Unit 1: vaccines, universal screenings, developmental milestones, bright futures. Flashcards
1
Q
universal screenings at birth?
A
hearing, bilirubin, PKU, congenital hypothyroid, sickle cell, CHD
2
Q
PKU screen was done <24h of age. When should it be re-tested?
A
by 2nd week
3
Q
untreated hyperphenylalaninemia results in?
A
intellectual disability, light complexion, eczema, seizures, hyperactivity
4
Q
institute _____ dietary restrictions shortly after birth to prevent neurodevelopmental effects of ???
A
PKU
5
Q
3 screening methods for PKU?
A
BIA: Guthrie Bacterial Inhibition Assay (BIA)
AFA: Automated fluorometric assay (AFA)
TMS: Tandem mass spectrometry (TMS)
6
Q
newborn screening tests mandatory?
A
thyroid function & PKU
7
Q
T or F: PKU testing should only be performed after the infant has ingested b.milk or formula
A
True. Abnormal results should be f/u w a venous T4 &; TSH
8
Q
infant w abnormally pitched cry may indicate which genetic disorder?
A
hypothyroidism. due to lethargy & delayed mental responsiveness
9
Q
two tests for sickle cell?
A
NO SOLUBILITY TESTS
- *hgb electropheresis
- HPLC: High performance liquid chromatography
- *DNA analysis
10
Q
T or F? IEF & HPLC are both sensitive and specific for sickle cell?
A
true
11
Q
what age do you perform confirmatory testing for sickle cell?
A
2 months
12
Q
What prophylactic med should be started by 2mo for a sickle cell baby?
A
PCN
13
Q
Important immunization for sickle cell babies?
A
Pneumococcal
14
Q
at what age MUST hearing be confirmed by?
A
3 months
15
Q
what well-checks include maternal depression screening?
A
1,2,4,6 months
“1,2,4,6, lets make sure that moms not sick!”
16
Q
what age do primary teeth usually erupt?
A
7 months
17
Q
when do you start oral health screenings?
A
6 months
18
Q
which well-check visits include oral health screenings?
A
6 & 9mo. Dental home to be established by 12mo but PCP can continue to screen at every visit if child does not establish w dental home
19
Q
child stands alone, follows 1-step commands, imitates peek-a-boo. age?
A
9-11mo
20
Q
child lifts head, turns side-to-back, & smiles. what age?
A
1-2mo
21
Q
child develops a mature pincer grasp. age?
A
12mo
22
Q
child is building blocks w 3-4 cubes, can scribble, follows 2-step commands. age?
A
18mo
23
Q
child verbalizes need to potty. age?
A
2y
24
Q
child sits independently. age?
A
6-8mo
25
child crawls. age?
9mo
26
child runs. age?
18mo per CDC. unclear in Hay
27
child walks backwards. age?
30mo
(as if you're making fun: "only a Thirrrrtyyyy moonnnth old would think walking backwards is cooooool")
or
("you take those 30 snakes right BACK where they came from)
28
child begin to use pronouns. age?
24mo
29
child holds crayon w fist. age?
30mo ("that kid has 30 crayons in his fists!")
30
child holds crayon w fingers. age?
3y (takes 3 fingers to hold a crayon)
31
can a 4-5yo tie shoes?
no, only lace
32
child COPIES drawing a circle at what age?
3y
33
child copies a cross at what age?
4y (4 quadrants in cross)
34
child copies a triangle at what age?
5y
35
child draws vertical lines at what age?
2y (2 lines... parallel lines... parallel play)
36
child can scribble at what age?
18mo
37
child will imitate scribbling at what age?
15mo
38
child uses tricycle at what age?
3y
39
child alternates feet up the stairs. age?
4y
40
child kicks ball. age?
2y (takes 2 feet to kick a ball)
41
child throws ball. age?
18mo
42
child engages in parallel play. age?
2y
43
child engages in cooperative play. age?
