Preventative Pediatrics

Question 1

What are high risk factors that should prompt initiation of statin therapy if lifestyle modification does not improve cholesterol? (7)

Answer 1

1. Type 2 diabetes
2. BMI > 97 percentile
3. HTN requiring tx
4. cigarette smoking
5. chronic renal disease
6. post renal/ heart transplant
7. Kawasaki disease with current coronary aneurysm

Question 2

What tetanus prophylaxis should be given to an adolescent (10-18 years) who requires tetanus toxoid containing vaccine as part of wound management?

Answer 2

Tdap (to include pertussis if has not received as adolescent)
(if clean wound, if no tetanus in 10 years)
(if contaminated wound, if no tetanus in 5 years)

Question 3

How many doses of Hib is required for a child aged 15-59 months who was not previously vaccinated?

Answer 3

1 dose

should receive 2 or 3 doses depending on manufacture at 2, 4 and 6 months old

Question 4

How many doses of PCV13 (Prevnar) are required for a child aged 24-59 months of age who was not previously vaccinated?

Answer 4

1 dose

should receive 4 doses if less than 24 months old at 2, 4 and 6 months and then 12-15 months old

Question 5

What vaccines must be administered intramuscularly? (4)

Answer 5

1. hep B
2. DTaP
3. Hib
4. PCV 13

Question 6

What vaccine must be administered subcutaneously?

Answer 6

MMR and Varicella

IPV can be either

Question 7

If MMR, varicella and/or live attenuated intranasal influenza vaccine are not given at the same time, how long do you need to wait before giving the other live parental vaccine?

Answer 7

28 days

if given before, can result in decreased efficacy & impaired immune response

Question 8

True or false. A child who has received a Hib vaccine at > 15 months of age does not require another Hib vaccine regardless of number of prior Hib vaccines.

Answer 8

True

Question 9

What is the oldest age a patient can receive their rotavirus vaccine?

Answer 9

8 months 0 days old

Question 10

At what age and interval do children routinely receive their Hep A vaccination?

Answer 10

starting at 12-23 months old with 6 months between the 2 doses

Question 11

What vaccines are not indicated for a child older than 5 years old whose immunization status is unknown or never started? (3)

Answer 11

1. Hib
2. Prevnar
3. Rotavirus

Question 12

What is the typical characteristics of varicella in previously vaccinated children (known as break through varicella)?

Answer 12

predominately maculopapular rather than vesicular, occurring anywhere, usually less than 50 lesions

Question 13

Why are children given MMR and varicella as vaccinations separately during ages of 12-23 months old?

Answer 13

increased risk of fever and febrile seizures at 5-12 day postvaccination

Question 14

What complication has been reported with the administration of Influenza or Menactra (MCV4) vaccinations?

Answer 14

Guillain-Barre syndrome

Question 15

At what age, should a preterm infant weighing less than 2 kg receive their first HepB vaccine?

Answer 15

1 month of age (or hospital discharge if comes 1st)

prior to that, less chance of seroconversion

Question 16

What vaccine is required to be stored frozen between -50 degress and -15 degress C?

Answer 16

Varicella

MMR can be frozen or refrigerated

Question 17

What is the recommendations for PPSV23 vaccine?

Answer 17

given to kids with congenital or acquired asplenia (including sickle cell) at > 2 years old and 8 weeks after last PCV13 vaccine; 2 dose series 5 years apart

Question 18

Which patients should receive Menveo (meningococcal vaccine available for infants) starting at age 2 months? (4)

Answer 18

1. HIV pts
2. Sickle cell
3. functional or anatomic asplenia
4. complement deficiencies

(given at 2, 4, 6, and 12 months of age)

Question 19

Treatment with what therapeutic agent requires administration of MMR and varicella vaccine to be delayed and for how long?

Answer 19

IVIG and transfusion of blood products; for 3-11 months after receiving IVIG

(will need repeat dose if vaccine given less than 2 weeks prior to IVIG)

Question 20

What are contraindications for pertussis-containing vaccine?

Answer 20

1. Encephalopathy within 7 days of previous vaccination

2. Anaphylaxis

Question 21

What are contraindications for rotavirus vaccine? (2)

Answer 21

1. History of intussusception
2. SCID (Severe combined immunodeficiency)
3. Anaphylaxis

Question 22

What is the current recommendation for the use of pneumococcal vaccines in sickle cell patients?

