Total and free testosterone (if with s/sx suggestive of PCOS) - Liver, kidney, and thyroid function studies - Complete blood count with platelet count - Urine pregnancy test - NAAT for Chlamydia, Gonorrhea, Trichomonas - PT/PTT - Ferritin level - VWB factor antigen, ristocetin cofactor, factor VIII activity - Pelvic UTZ (if bleeding persists despite treatment) "

Answer 31

B "Prev Ped 2018 p19 Gross motor red flags 4 1/2 months - does not pull up to sit 5 months - does not roll over 7-8 months - does not sit without support 9-10 months - does not stand while holding on 15 months - not walking 2 years - not climbing up or down the stairs 2 1/2 years - not jumping with both feet 3 years - unable to stand on 1 foot momentarily 4 years - not hopping 5 years - unable to walk in a straight line back and forth or balance on 1 foot for 5-10 seconds "

Answer 32

A "Nelson 21st p106 Prevention of child abuse and neglect 1. Parent and child education regarding medical conditions helps to ensure the implementation of a the treatment plan and prevent neglect 2. Screening for major psychosocial risk factors for maltreatment (depression, substance abuse, intimate partner violence, major stress) and helping address identified problems, often through referrals, may help prevent maltreatment. 3. Child healthcare professionals should also need to recognize their limitations and facilitate referrals to other community resources. 4. The problems underpinning child maltreatment, such as poverty, parental stress, substance abuse, and limited child-rearing resources, require policies and programs that enhance families' abilities to care for their children adequately"

Answer 33

Weight of 5400g, length of 58cm, head circumference of 42cm. "Fundamentals of pediatrics p122 Table 8-1 Useful mnemonic for common growth standards Weight 0-6 months: age in months x 600 + birth weight (g) 6-12 months: 3600 + (age in months after 6 months x 500) + birth weight (g) 1-6 years: age in years x 2 + 8 (kg) 7-12 years: 1/2 [(age in years x 7) - 5)] (in kg) Length 0-3 months: birth length + 9cm 4-6 months: birth length + 9cm + 8cm 7-9 months: birth length + 9cm + 8cm + 5cm 10-12 months: birth length + 9cm +8cm + 5cm + 3cm Length/height 2-12 years: age in years x 6 + 77 (cm) Mid-parental height All ages, boys: 1/2 [(paternal + maternal height) + 13] (in cm) All ages, girls: 1/2 [(paternal + maternal height) - 13)] (in cm) "

Answer 34

B "Prev Ped 2016 p33 Figure 3. Z score interpretation Length/Height for age - Below -2: Stunted - Below -3: Severely stunted Weight for age - Below -2: Underweight - Below -3: Severely underweight Weight for length/height - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted BMI for age - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted"

Answer 35

A "Nelson 21st p143 Visual acuity reaches 20/30 by age 3yr and 20/20 by age 4yr. "

Answer 36

B "Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age 24 months / 2 years Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures 30 months Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure Language: Refers to self by pronoun ""I"", knowns full name Social: Helps put things away, pretends in play 36 months / 3 years Motor: Rides tricycle, stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes, imitates construction of ""bridge"" of 3 cubes, copies circle, imitates cross Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands 48 months / 4 years Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well Adaptive: Copies bridge from model, imitates construction of ""gate"" of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines Language: Counts 4 pennies accurately, tells story Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone 60 months / 5 years Motor: Skips Adaptive: Draws triangle from copy, names heavier of 2 weights Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying "

Answer 37

B "Nelson 21st p1018 Early adolescents have increased sexual awareness and interest, which may manifest as sexual talk and gossip, and often is focused on sexual activity. Masturbation and other sexual exploration, sometimes with same-sex peers, are common. "

Answer 38

C "Nelson 21st p120 Table 18.2 Classic developmental stage theories Freud - psychosexual Erikson - psychosocial Piaget - cognitive Kohlberg - moral Infancy (0-1yr) - Freud: oral - Erikson: basic trust vs mistrust - Piaget: sensorimotor Toddlerhood (2-3yr) - Freud: anal - Erikson: autonomy vs shame and doubt - Piaget: sensorimotor - Kohlberg: preconventional - avoid punishment/obtain reward Preschool (3-6yr) - Freud: phallic/oepedal - Erikson: initiative vs guilt - Piaget: operational - Kohlberg: conventional - conformity School age (6-12yr) - Freud: latency - Erikson: industry vs inferiority - Piaget: concrete operations - Kohlberg: conventional - law and order Adolescence (12-20yr) - Freud: genital - Erikson: identity vs role diffusion - Piaget: formal operations - Kolbherg: postconventional - moral principles "

Answer 39

A "Nelson 21st p1015 Table 132.2 Sexual maturity rating stages in females SMR 1 - pubic hair: preadolescent - breasts: preadolescent SMR 2 - pubic hair: sparse, lightly pigmented, straight, medial border of labia - breasts: breast and papilla elevated as a small mound, diameter of areola increased SMR 3 - pubic hair: darker, beginning to curl, increased amount - breasts: breast and areola enlarged, no contour separation SMR 4 - pubic hair: coarse, curly, abundant but less than in adult - breasts: areola and papilla form secondary mound SMR 5 - pubic hair: adult feminine triangle, spread to medial surface of thighs - breasts: mature, nipple projects, areola part of general breast contour "

Answer 40

C "Nelson 21st p128 For any potential fetal insult, the extent and nature of its effects are determined by the characteristics of the host as well as the dose and timing of the exposure. Organ systems are most vulnerable during periods of maximum growth and differentiation, generally during the first trimester (organogenesis) "

Answer 41

C "(13 x 6) + 77 = 155cm Fundamentals of Pediatric vol 1 p122 Table 8-1 Useful mnemonic for common growth standards Weight 0-6 months: age in months x 600 + birth weight (g) 6-12 months: 3600 + (age in months after 6 months x 500) + birth weight (g) 1-6 years: age in years x 2 + 8 (kg) 7-12 years: 1/2 [(age in years x 7) - 5)] (in kg) Length 0-3 months: birth length + 9cm 4-6 months: birth length + 9cm + 8cm 7-9 months: birth length + 9cm + 8cm + 5cm 10-12 months: birth length + 9cm +8cm + 5cm + 3cm Length/height 2-12 years: age in years x 6 + 77 (cm) Mid-parental height All ages, boys: 1/2 [(paternal + maternal height) + 13] (in cm) All ages, girls: 1/2 [(paternal + maternal height) - 13)] (in cm) "

Answer 42

D "Nelson 21st p142 The relative independence of the previous half-year often gives way to increased clinginess at about 18mo. This stage, described as rapproachment, may be a reaction to growing awareness at the possibility of separation. Many parents report that they cannot go anywhere without having a small child attached to them. Separation anxiety will manifest at bedtime. Many children will use a special blanket or stuffed toy as a transitional object, which functions as a symbol of the absent parent. The transitional object remains important until the transition to symbolic thought has been completed and the symbolic presence of the parent fully internalized. "

