Flashcards in Preventative Peds Deck (111):
lead screening ages
level causing cognitive issues
level for chelation
level for severe tox
lead lines: calcification on bone xr, basophilic stippling
cognitive delay 10-20
chelation at >45 mcg/dl
>60: severe tox: ha, encephalopathy, above signs
type of level needed to base lead treatment on, and other studies for confirmation of lead poisoning (3)
venous lead level
XR long bones
When is DTaP given?
2, 4, 6,15 mos and kindergarten
S/e of DTaP
fever, irritability, local erythema
Tdap vs DTap
DTaP NOT used in anyone older than 7y (DTaP has higher diphtheria toxoid)
Adolescents 11-18 should get what if they had DTaP?
Rule of Td, Tdap
Tdap (Boostrix and Adacel)
Rule: need 5 yrs between Td and Tdap, unless very high risk then after 18 mos ok
Adolescents can receive what two vaccines, and time rule?
Tdap and MCV4, ok on same visit or wait 1 month
Which should be given to adol if they need tetanus toxoid?
What if not finished original tetanus series?
Tdap > Td
If no primary tetanus vaccination series, then ALSO needs tetanus IG
CAtch up regarding Dtap?
7-9y: 3 doses of Td, 1 --> 4wk --> 6 mos
10: Tdap for one dose can count as adolescent dose
11-18 y: two Td, one Tdap
Can check Ab concentrations to determine if prior immunity is inadequate
what to do if tdap in <7 of 4, 5 dose
3. if 7-9
1. redo, even on same day
2. its okay, just give DTap for 5th
3. tdap can count as adolescent booster, and give Td 10 yrs later
Can DTap be given for an adolescent?
it shouldn't be, but it would count
Precautions for Tdap vaccine? (3)
When is okay (5)
1. GBS after previous tetanus toxoid vaccine (w/in 6 wks of vacc)
2. progressive neurologic disorder due to the pertussis part
3. Defer if acute illness until resolved, or if hx of severe Arthus hypersens rxn after prior dose, defer 10yrs
4. okay to give vaccine if prior limb swelling, brachial neuritis, pregnancy/BF, immunosuppressed, minor illness
The situation with latex allergy and Tdap?
If anaphylaxis rxn, then would not give standard vaccine, but the single dose Boostrix and Adacel are latex free
When to give Tdap to pregnant lady?
T2 or T3, or immediately postpartum to prevent mother contracting and passing to baby (Td or Tdap)...
Should adol 11-18 w/ x pertussis receive Tdap?
Invasive Hib disease before age 5 prior to vaccination? Mortality rate?
1/200, 5% mortality
When are children at risk for Hep B? (three risk categories)
2. early childhood from household/daycare
How often are risk fx identified in childhood case of Hep B?
Typical timing of Hep B vaccinations?
birth, 1-2 mo, 6-18 mo (after 1st dose)
When should a newborn get hep B IG?
If mother is HBsAg positive or unknown hepatitis status
(If unknown, can give HBV, then wait to see if mom is positive within 7d, or just give if baby unstable in any way)
Only contraindication to Hep B vacc?
severe allergic rxn to dose, (Not pregnancy, SLE...)
When can't you give the DTaP, HeB, IPV combo vaccine?
1. >/= 7 y
2. prior to 6 wks of age
What strains does the new MCV4 vaccine provide coverage for?
What doesn't it cover?
A, C, Y, W-135
B is the common Bad strain of menigococcus, most common in Babies.
Who gets MCV4 vaccination? (3 groups)
Is it okay in HIV pos kids?
Is it sub q or IM comp to MSV4
If MSV4 was gievn, when can MCV4 be given in high risk patients 2-10 yo?
Preadol 11-12 y
adol at HS entry or 15yo
college dorm students
ok for HIV pos kids over age 2
MCV4 is IM, MPSV4 is sQ
need three yrs between MPSV4 and MCV4
HPV can be given to who?
age 9-26. recommended for 11-12yo
When is 2nd dose MMR given? WHy
Any time 4 wks after first, before age 11-12. Usu between 4-6y
Give the 2nd dose b/c 5% of children don't respond to only one dose. (99% respond after 2 doses)
When do you give MMR vs Measles IG in patient exposed?
Within 72 hrs of exposure: MMR vaccine protects if at least 6mos old.