Answer 22

PCV13 at 2, 4, 6 and 12 months of age

PPSV23 at 2 years old followed by 2nd dose 5 years later

Question 23

What is the most common adverse effect of pertussis-containing vaccines?

Answer 23

extreme irritability and crying for an extended period of time (> 3 hours)

Question 24

What is the most likely diagnosis of a pt presenting with whitish lines running across chalky-brown, discolored and pitted teeth?

Answer 24

Fluorosis (excessive fluoride)

• use rice grain size fluoride toothpaste after 1st tooth eruption
• use pea size fluoride toothpaste after 3 years old

Question 25

What are the contraindications for varicella vaccination?

Answer 25

1. Anaphylaxis 2. Severe immunosuppression 3. pregnancy (possible pregnancy in 4 weeks) 4. IVIG (can give varicella and MMR to HIV pts with Tcell count > 15%)

Question 26

What is the recommendation for HPV vaccination in pt less than 15 years old?

Answer 26

start at 11-12 years old, 2 doses 6 months apart

Question 27

What is the recommendation for HPV vaccination in pt older than 15 years old?

Answer 27

3 doses, 2nd dose 1-2 months after 1st, 3rd dose 6 months after 1st

Question 28

What is the most frequently reported vaccine associated with post-vaccination syncope?

Answer 28

HPV vaccine | due to vasovagal

Question 29

What is the typical sequence for eruption of primary teeth?

Answer 29

mandibular (lower) central incisors then maxillary (upper) central incisors then mandibular lateral incisors then 1st molars then canines (7+ 4 rule for timing of eruption, starting at 7 months and going up by 4 months and 4 teeth)

Question 30

What is a true contraindication to receiving the yellow fever vaccine?

Answer 30

Egg hypersensitivity/ allergy

Question 31

What is the recommendation to increase the likelihood that an avulsed permanent tooth remains viable on way to dental office?

Answer 31

rinse with water, avoid holding by root, and transport in cold cow's milk or holding it in place

Question 32

When should routine blood pressure screening begin?

Answer 32

At 3 years of age

Question 33

What is the routine recommendation for the meningococcal (MCV4) vaccine?

Answer 33

1st dose at 11-12 years old, 2nd dose at 16 years old | single dose if initial dose given at 16 or older

Question 34

At what age is DTaP not recommended?

Answer 34

7 years or older | should receive Tdap

Question 35

What is the potential adverse effect of giving the pnemococcal (PCV13) and trivalent inactivated influenza vaccine simutaneously?

Answer 35

Febrile seizures during the initial 24 hours after vaccines

Question 36

True or False. MMR vaccine can be administered the same day as the tuberculin skin test (TST), but if MMR given previously, you must postpone the TST for 4-6 weeks.

Answer 36

True MMR vaccine given earlier can suppress reactivity to TST

Question 37

When does visual acuity reach the adult level of 20/20?

Answer 37

by 3-5 years old

Question 38

What is the treatment for labial adhesions?

Answer 38

Topical estrogen cream BID (side effect of breast bud formation transient) (peaks at 12-24 months of age)

Question 39

What is the recommended duration between dose 1 and dose 2 of varicella?

Answer 39

at least 3 months | 1 month if older than 13 years old

Question 40

what is the recommendation for MMR vaccination for infants less than 12 months old traveling abroad to endemic area?

Answer 40

all infants 6-11 months should receive at least 1 MMR vaccine (still require 2 doses of MMR after 12 months of age)

Question 41

What is the minimum age at which only 1 dose of influenza vaccine is recommended for children who have not previously received an influenza vaccine?

Answer 41

9 years old

Question 42

What test modality is the most accurate and specific regarding sensorineural hearing loss, especially following meningitis?

Answer 42

Auditory brainstem response (ABR)

Question 43

What is the recommended catch-up schedule for a patient who has never received pertussis/ tetanus containing vaccine?

Answer 43

Tdap followed by Td in 4 weeks followed by 2nd Td 6 months later

Question 44

what is the contraindication for the Rotarix (live, oral human attenuated monovalent rotavirus) vaccine?