Answer 43

C "Prev Ped 2018 p70 Rotavirus vaccine - Given per orem - Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should be administered not later than 32 weeks of age - The monovalent human rotavirus vaccine (RV1) is given as a 2 dose series and the pentavalent human bovine rotavirus vaccine (RV5) is given as a 3 dose series "

Answer 44

B "Philippine Labor Code (Presidential Decree No. 442 of 1974, as amended), Article 139 Article 139 governs the minimum working age and the employment of minors. The minimum working age is set at 15, except where the child works directly under the sole responsibility of their parent or guardian, and their employment does not interfere with their education. The working hours of young workers between 15 and 18 years of age are determined by the Secretary of Labor and Employment. No person younger than 18 may perform work that is hazardous or detrimental in nature. "

Answer 45

C "Nelson 21st p1920-1921 The most effective preventive measure against dental caries is communal water supplies with optimal flouride content. Dental brushing, especially with flouridated toothpaste, helps to prevent dental caries Frequent consumption of sweetened fruit drinks is not generally recognized by parents for its cariogenic potential. Consuming sweetened beverages in a nursing bottle or sippy cup should be discouraged and special efforts made to instruct parents that their child should consume sweetened beverages only at meal times and not exceed 6oz/day Plastic dental sealants have been shown to be effective at preventing caries on the pit and fissure of the primary and pernant molars. "

Answer 46

B "Nelson 21st p346 Obesity or increased adiposity is defined using the body mass index, an excellent proxy for more direct measurement of body fat. During childhood, levels of body fat change beginning with high adiposity during infancy. Body fact levels decrease for approximately 5.5 yr until the period called adiposity rebound, when body fat is typically at the lowest level. Adiposity then increases until early adulthood. Consequently, obesity and overweight are defined using BMI percentiles for children >=2 yr old and weight/length percentiles for infants <2 yr old. The criterion for obesity is BMI >= 95th percentile and for overweight is BMI between 85th and 95th percentiles. "

Answer 47

IDENTIFY HIGH RISK POPULATION IN THE STUDENT BODY

Answer 48

C "Nelson 21st p2029 Zinc supplementation in children with diarrhea in developing countries leads to reduced duration and severity of diarrhea and could potentially prevent a large proportion of cases from recurring. All children older than 6mo of age with acute diarrhea in at-risk areas should recieve oral zinc (20mg/day) in some form for 10-14 days during and continued after diarrhea. "

Answer 49

B "Nelsons 21st p101 Fractures that strongly suggest abuse include classic metaphyseal lesions, posterior rib fractures, and fractures of the scapula, sternum, and spinous processes, especially in young children. These fracture all require more force that would be expected from a minor fall or routine handling and activities of a child. In abused infants, rub, metaphyseal, and skull fractures are most common. Femoral and humeral fractures in nonambulatory infants are also very worrisome for abuse. With increasing mobility and running, toddlers can fall with enough rotational force to cause a spiral femoral fracture. Multiple fractures in various stages of healing are suggestive of abuse. Clavicular, femoral, supracondylar, humeral, and distal extremity fractures in children older than 2 yr are most likely noninflicted unless they are multiple or accompanied by other signs of abuse. "

Answer 50

A "Nelson 21st p99 Neglect refers to omissions in care, resulting in actual or potential harm. Omissions include inadequate healthcare, education, supervision, protection from hazards in the environment, and unmet physical needs (e.g. food, clothing) and emotional support. A preferable aternative to focusing on caregiver omissions is to instead consider the basic needs (or rights) of children (e.g. adequate food, clothing, shelter, healthcare, education, nurturance). Neglect occurs when a need is not adequately met and results in physical harm, whatever the reasons. A child whose helath is jeopardized or harmed by not recieving necessary care experiences medical neglect. "

Answer 51

Blood lead level "Nelson 21st p3799 Until 1997, universal screening by blood lead testing of all children ages 12 and 24mo was the standard in the United States. Given the national decline in the prevalence of lead poisoning, the recommendations have been revised to target blood lead testing of high risk populations. "

Answer 52

Take folic acid "Nelson p3066-3067 All women of childbearing age who can become pregnant should take 0.4mg folic acid daily. If, however, a pregnancy is planned in high risk women (previously affected child), supplementation should be started with 4mg of folic acid daily, beginning 1mo before the time of the planned conception. "

Answer 53

B "Nelson 21st p202-203 Risk factors for psychosomatic symptoms Individual 1. Temperament/Coping styles - more common in children who are conscientious, sensitive, insecure, internalizers, and anxious, and in those who strive for high academic achievement. Somatization may also occur in children who are unable to verbalize emotional distress 2. Learned behavior - Somatic complaints may be reinforced through a decrease in responsibilities or expectations by other and through recieving attention and sympathy 3. Psychiatric comorbidity - e.g. depressive and anxiety disorders 4. Childhood physical illness - history of previous physical illness Family and Environmental 1. Symptom modeling - A significant proportion of patient with SSRD had recently encountered similar symptoms in their environment or live with family members who complain of similar physical symptoms (e.g. child with nonepileptic seizures who has parent or sibling with seizure disorder) 2. Parental Responses - Parental beliefs about the significance of symptoms influence the extent of symptoms the child reports 3. School and family stressors - Common stressors include bullying, beginning the school year, fear of academic failure, participation in extracurricular activities, dysfunction and less support within the family system, transition within the family system 4. Trauma - e.g. sexual, physical, emotional abuse 5. Genetic and biologic variabilities - e.g. increased pain sensitivity"

Answer 54

B "Nelson 21st p133 Table 22.2 Emerging patterns of behavior during the first year of life Neonatal period (1st 4wk) Prone: lies in flexed attitude, turns head from side to side, head sags on ventral suspension Supine: generally flexed and a little stiff Visual: may fixate on face on light and in line of vision; dolls eye movement (oculocephalic reflex) of eyes on turning of body Reflex: Moro response active, stepping and placing reflexes, grasp reflex active Social: visual preference for human face 1mo Prone: legs more extended, holds chin up, turns head; head lifted momentarily to plane of body on ventral suspension Supine: tonic neck posture predominates, supple and relaxed, head lags when pulled to sitting position Visual: watches person, follows moving object Social: body movements in cadence with voice of other in social contact, beginning to smile 2mo Prone: raises head slightly further; head sustained in plane of body on ventral suspension Supine: tonic neck posture predominates; head lags when pulled to sitting position Visual: follows moving object 180 degrees Social: smiles on social contact, listens to voice and coos"