If 72 hrs - 6 days, need Measles IG
All HIV infected within 6 days exosure regardless of previous vaccination
5% of kids get what reactions with MMR?
high fever and rash 7-12 days later, lasts 1-2 days... reassure
If someone gets measles Ig, when should they get MMR vaccine?
5-6 mos later (passive blocks active immunity)
contraindications to MMR?
Pregnancy (though no birth defects documented), immunodef (EXCEPT HIV), severe allergic rxn
PPD and MMR relationship
MMR and TB?
No PPD in 4-6 wk period after MMR is given.
If TB, no MMR (it can worsen TB)
Vaccine skin testing?
MMR NO (not enough egg)
Yellow fever: yes (Yellow Yes)
Influenza: yes (Indeed Yes)
Epi pen jr to what weight?
30 kg , 66 lbs
WHo gets what pneumococcal vaccine?
PCV-7 (Prevnar): 2,4, 6, 12 mos
PPV-23 (pneumovax): kids over 2y w/ chronic illness or asplenia (not immunogenic in kids < 2)
Rota vaccine: pentavalent bovine
Who? how many?
Rules about timing?
infants: 2, 4, 6 mos
(4-10 wk intervals x3)
First dose not after 3 mos, all w/in 32 wks
When to give varicella vaccine? How many?
12- 18 mos, and older children
if > 13y, need 2 doses four weeks apart
Contraindications to Varicella vaccine?
2. allergic rxn (gelatin, neomycin)
3. cellular immunocomprose (child on hi dose prednisone)
Special vaccine for pts w/ ALL in full remission.
Live vaccines are?
MMR and varicella
aluminum hydroxide and phenoxyethanol are in what vaccine and pose concern for allergy?
in hep A vaccine for people allergic: do not give
Hep A should be given how long before travel to endemic area?
Must be what age
12 months (may need immune globulin instead if travel to endemic area)
Influenza vaccine ages recommended
standard 6-60 mos
everyone > 6 mos if risk fx
What defines HTN and when do we screen?
HTN: BP > 95% for age x 3, one month apart
Start screening age 3
Is there hearing loss with choleastoma or tympanosclerosis?
What causes most common hearing loss?
Most severe hearing loss?
OM w/ effusion
Atresia of ear canal
Management for kid with parent total cholesterol > 240
Screen w/ nonfasting. If >170 rpt / get fasting lipoprotein.
>130: diet only
>190: diet, meds
Management of high cholest in kids w/ smoking, htn, obesity, dm, poor exercise
Check nonfasting cholesterol, *170 cut off, 190 rule for meds
Management of child w/ parent/grandparent w/ coronary atherosclerosis, event before age 55y:
GEt fasting lipoprotein right away, if >110 repeat, consider diet.
If >160 may need meds after diet.
Risk factors for hypercholeterolemia: (7)
Exact cholesterol screening numbers:
parent > 240
parent, grandparent, aunt, uncle < 55y
Situations where hyperviscosity (polycythemia in VENOus sample) syndrome should be considered (4)
2. twin/twin transfusion
3. delayed cord clamping
4. infant of diabetic mother
Polycythemia often co-occurs with what two other things?
hypoglycemia (think: RBC take up all the sugar)
loss of visual acuity due to active cortical suppression of the vision of one eye (can be deprivational)
Esophoria vs esotropia?
Esophoria: inward deviation of eye only found when eye is covered / uncovered. Esotropia is inward turning of the eye
eye alignment difficulty when significant focusing effort is required. Most normal children have this mildly, and its the refractive state most likely seen in three year old.
describe cover / uncover test.
ask child to look at spot, cover one eye. If esotropia, the uncovered eye moves outward to find the spot. If exotropia the uncovered eye moves inward to find it. (Compensation)
If a child has a cataract, what might be the problem with vision? (2)
depth perception, may result in amblyopia if not picked up.
optokinetic nystagmus is normal when?
in newborn at birth
when can infant fixate?
Fix at 6 WEEKS
when can infant color perception occur?
Binocular vision w/ convergence?
Pref for patterns
Color at 2 mo
Binocular + convergence at 3 mo
Preference for patterns at 4 mo
Typical acuity of 1 mo old?
PPD 5-10mm is insignificant except when (3)
close TB contacts, Pos XR findings, Immunosuppression
How do you decide what to do with newborn of mother w/ active TB disease or a positive CXR?