Answer 44

Anaphylactic allergy to latex

Question 45

Is it safe to administer the varicella vaccine to nursing mothers without evidence of immunity regardless of the age of their infant?

Answer 45

Yes (does not transmit into breastmilk) | do not give to pregnant women

Question 46

When can children move from booster seats to standard seat blets?

Answer 46

reached 4 feet 9 inches tall and between ages of 8-12 years old (should still be in the rear with a lap and shoulder belt)

Question 47

What are the first permanent teeth to erupt?

Answer 47

1st molars (known as the 6 year molars) or the lower central incisors

Question 48

What is the next best step in management of an unimmunized child that is in contact with a person with active varicella infection and has no personal history of prior varciella infection?

Answer 48

Varicella vaccine administration within 3-5 days of contact | as long as older than 12 months

Question 49

What are the recommendations for routine cholesterol screening?

Answer 49

universal screening at 9-11 years old and again at 17-21 years old

Question 50

How long should a pt wait to receive a live attenuated vaccine after being treated with more than 2 mg/kg/day of steroids for more than 14 days?

Answer 50

at least 4 weeks after steroids complete

Question 51

What is the appropriate needle size for an intramuscular vaccination?

Answer 51

1 inch for 4 month old thigh | 1.5 inch for 120 kg deltoid muscle

Question 52

How often should sexually active adolescents be screened for gonorrhea and chlamydia?

Answer 52

yearly

Question 53

what is the recommended varicella vaccination schedule for an unimmunized child older than 13 years old?

Answer 53

2 doses at least 4 weeks apart

Question 54

How long should a patient remain in a forward facing 5 point harness carseat?

Answer 54

until exceed the weight and height limitations of the carseat, then transition to booster seat

Question 55

What vaccines are contraindicated for pregnant women?

Answer 55

Live attenuated vaccines | MMR, Varicella, live influenza

Question 56

What are contraindications for flu mist?

Answer 56

1) asthma/ reactive airway 2) pregnancy 3) diabetes 4) immunocompromised 5) chronic heart disease 6) chronic renal disease

Question 57

What is the typical time period that the MMR vaccine is not effective if patient receives IVIG?

Answer 57

2 weeks prior to IVIG and up to 11 months after IVIG

Question 58

What is the possible risk of given a patient younger than 4 years old Proquad (MMRV)?

Answer 58

febrile seizures

Question 59

What is the recommendation regarding Polio vaccination for patients traveling to country with active polio cases for longer than 4 weeks?

Answer 59

5th Polio dose if last dose was over 1 year ago

Question 60

What vaccination is contraindicated for individuals who live with severely immunocompromised individuals?

Answer 60

live attentuated Influenza

Question 61

When should an MMR or Varicella vaccine be given if a patient is on high dose ( greater than 2 mg/kg/day) of prednisone?

Answer 61

At least 4 weeks after completing prednisone treatment

Question 62

What is the potential complication related to breastfeeding a preterm infant without supplementation?

Answer 62

hypoproteinemia (low protein due to rapid growth and high protein demand)

Question 63

What is a possible adverse reaction that can occur with the Dtap vaccination?

Answer 63

prolonged period of crying and inconsolable state for more than 3 hours

Question 64

what are the 2 requirements for a passing CCHD test?

Answer 64

1) oxygen saturation of 95% or above | 2) 3% or less difference between upper and lower extremity

Question 65

what is the preferred test to assess for TB in patient under 2 years old?

Answer 65

TST

Question 66

What is the best initial step in management for patient under 4 years old who had direct contact with TB positive person?

Answer 66

start latent TB infection treatment (despite negative TB screen) and repeat screen in 10-12 weeks (if negative, then can stop tx)

Question 67

What is the recommended catch-up vaccination schedule for patients older than 15 months of age and who have not had a prior HIB vaccine?

Answer 67

single dose needed

Question 68

What is the recommended catch-up vaccination schedule for patients older than 24 months of age who have not had a prior prevnar vaccine?

Answer 68

single dose needed

Question 69

What is the minimum age at which only 1 dose of Influenza vaccine is recommended in children who have not been previously vaccinated?

Answer 69

9 years old