Answer 55

B """Nelson 21st p1015 Table 132.2 Sexual maturity rating stages in females SMR 1 - pubic hair: preadolescent - breasts: preadolescent SMR 2 - pubic hair: sparse, lightly pigmented, straight, medial border of labia - breasts: breast and papilla elevated as a small mound, diameter of areola increased SMR 3 - pubic hair: darker, beginning to curl, increased amount - breasts: breast and areola enlarged, no contour separation SMR 4 - pubic hair: coarse, curly, abundant but less than in adult - breasts: areola and papilla form secondary mound SMR 5 - pubic hair: adult feminine triangle, spread to medial surface of thighs - breasts: mature, nipple projects, areola part of general breast contour """

Answer 56

B "Nelson 21st p1014 Females attain a peak height velocity of 8-9cm/yr at SMR 2-3, approximately 6mo before menarche. Males typically begin their growth acceleration at a later SMR stage, achieve a peak height velocity of 9-10cm later in the course of puberty (SMR 3-4), and continue their linear growth for approximately 2-3yr after females have stopped growing. "

Answer 57

C "Choice A: Early adolescence (self-consicousness about appearance and attractiveness Choice B: Late adolescence (future-oriented with sense of perspective) Choice D: Late adolescence (consolidation of identity( Nelson 21st p1015 Table 132.1 Milestones in early, middle, and late adolescent development Middle adolescence (14-17yr) Cognitive and moral - Emergence of abstract thought (formal operations) - May perceive future implications, but may not apply in decision-makring - Strong emotions may drive decision-making - Sense of invulnerability - Growing ability to see others' perspectives Self-concept / identity formation - Concern with attractiveness - Increasing introspection Family - Conflicts over control and independence - Struggle for greater autonomy - Increased separation from parents Peers - Intense peer group involvement - Preoccupation with peer culture, conformity Sexual - Testing ability to attract partner - Initiation of relationships and sexual activity - Exploration of sexual identity "

Answer 58

C "Prev Ped 2016 p33 Figure 3. Z score interpretation Length/Height for age - Below -2: Stunted - Below -3: Severely stunted Weight for age - Below -2: Underweight - Below -3: Severely underweight Weight for length/height - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted BMI for age - Above 3: Obese - Above 2: Overweight - Above 1: Possible risk for overweight - Below -2: Wasted - Below -3: Severely wasted"

Answer 59

D """3600 + (2x500) + 3400 = 8000 = 8kg Fundamentals of pediatrics p122 Table 8-1 Useful mnemonic for common growth standards Weight 0-6 months: age in months x 600 + birth weight (g) 6-12 months: 3600 + (age in months after 6 months x 500) + birth weight (g) 1-6 years: age in years x 2 + 8 (kg) 7-12 years: 1/2 [(age in years x 7) - 5)] (in kg) Length 0-3 months: birth length + 9cm 4-6 months: birth length + 9cm + 8cm 7-9 months: birth length + 9cm + 8cm + 5cm 10-12 months: birth length + 9cm +8cm + 5cm + 3cm Length/height 2-12 years: age in years x 6 + 77 (cm) Mid-parental height All ages, boys: 1/2 [(paternal + maternal height) + 13] (in cm) All ages, girls: 1/2 [(paternal + maternal height) - 13)] (in cm)"""

Answer 60

*12 cm in 1 year= 46

Answer 61

D "Nelsons 21st p3059 Table 608.2 Timing of selected primitive reflexes Palmar grasp - onset 28 wk AOG - fully developed 32 wk AOG - duration 2-3mo postnatal Rooting - onset 32wk AOG - fully developed 36wk AOG - less prominent after 1 mo postnatal Moro - onset 28-32wk AOG - fully developed 37wk AOG - duration 5-6mo postnatal Tonic neck - onset 35wk AOG - full developed 1 mo postnatal - duration 6-7 mo postnatal Parachute - onset 7-8mo postnatal - fully developed 10-11mo postnatal - remains throughout life "

Answer 62

C """Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age 24 months / 2 years Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures 30 months Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure Language: Refers to self by pronoun """"I"""", knowns full name Social: Helps put things away, pretends in play 36 months / 3 years Motor: Rides tricycle, stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes, imitates construction of """"bridge"""" of 3 cubes, copies circle, imitates cross Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands 48 months / 4 years Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well Adaptive: Copies bridge from model, imitates construction of """"gate"""" of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines Language: Counts 4 pennies accurately, tells story Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone 60 months / 5 years Motor: Skips Adaptive: Draws triangle from copy, names heavier of 2 weights Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying """

Answer 63

B "Nelson 21st p1021 Gender identity develops early in life and is generally fixed by 2-3 yr of age. Children first learn to identify their own and others' sex (gender labeling), then learn that gender is most often stable over time (gender constancy), and finally learn that gender is typically permanent (gender consistency). What determines gender identity is largely unknown, but it is thought to be an interaction of biologic, environmental, and sociocultural factors. "

Answer 64

D "Nelson 21st p135 6-12 months Physical development Many infants begin crawling and pulling to stand around 8mo, followed by cruising. Some walk by 1 year. These gross motor skills expand infants' exploratory range and create new physical dangers, as well as opportunities for learning. Emotional development The advent of object permanence (9mo) corresponds with qualitative changes in social and communicative development. Infants look back and forth between an approaching stranger and a parent and may cling or cry anxiously, demonstrating stranger anxiety. "

Answer 65

C "Nelson 21st p146 Growth of the midface and lower face occurs gradually, loss of deciduous (baby) teeth is a more dramatic sign of maturatin, beginning at around 6yr of age. Replacement with adult teeth occurs at a rate of around 4 per year, so that by 9yr of age, children will have 8 permanent incisors and 4 permanent molars. Premolars erupt by 11-12 yr of age. Lymphoid tissues hypertrophy and reach maximal size, often giving rise to impressive tonsils and adenoids. "

Answer 66

B """Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age 24 months / 2 years Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures 30 months Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure Language: Refers to self by pronoun ""I"", knowns full name Social: Helps put things away, pretends in play 36 months / 3 years Motor: Rides tricycle, stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes, imitates construction of ""bridge"" of 3 cubes, copies circle, imitates cross Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands 48 months / 4 years Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well Adaptive: Copies bridge from model, imitates construction of ""gate"" of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines Language: Counts 4 pennies accurately, tells story Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone 60 months / 5 years Motor: Skips Adaptive: Draws triangle from copy, names heavier of 2 weights Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying """

Answer 67

C """Nelson 21st p1014 In males the first visible sign of puberty and the hallmark of SMR 2 is testicular enlargement, beginning as early as 9.5yr, followed by the development of pubic hair. This is followed by penile growth during SMR 3. Peak growth occurs when testes volumes reach approximately 9-10cm3 during SMR 4. In females, typically the first visible sign of puberty and the hallmark of SMR 2 is the appearance of breast buds (thelarche) between 7 and 12 yr of age. A significant minority of females develops pubic hair (pubarche) prior to thelarche. Menses typically begin within 3 yr of thelarche during SMR 3-4 (average age 12.5yr, normal range 9-15yr). Females attain a peak height velocity of 8-9cm/yr at SMR 2-3, approximately 6mo before menarche. Males typically begin their growth acceleration at a later SMR stage, achieve a peak height velocity of 9-10cm later in the course of puberty (SMR 3-4), and continue their linear growth for approximately 2-3yr after females have stopped growing. """