Infant CXR: If negative: INH. If positive Triple meds
What do you do w/ Newborn of mother w/ +PPD and negative CXR?
Check PPD every 3mos.
If +, but neg CXR --> INH x 1 yr
If +, and CXR pos --> triple meds
Who do you prophylax if exposure to meningococcus?
household and daycare contacts only (not school contacts)
Who do you prophylax if H flu contact?
Who do you prophylax tx for TB exposure
What do you tx with?
Active TB only in
-household contacts (3 mos INH regardless)
-If PPD positive: 9 mos INH
What is the key for determining infectivity of TB?
Sputum for Acid Fast Bacilli, NOT CXR.
Prophylactic treatment for Hep A?
All households and sexual contacts should be treated with IgG IG.
Maybe also those in the same room (but not classroom exposure in general)
Hepatitis B revaccination in the event of a needle stick for:
1. infants and unvaccinated people should get HBIG and vaccine series started.
2. IF they had series and are Ab +, they need no more tx
3. If they received series but are Ab -, consider unvaccinated: HBIG + series.
4. If unknown, check for antibody
UV light, A vs B
-which is strongest during business hours and what does it cause?
-which is present all day and what does it cause?
B: business: skin aging, sunburn, skin cancer
A: all day constant: photosensitivity rxns, contributes to above probs.
Using sunscreen in pedi population before age 20 decr risk of sun exposure by how much?
What weight can you turn the carseat forward facing?
Rules for switching to booster?
4 yrs AND > 40lbs
When can a kid sit in the front seat?
age 12 at least
bicycle helmets reduce serious injury by how much, and what % of deaths are due to head injuries?
reduce injury by 85%
75% deaths due to head injuries
What % of US households have firearms?
HAving a gun in the home increases risk of adoles suicide by how much?
Group at highest risk of suicide?
Drowning higher in what demo group?
(Males 75% comp to females)
AAP rec for home pools?
four sided fence w/ locked gate. Above ground pools safer
Do infant / toddler swim programs prevent drowning?
Rule of linear growth in orphanage?
loss of 1 month of linear growth for every 3 mos in orphanage
(developmental milestones in accordance w/ linear growth)
% of low birthwt infants due to smoking in pregnancy?
Meds used in adolescent tobacco quitting?
FDA has NOT approved nicotine replacement. Counseling first. If needed, consider nicotine replacement then buproprion + counseling.
when does colic stop?
amount of crying normal from birth to 6 wks?
Then after 6 wks?
2h/day --> 3 h/day
percentage of children with bladder/bowel control by 36 mos?
Risk of enuresis if 1 parent and 2 parents have hx?
Causes of enuresis?
Sickle Cell or Seizures
recurrence of enuresis w/ tx with desmopressin?
% of children with enuresis at age 5y
% of enuresis cases that resolve yearly without intervention?
most likely dx in new onset diurnal enuresis?
behavioral withholding pattern
timing of breath holding spells?
simple breath holding spell vs complex
simple: becomes pale/cyanotic, complex: LOC
time when active measures should be taken for thumb sucking?
response to divorce in early school age 6-8y vs late 9-12y?
early; overt grieving, guilt, fantasies parents will get back together
late: anger, open mourning
Sequence of reaction to child w/ malformation?
STages of grief?
M/F ratio for teens w/ conversion?
F 3:1 M
ave tv watching per week in kids?
which sleep disturbance occurs during first third of night?
% of kids w/ ADHD?
do we use acellular or whole cell vaccines for pertussis, and whats the difference?
we use acellular, its less efficacious but less reactogenicity... (why there is incr cases now.)
VAccination if mom HepBsAg pos
at birth, 1 month, 6 months. No lead way
Unless small, in which case really need 4 doses
what age can you get the live attenuated flu vaccine?
2y and healthy
virus vaccine most likely to be transmitted to susceptible household contact?
OPV! very rare in varicella, not in MMR, very rare in Rota, very rare in live attenuated influenza
who gets meningococcal vaccines
what are the types
conjugated better than polysaccharide.
Conjugated for adolescents
Not effective against serotype B, which causes disease in infants
school age child with lacy reticular rash on extremities
adol with postauricular and occipital adenopathy and DISCRETE maculopap rash on face
Rubella (measles is confluent)
HHV 6 also called what and typical presentation
Roseola: high fever then rash