Answer 68

B "Nelson 21st p1015 Table 132.3 Sexual maturity rating stages in males SMR 1 - pubic hair: none - penis: preadolescent - testes: preadolescent SMR 2 - pubic hair: scant, long, slightly pigmented - penis: minimal change/enlargement - testes: enlarged scrotum, pink, texture altered SMR 3 - pubic hair: darker, starting to curl, small amount - penis: lengthens - testes: larger SMR 4 - pubic hair: resembles adult type byt less quantity, coarse, curly - penis: larger, glans and breadth increase in size - testes: larger, scrotum dark SMR 5 - pubic hair: adult distribution, spread to medial surface of thighs - penis: adult size - testes: adult size "

Answer 69

C "Nelson 21st p1015 Table 132.1 Milestones in early, middle, and late adolescent development Early adolescence (10-13yr) Cognitive and moral - concrete operations - egocentricity - unable to percieve long-term outcome of current decisions - follow rules to avoid punishment Self-concept/identity formation - preoccupied with changing body - self-consciousness about appearance and attractiveness Family - increased need for privacy - exploration of boundaries of dependence vs independence Peers - same sex peer affilications Sexual - increased interest in sexual anatomy - anxieties and questions about pubertal changes - limited capacity for intimacy "

Answer 70

B "CBC not necessary since the patient has been your regular patient since school-age and presumably has had his CBC for middle adolescence at his annual checkup at 14 years old. Prev Ped 2018 p16 During the annual visit, the adolescent should undergo the following: 1. Complete history-taking to screen for risks and protective factors using the tool HEEADSSS 2. Physical examination. In addition to the routine physical examinatinon, the following should be done: - Tanner staging/SMR - breast examination - examination of the spine and shoulders, check for scoliosis and kyphosis - inspection of the genitals and anus 3. Screening procedures - CBC at every stage of adolesence - UA on first encounter - Vaginal wet mount, PAP smear for sexually active females - Serologic test for syphilis for sexually active males, nonculture test for gonorrhea and chlamydia for sexually active males and females 4. Immunization update 5. Anticipatory guidance and counseling - Self breast examination for females - healthy lifestyle: physical activity, diet, avoidance of alcohol, smoking, drug abuse - sexual behavior and risk of acquiring STIs - injury and accident prevention: use of sports protetive gear, seat belts, no driving under the influence of alcohol, no smoking in bed, no hand gun use "

Answer 71

B "Priority is to give DTP 4th dose. Prev Ped 2018 p70-71 Varicella Vaccine - given subcutaneously - given at a minimum age of 12 months - 2 doses of varicella vaccine are recommended - the 2nd dose is usually given at 4-6 years of age, but may be given earlier at an interval of 3 months from the 1st dose - if the 2nd dose was given 4 weeks from the 1st dose, it is considered valid - for children 13 years old and above, the recommeneded minimum interval between doses is 4 weeks MMR vaccine - given subcutaneously - given at a minimum age of 12 months - 2 doses of MMR vaccine are recommended - the 2nd dose is usually given from 4-6 years of age, but may be given at an earlier age with a minimum 4 weeks interval between doses Rotavirus - given per orem - given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses; the last dose should be administered not later than 32 weeks of age Diphtheria and tetanus toxoid and pertussis vaccine (DTP) - given intramuscularly - given at a minimum age of 6 weeks with a minimum interval of 4 weeks - complete a 5 dose seires at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years; the recommended interval between the 3rd and 4th dose is 6 months, but a minimum interval of 4 months is valid - the 5th dose of DTaP vaccine may not be given if the 4th dose was administered at age 4 years or older"

Answer 72

D "Prev Ped 2018 p10-11 The WHO and DOH both recommend the use of either albendazole or mebendazole in the following doses and schedule Albendazole 12-23 months: 200mg SD every 6 months 24 months and above: 400mg SD every 6 months Mebendazole 12 months and above: 500mg SD every 6 months Deworming must not be done in children with the following: - severe malnutrition - high grade fever - profuse diarrhea - abdominal pain - serious illness - previous hypersensitivity to antihelminthic drug "

Answer 73

C "Gross motor red flag for not walking is 15 months (Prev Ped 2018 p19) or 18 months (Nelsons 21st p 158 Table 28.2) Prev Ped 2018 p19 As children grow and develop, one needs to be mindful that each child develops at his/her own pace and the range of what is considered to be ""normal"" is quite wide. However, there are absolute indicators often referred to as red flags that identify developmental markers suggesting the need for further neurodevelopmental evaluation"

Answer 74

B "Prev Ped 2018 p7 The Pediatric Nephrology Society of the Philippines recommends routine BP measurement annualy for all children >3 years of age and adolescents. BP however should also be checked in every encounter on all ill patients and all patients at risk such as those with obesity, those taking medications known to increase BP, those with renal disease, history of aortic arch obstruction, diabetes. "

Answer 75

C "Nelson 21st p2907 Delayed puberty is a failure of development of any pubertal feature by 13 yr of age in females and 14 yr of age in males Delay or absence of puberty is caused by 1. Constitutional delay: a variant of normal 2. Hypogonadotropic hypogonadism: low gonadotropin levels as a result of a defect of the hypothalamus/pituitary gland 3. Hypergonadotropic hypogonadism: high gonadotropic levels as a result of a lack of negative feedback because of a gonadal problem. Females may have isolated absence of adrenarche with normal breast development "

Answer 76

C "Phaeochromocytomas and catecholamine secreting neuroblastomas produce similar symptoms, however phaeochromocytomas usually dont present with flank mass Nelson 21st p2986 Phaeochromocytoma Phaeochromocytomas detected by surveillance of patients who are known carriers of mutations in tumor-suppression genes may be asymptomatic. Otherwise, patients are detected owing to hypertension, which results from excessive secretion of metanephrines, epinephrine, and norepinephrine. Between attacks of hypertension, the patient may be free of symptoms. During attacks, the patient complains of headache, palpitations, abdominal pain and dizziness; pallor, vomiting, and sweating also occur. Seizures and other manifestations of hypertensive encephalopathy may occur. Nelson 21st p2680 The signs and symptoms of neuroblastoma reflect the tumor site and extent of disease and may mimic other disorders, which may result in a delayed diagnosis. Some tumors produce catecholamines that can cause increased sweating and hypertension, and may release vasoactive intestinal peptide, causing a profound secretory diarrhea. Children with extensive tumors can also experience tumor lysis syndrome and disseminated intravascular coagulation. Nelson 21st p2683 The most common initial clinical presentaiton for Wilms tumor is the incidental discovery of an asymptomatic abdominal mass by parents while bathing or clothing an affected child or by a physician during a routine physical examination. At presentation, the mass can be quite large, because retroperitoneal masses can grow unhampered by strict anatomic boundaries. Functional defects in paired organs, such as the kidney, with good functional reserve, are also unlikely to be detected early. "

Answer 77

A "Nelson 21st p2650 ALL is diagnosed by a bone marrow evaluation that demonstrates >25% of the bone marrow cells as a homogenous population of lymphoblasts Nelson 21st p2654 The characteristic feature of AML is that >20% of bone marrow cells on bone marrow aspiration constitute a fairly homogenous population of blast cells, with features similar to those that characterize early differentiation states of the myeloid-monocyte-megakaryocyte series of blood cells"

Answer 78

A "Nelson 21st p2654 The characteristic feature of AML is that >20% of bone marrow cells on bone marrow aspiration constitute a fairly homogenous population of blast cells, with features similar to those that characterize early differentiation states of the myeloid-monocyte-megakaryocyte series of blood cells' Nelson 21st p2516-2517 Physiologic anemia of infancy At birth, normal full-term infants have higher hemoglobin and larger RBCs than do older children and adults. However within the 1st wk of life, a progressive decline in Hgb level begins and persists for 6-8 wk. The resulting anemia is known as physiologic anemia of infancy Normally this point is reached between 8 and 12 wk of age, when the Hgb concentration is about 11g/dl. In healthy term infants, the nadir rarely falls below 10g/dl Nelson 21st p2522 IDA Most children with IDA are asymptomatic and are identified by routine laboratory screening at 9-12 mo of age. Pallor is the most recognized clinical sign of IDA but is not usually visible until the Hgb falls to 7-8g/dl Nelson 21st p2513 Anemia of chronic disease ACD is found in conditions where there is ongoing immune activation. It occurs in conditions including infections, malignancies, CKD, autoimmunity, and graft-vs-host disease. ACD is typically a mild to moderate normocytic, normochromic, hypoproliferative anemia associated with decreased serum iron and low transferrin saturation. "

Answer 79

C "Nelson 21st p2500 In the developing human embryo and fetus, hematopoiesis has 3 developmental waves and is conceptually divided into 3 anatomic stages: mesoblastic, hepatic, and myeloid 1. Mesoblastic hematopoiesis occurs in extraembryonic structures, principally in the yolk sac, and begins between the 10th and 14th days of gestation. By 10-12wk, extraembryonic hematopoiesis has ceased 2. By 6-8wk of gestation, the liver replaces the yolk sac as the primary site of blood production, and during this time the placenta also contributes as a hematopoietic site. Hepatic hematopoiesis occurs throughout the remainder of the gestation and then diminishes duing the third trimester. The liver is the predominant hematopoietic organ through 20-24wk of gestation. 3. Myeloid (bone marrow) hematopoiesis increases during the third trimester until birth and beyond. Each hematopoietic organ houses distinct populations of cells: 1. Yolk sac - erythrocytes, megakaryocytes, macrophages 2. Liver - erythrocytes 3. Bone marrow - erythrocytes, megakaryocytes, leukocytes"

Answer 80

D "Nelson 21st p2530 Table 484.4 Hemolytic anemia: Diagnostic clues based on RBC shape - Sickle cells - sickle cell disease - Target cells - hemoglobinopathies, liver disease - Schistocytes/burr cells/helmet cells/RBC fragments - microangiopathic hemolytic anemia (DIC, HUS, TTP) - Spherocytes - hereditary spherocytosis, autoimmune hemolytic anemia - Cigar shaped cells - hereditary elliptocytosis - Bite cells - G6PD deficiency - poikilocytosis, microcytosis, fragmented erythrocytes, elliptocytes - hereditary pyropoikilocytosis "

Answer 81

C """Indicators of iron deficiency anemia 1. Low Hemoglobin - when used alone, has low specificity and sensitivity 2. Low MCV - reliable but late indicator of iron deficiency; low values can also be a result of thalassemias and other causes of microcytosis. False negative results in liver disease 3. Low serum ferritin (<12 less than 5 yrs, <15 in greater than 5yrs) - most useful laboratory measure of iron stores. Low ferritin is diagnostic of iron deficiency anemia in a patient with anemia. Ferritin is an acute phase reactant that increases in many acute or chronic inflammatory conditions independent of iron status. In all age groups with infection, ferritin <30-100 4. Low Reticulocyte hemoglobin content - sensitive indicator that alls within days of onset of iron deficient erythropoiesis and is unaffected by inflammation. Not widely available 5. High Serum transferrin receptor - upregulated in iron deficiency 6. Low transferrin - limited by diurnal variation in serum iron and inflammatory conditions, aging, and nutrition 7. High Erythrocyte zinc protoporphyrin - useful screening test 8. Low Hepcidin - extremely elevated in anemia of inflammation and suppressed in IDA but limited availability (Nelson 21st p2523)"""

Answer 82

D "Nelson 21st p2703 Kasabach-Merritt syndrome is characterized by a rapidly enlarging lesion, thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy as a result of platelet and RBC trapping and activation of the clotting system within the vasculature of the hemangioma. The syndrome is associated with kaposiform hemangioendotheliomas or tufted angiomas but not with infantile hemangiomas. "

Answer 83

A "Nelson 21st p2517 Megaloblastic anemia describes a group of disorders that are caused by impaired DNA synthesis. RBCs are larger than normal at every developmental stage, and there is maturational asynchrony between the nucleus and cytoplasm of erythrocytes. Most cases of childhood megaloblastic anemia result from a deficiency of folic acid or vitamin B12 (cobalamin), vitamins essential for DNA synthesis"

Answer 84

B "Nelson 21st p2657 The Reed-Sternberg cell, a pathognomonic feature of Hodgkin lymphoma is a large cell (15-45 um in diameter) with multiple or multilobulated nuclei. This cell type is considered the hallmark of HL, although similar cells are seen in infectious mononucleosis, non-Hodgkin lymphoma, and other conditions The RS cell is clonal in origin and arises from the germinal center B cells but typically has lost most B-cell gene expression and function. "

Answer 85

B "Nelson 21st p2690 Bone tumor should be suspected in a patient who presents with deep bone pain, often causing nighttime awakening, and has a palpable mass with radiographs that demonstrate a lesion. The lesion may be mixed lytic and blastic in appearance, but new bone formation is usually visible. The classic appearance of osteosarcoma is the sunburst pattern. Nelson 21st p2691 The diagnosis of Ewing sarcoma should be suspected in a patient who presents with pain and swelling, with or without systemic symptoms, and with a radiographic appearance of primarily lytic bone lesion with periosteal reaction, the characteristic onion-skinning. "

Answer 86

A "Nelson 21st Chapter 503 Hemophilia A - Factor 8 deficiency Hemophilia B - Factor 9 deficiency Hemophilia C - Factor 11 deficiency Nelson 21st p2594 Reduced level of factor 8 and factor 9 will result in a laboratory finding of prolonged PTT PT measures the activation of factor 10 by factor 7 and is therefore normal in patients with factor 8 or factor 9 deficiency Nelson 21st p2597 Factor 9 deficiency is an autosomal deficiency associated with mild to moderate bleeding symptoms. PTT is often longer than it is with patients with severe factor 8 or facotr 9 deficiency. The paradox of fewer clinical symptoms with longer PTT occurs because factor 7a can activate factor 11 in vivo"

Answer 87

A ``` "Nelson 21st p2612 ITP Sever thrombocytopenia (PC <20 x 10^9/L) is common, and platelet size is normal or increased, reflective of increased platelet turnover. In acute ITP the hemoglobin value, WBC count, and differential count should be normal. ``` Nelson 21st p1320 HSP No laboratory finding is diagnostic of HSP. Common but nonspecific findings include leukocytosis, thrombocytosis, mild anemia, and elevations of ESR and CRP. The platelet count is normal in HSP Nelson 21st p1472 Meningococcemia Laboratory findings are variable but may include leukocytopenia or leukocytosis, often with increased percentage of neutrophils and band forms and anemia, thromocytopenia, proteinuria, and hematuria. Nelson 21st p2650 The diagnosis of ALL is strongly suggested by peripheral blood findings that indicate bone marrow failure. Anemia and thrombocytopenia are seen in most patients. "

Answer 88

C "Thrombocytopenia may be seen with sequestration of platelets within the hemangioma, as seen in the pathophysiology of Kasabach-Meritt syndrome Nelson 21st p2703 Kasabach-Merritt syndrome is characterized by a rapidly enlarging lesion, thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy as a result of platelet and RBC trapping and activation of the clotting system within the vasculature of the hemangioma. The syndrome is associated with kaposiform hemangioendotheliomas or tufted angiomas but not with infantile hemangiomas. "

Answer 89

A "Nelson 21st p2555 Infants with serious B-thalassemia disorders have a progressive anemia after the newborn period. Microcytosis, hypochromia, and targeting characterize the RBCs. Nucleated RBCs, marked anisopoikilocytosis, and a relative reticulocytopenia are typically seen. The Hgb level falls progressively often to <6 g/dL unless transfusions are given. The reticulocyte count is commonly <8% and is inappropriately low compared to the degree of anemia caused by ineffective erythropoiesis. "

Answer 90

D "Nelson 21st p2586 Table 500.1 Guidelines for children and infants for plasma transfusions 1. Severe clotting factor deficiency AND bleeding 2. Severe clotting factor deficiency AND an invasive procedure 3. Emergency reversal of warfarin effects 4. Dilutional coagulopathy and bleeding (e.g. massive transfusion) 5. Anticoagulant protein (antithrombin III, proteins C and S) replacement 6. Plasma exchange replacement fluid for thrombotic thrombocytopoenic purpura or for disorders with overt bleeding or in which there is a risk of bleeding because of clotting protein abnormalities"

Answer 91

D "Lanzkowsky 6th ed p376 Table 18.6 prognostic factors in childhood acute lymphoblastic leukemia Favorable - age 1-9 years - WBC count <50 x 10^9/l - B-precursor cell immunophenotype - female sex - Trisomy 4, 10, 17 - t(12;21) / ETV6-RUNX1 - no CNS involvement - end of induction D29 minimal residual disease <0.01% Less favborable - age <1 or >10 - WBC count >50 x 10^9/l - T-cell immunophenotype - male sex - MLL rearrangement - t(9;22) / BCR-ABL1 iAMP21 (Philadelphia Chromosome) - with CNS involvement - end of induction D29 minimal residual disease >0.01% - positive minimal residual disease at end consolidation"

Answer 92

C Live attenuated vaccines are contraindicated in patients recieving chemotherapy

Answer 93

B "Nelson 21st p2594 Hemophilia Reduced level of factor 8 and factor 9 will result in a laboratory finding of prolonged PTT PT measures the activation of factor 10 by factor 7 and is therefore normal in patients with factor 8 or factor 9 deficiency Nelson 21st p972 VKDB Laboratory testing reveals that both the PT and PPT are prolonged, plasma levels of prothrombin (factor 2), and factors 7, 9, and 10 are substantially decreased The pathophysiology of this acquired hemorrhagic disorder results because vitamin K facilitates posttranscriptional carboxylation of factors 9, 10, 7, and 2, which is necessary for their full coagulation effects. "

Answer 94

C "Nelson 21st p2599 Von Willebrand disease is the most common inherited bleeding disorder. VWD is caused by a defect in or deficiency of von Willebrand factor. VWF serves to tether platelets to injured subendothelium via binding sites for platelets and collagen, and is also a carrier protein for factor 8, protecting factor 8 from degradation in plasma. VWD typically presents with mucosal bleeding, similar to that seen with other platelet defects. Epistaxis, easy bruising, and menorrhagia in women are common complaints. "

Answer 95

C "Nelsons 21st p2612 The most common cause of acute onset of thrombocytopenia in an otherwise well child is idiopathic thrombocytopenic purpura (ITP) The classic presentation of ITP is a previously healthy 1-4yr old child who has sudden onset generalized petechiae and purpura. There is a history of preceding viral infection 1-4 wk before the onset of thrombocytopenia. Findings on PE are normal, other than petechiae and purpura. Severe thrombocytopenia (PC <20 x 10^9/L) is common, and platelet size is normal or increased, reflective of increased platelet turnover. In acute ITP, Hgb, WBC and differential count should be normal. Bone marrow examination shows normal granulocytic and erythrocytic series, with characteristically normal or increased numbers of megakaryocytes. Some of the megakaryocytes may appear immature and reflect increased platelet turnover. Indications for bone marrow biopsy include an abnormal WBC count or differential or unexplained anemia, as well as history and PE findings suggestive of a bone marrow failure syndrome or malignancy. "

Answer 96

C " Nelson 21st p2524 Table 482/2 Laboratory studies differentiating the most common microcytic anemias ``` IDA Decreased Hgb Decreased MCV Increased RDW Decreased RBC Decreased serum ferritin Increased total Fe binding capacity Decreased transferrin saturation Increased FEP Increased soluble transferrin receptor Decreased reticulocyte Hgb concentration ``` ``` ACD Decreased Hgb Normal-Decreased MCV Normal-Increased RDW Normal-Decreased RBC Increased serum ferritin Decreased total Fe binding capacity Decreased transferrin saturation Increased FEP Normal soluble transferrin receptor Normal-Decreased reticulocyte Hgb concentration ``` ``` Thalassemia Decreased Hgb Decreased MCV Normal or minimally increased RDW Normal-increased RBC Normal serum ferritin Normal total Fe binding capccity Normal transferrin saturation Normal FEP Normal soluble transferrin receptor Normal reticulocyte Hgb concentration" ```

Answer 97

C "Nelson 21st p2561 G6PD deficiency Typically, hemolysis ensues in about 24-48hr after a patient has ingested a substance with oxidant properties. In severe cases, hemoglobinuria and jaundice result, the the Hgb concentration may fall precipitously. The onset of acute hemolysis usually results in a precipitous fall in hemoglobin or hematocrit. If the episode is severe, the Hgb binding globulins such as haptoglobin are saturated, and free hemoglobin may appear in the plasma and subsequently in the urine. Unstained or supravital preparations of RBCs reveal precipitated hemoglobin, or Heinz bodies. Also, the blood film may contain red cells with what appears to be a bite taken from their periphery (bite cells) and polychromasia (blueish larger RBCs) representing reticulocytosis. "

Answer 98

B "Prev Ped 2018 p70-71 Varicella Vaccine - given subcutaneously - given at a minimum age of 12 months - 2 doses of varicella vaccine are recommended - the 2nd dose is usually given at 4-6 years of age, but may be given earlier at an interval of 3 months from the 1st dose - if the 2nd dose was given 4 weeks from the 1st dose, it is considered valid - for children 13 years old and above, the recommeneded minimum interval between doses is 4 weeks"

Answer 99

Varicella "Nelson 21st p1709 Within households, transmission of VZV to susceptible individuals occurs at a rate of 65-86%; more casual contact, such as occurs in a school classroom, is associated with lower attack rates among susceptible children. "

Answer 100

A """Persons with varicella may be contagious 24-48 hours before rash is evident and until vesicles are crusted, usually 3-7 days after onset of rash. Varicella is spread by aerosolization of virus in cutaneous lesions and by oropharyngeal secretions (Nelson 21st p1709) Mortality is particularly high in neonates born to susceptible mothers who contract varicella around the time of delivery. Infants whose mothers demonstrate varicella in the period from 5 days prior to delivery to 2 days afterwards are at high risk for severe varicella. (Nelson 21st p1710)"""

Answer 101

C "Nelson 21st p1671-1672 Measles is a serious infection characterized by high fever, an enanthem, cough, coryza, conjunctivitis, and a prominent exanthem. After an incubation period of 8-12 days, the prodromal phase begins with a mild fever followed by onset of conjunctivitis with photophobia, coryza, a prominent cough, and increasing fever. Koplik spots represent the enanthem and are the pathognomonic sign of measles, appearing 1-4 days prior to the onset of the rash. They first appear as discrete red lesions with bluish white spots on the center on the inner aspects of the cheeks at the level of the premolars. Symptoms increase in intensity for 2-4 days until the 1st day of the rash. The rash begins on the forehead, behind the ears, and on the upper neck as a red maculopapular eruption. It then spreads downwards to the torso and extremities, reaching the palms and soles in 50% of cases. The exanthem frequently becomes confluent on the face and upper trunk. With the onset of the rash, symptoms begin to subside. The rash fades over about 7 days in the same progression as it eveolved, often leaving a fine desquamation of skin in its wake. Of the major symptoms, the cough last the longest, often up to 10 days. "

Answer 102

C "Nelson 21st p2274 The most common cause of pleural effusion in children is bacterial pneumonia. Heart failure, rheumatologic causes, and metastatic intrathoracic malignancy are also common causes."

Answer 103

C "Nelson 21st p1878 Treatment for gastrointestinal ascariasis 1. Albendazole 400mg PO SD for all ages 2. Mebendazole 100mg PO BID x 3 days OR 500mg PO SD for all ages) 3. Ivermectin (150-200 ug/kg PO SD) Intestinal or biliary obstruction 1. Piperazine citrate (75mg/kg/day x 2 days), causes neuromuscular paralysis and rapid expulsion of worms "

Answer 104

C "Nelson 21st p1877 Ascaris Transmission is primarily hand to mouth but also may involve ingestion of contaminated raw fruits and vegetables. Transmission is enhanced by the high output of eggs and the resistance of ove to the outside environment Nelson 21st p1889 Trichinella Human trichinellosis is caused by consumption of mean containing encysted larvae of Trichinella spiralis, a tissue-dwelling nematode with a worldwide distribution Nelson 21st p1883 Strongyloides Humans are usually infected through skin contact with soil contaminated with infectious larvae. Larvae penetrate the skin, enter the venous circulation and then pass into the lungs, break into alveolar spaces, and migrate up the bronchial tree. They are then swallowed and pass through the stomach, and adult worms develop in the small intestine. Nelson 21st p1882 Enterobius Human infection occurs by the fecal-oral route typically by ingestion of embryonated eggs that are carried on fingernails, clothing, bedding, or house dust. "

Answer 105

A "Nelson 21st p1877 Ascariasis The most common clinical problems are from pulmonary disease and obstruction of the intestinal or biliary tract. The pulmonary manifestation resemble Loeffler syndrome and include transient respiratory symptoms such as cough and dyspnea, pulmonary infiltrates, and blood eosinophilia. A more serious complication occurs when a large mass of worms leads to acute bowel obstruction. Ascaris worms also occasionally migrate into the biliary and pancreatic ducts, where they cause cholecystitis or pancreatitis. "

Answer 106

A "Nelson 21st p1832 Invasive amebiasis is treated with nitroimidazoles such as metronidazole or tinidazole and then a luminal amebecide. Therapy with a nitroimidazole should be followed by a luminal agent such as paramomycin or iodoquinol. Diloxannide furoate can also be used in children >2yr of age but it is no longer available in the United States. "

Answer 107

A "Nelson 21st p1740 Pharyngoconjunctival fever is a distinct syndrome that includes a high temperature, pharyngitis, nonpurulent conjunctivitis, and preauricular and cervical lymphadenopathy Kawasaki also presents with fever and nonsuppurative conjunctivitis"

Answer 108

D "Nelson 21st p1552 Table 238.1 Tetanus vaccination and immune globulin use in wound management Uncertain or <3 doses tetanus toxoid 1. Clean minor wounds - give DTaP, Tdap, or Td, do not give TIG 2. All other wounds - give DTaP, Tdap or Td, give TIG >=3 doses tetanus toxoid 1. Clean minor wounds - do not give DTaP, Tdap, or Td if <10 yr since last dose of tetanus containing vaccine - give DTaP, Tdap or Td if >=10 yr since last dose of tetanus containing vaccine - do not give TIG 2. All other wounds - do not give DTaP, Tdap or Td if <5 yr since last dose of tetanus containing vaccine - give DTaP, Tdap or Td if >=5 yr since last dose of tetanus containing vaccine - do not give TIG"

Answer 109

A "Nelson 21st p1787 All infants born to HIV-infected mothers test antibody-positive at birth because of passive trasnffer of maternal HIV antibody across the placenta during gestation; therefore, antibody should not be used to establish the diagnosis of HIV in an infant. Viral diagnostic testing should be performed within the first 12-24 hr of life, particularly for high-risk infants. "

Answer 110

A "Nelson 21st p2185 The most common pathogens associated with the common cold are the more than 200 types of human rhinoviruses. Many viruses that cause rhinitis are also assocaited with other symptoms and signs such as cough, wheezing, and fever. "

Answer 111

A """Nelson 21st p1671-1672 Measles is a serious infection characterized by high fever, an enanthem, cough, coryza, conjunctivitis, and a prominent exanthem. After an incubation period of 8-12 days, the prodromal phase begins with a mild fever followed by onset of conjunctivitis with photophobia, coryza, a prominent cough, and increasing fever. Koplik spots represent the enanthem and are the pathognomonic sign of measles, appearing 1-4 days prior to the onset of the rash. They first appear as discrete red lesions with bluish white spots on the center on the inner aspects of the cheeks at the level of the premolars. Symptoms increase in intensity for 2-4 days until the 1st day of the rash. The rash begins on the forehead, behind the ears, and on the upper neck as a red maculopapular eruption. It then spreads downwards to the torso and extremities, reaching the palms and soles in 50% of cases. The exanthem frequently becomes confluent on the face and upper trunk. With the onset of the rash, symptoms begin to subside. The rash fades over about 7 days in the same progression as it eveolved, often leaving a fine desquamation of skin in its wake. Of the major symptoms, the cough last the longest, often up to 10 days. """

Answer 112

A "Nelson 21st p2109 Indications for intramuscular administration of Ig include preexposure and postexposure prophylaxis. Ig is recommended for preexposure prophylaxis for susceptible travelers to countries where HAV is epidemic. HAV vaccine given any time before travel is preferred for preexposure prophylaxis in healthy persons by Ig ensures an appropriate prophylaxis in children younger than 12mo old, patients allergic to a vaccine component, or those who elect not to recieve the vaccine. If travel is planned in <2wk, older patients, immunocopromised hosts, and those with chronic liver disease or other medical conditions should recieve both Ig and HAV vaccine. Ig prophylaxis in postexposure situations should be used as soon as possible (it is not effective if administered more than 2wk after exposure). It is exclusively used for children younger than 12mo old, immunocompromised hosts, those with chronic liver disease or in whom vaccine is contraindicated. Ig is preferred in patients older than 40yr of age, with HAV vaccine preferred in healthy persons 12mo to 40yr old."

Answer 113

A "Nelsons 21st p2112 HbsAg is an early serologic marker of infection and is found in almost all infected persons; its rise closely coincides with the onset of symptoms. Persistence of HBsAg beyond 6mo defines the chronic infection state. During recovery from acute infection, because HbsAg levels falls before symptoms wane, anti-HBc IgM might be the only marker of acute infection. Anti-HBc IgM rises early after the infection and remains positive for many months before being replaced by anti-HBc IgG, which then persists for years. Anti-Hbs marks serologic recovery and protection. Only Anti-HBs is present in persons immunized with hepatitis B vaccine, whereas both anti-HBs and anti-HBc are detected in persons with resolved infection. HBeAg is present in active acute or chronic infection and is a marker of infectivity. The development of anti-HBe, termed seroconversion, marks improvement and is a goal of threapy in chronically infected patients. HBV DNA can be detected in the serum of acutely infected patients and chronic carriers. High DNA titers are seen in patients with HBeAg, then typically fall once anti-HBe develops. "

Answer 114

B """Nelsons 21st p2112 HbsAg is an early serologic marker of infection and is found in almost all infected persons; its rise closely coincides with the onset of symptoms. Persistence of HBsAg beyond 6mo defines the chronic infection state. During recovery from acute infection, because HbsAg levels falls before symptoms wane, anti-HBc IgM might be the only marker of acute infection. Anti-HBc IgM rises early after the infection and remains positive for many months before being replaced by anti-HBc IgG, which then persists for years. Anti-Hbs marks serologic recovery and protection. Only Anti-HBs is present in persons immunized with hepatitis B vaccine, whereas both anti-HBs and anti-HBc are detected in persons with resolved infection. HBeAg is present in active acute or chronic infection and is a marker of infectivity. The development of anti-HBe, termed seroconversion, marks improvement and is a goal of threapy in chronically infected patients. HBV DNA can be detected in the serum of acutely infected patients and chronic carriers. High DNA titers are seen in patients with HBeAg, then typically fall once anti-HBe develops. """

Answer 115

D "Likely atypical pneumonia based on prevalence for age, CBC findings. Nelson 21st p2268 Table 428.3 Pneumonia etiologies grouped by age of the patient For >=5 yr, frequent pathogens include M. pnuemoniae, S. pneuoniae, C. pneumophila, Hib, influenza virus, adenovirus, other respiratory viruses, Legionella Nelson 21st p2271 In viral pnuemonia, the WBC count can be normal or elevated but is usually not higher than 20,000 mm3 with a lymphocyte predominance. Bacterial pneumonia is often associated with an elevated WBC count in the range of 15,000-40,000/mm3 and a predominance of polymorphonuclear leukocytes. Atypical pnuemonia caused by C. pneumoniae or M. pneumoniae is difficult to distinguish from pneumococcal pneumonia on the basis of radiographic and laboratory findings. For school-aged children and adolescents or when infection with M. pneumoniae or C. pneumoniae is syspected, a macrolide antibiotic is an appropraite choice for outpatient management. "

Answer 116

A "Nelson 21st p1575 Tuberculous enteritis is caused by hematogenous dissemination or by swallowing tubercle bacilli discharged from the patient's own lungs. The jejunum and ileum near Peyer patches and the appendix are the most common sites of involvement."

Answer 117

A "Nelson 21st p3335 GBS may follow administration of vaccines against rabies, influenza, and conjungated meningococcal vaccine. "

Answer 118

C "Likely atypical pneumonia based on prevalence for age, CBC findings, nonresponse to ampicillin Nelson 21st p2268 Table 428.3 Pneumonia etiologies grouped by age of the patient For >=5 yr, frequent pathogens include M. pnuemoniae, S. pneuoniae, C. pneumophila, Hib, influenza virus, adenovirus, other respiratory viruses, Legionella Nelson 21st p2271 In viral pnuemonia, the WBC count can be normal or elevated but is usually not higher than 20,000 mm3 with a lymphocyte predominance. Bacterial pneumonia is often associated with an elevated WBC count in the range of 15,000-40,000/mm3 and a predominance of polymorphonuclear leukocytes. Atypical pnuemonia caused by C. pneumoniae or M. pneumoniae is difficult to distinguish from pneumococcal pneumonia on the basis of radiographic and laboratory findings. For school-aged children and adolescents or when infection with M. pneumoniae or C. pneumoniae is syspected, a macrolide antibiotic is an appropraite choice for outpatient management. "