4y (double that of parallel play milestone at 2)
44
child reaches w one hand. age?
6-8mo (passes from hand to hand. babbles)
45
child reaches w both hands & puts object in mouth. age?
3-5mo (drooly baby)
46
child has 4-word phrases. age?
4y (4 words, 4 years)
47
child says "you, me, and I" & makes 3 cube bridge. age?
3y (3 pronouns, 3 cubes)
48
child jumps w 2 feet. age?
2y (takes 2 feet to jump with 2 feet.....)
49
child has 4-20 words. age?
18mo (w/i word count range)
50
child has 1-2 word vocabulary at least. age?
12mo
51
child coos. age?
3-5mo
52
child babbles. age?
6-8mo
53
child draws person as circle. age?
4y (4 arcs make up a circle)
54
child draws a person w appendages & eyes but no torso. age?
4-5y (4-5 appendages = 4-5y)
55
child follows 1-step commands. age?
9mo
56
child follows 2-step commands. age?
18mo (double their 1-step @ 9mo)
57
when do you conduct anemia & lead testing?
12mo & 24mo (or 1 & 2y)
58
what ages do you perform developmental screening?
9, 18, 30mo (memory tool: some kids develop at 9, some at 18, some not until 30)
59
what ages are screened for ASD?
18 & 24mo
60
earliest age a child can be dx'd w ASD?
2y
61
4 most common EARLY characteristics of autism?
1. consistent failure to orient to one's name
2. failure to regard people directly
3. failure to use gestures
4. failure to develop speech
62
what age should universal VISION screenings start?
3y (they can use a chart now, you no longer have to test red reflex to assess if the pt can see)
63
what tests are used for vision screening?
visual acuity using HOTV (letters) LEA (shapes)
64
what age can you stop screening for red reflex?
3y: when they start reading the chart
65
what is assessed in vision screening for birth-3y?
inspection, alignment, visual acuity, red reflex
66
what age should audiometry be performed?
birth, 4y
67
by age 3 what vaccines should you have?
```
4 Dtap
4 pvc13
3-4 HiB
3 hep B
3 RV
3 IPV
2 Hep A
1 influenza
1 varicella
1 MMR
```
(3 years ago, 3-4 Horses split 4 Dr. Peppers and 3 RIBs, 2 Ate 1 INch of VegeMite)
```
10 types total. 25-26 doses total (when counted uncombined)
4 = D&P
3-4 = H
3 = B, RV, IPV
2 = A
1 = In, V, M
```
68
3 allergies contraindicated for vaccine?
egg, yeast, gelatin
69
what vaccine should not be given for current gastroenteritis or hx of intussusception?
rotavirus
70
what vaccine should NOT be given to people w serious allergic rxn to YEAST?
Hep B (think B for bread or bakers' yeast)
71
what vaccine has a small increased chance of febrile seizures when given w the flu vaccine?
PVC (think PNA + FLU would be a HIGH fever)
72
what vaccines are contraindicated in pregnancy?
"Vagina Is A Monster" =
| Varicella, IPV, Hep A, MMR
73
children or adolescents receiving long-term Aspirin therapy should NOT receive what vaccine?
LAIV (flu)
74
What law requires VIS?
NVCIA: national vaccine childhood injury act (federal law)
75
Severe allergic reaction or encephalopathy not attributable to another cause w/i 7d of admin is a TRUE contraindication for which vaccine?
Dtap
76
What documentation is required for every vaccine admin?
manufacturer, vaccine lot #, expiration date, injection site, nurse signature, parent signature
77
T or F. Polyvalent pneumococcal vaccine (PNA23) is recommended for children under 2y w chronic disease (including DM)?
False.
polyvalent = PNA23 = 2y+
PVC13 = 6w+
78
only contraindication to Hep B vaccine?
prior anaphylactic rxn or severe hypersensitivity
79
live attenuated virus vaccines include?
MMR, RV, varicella
| to stayin alive: "M-M-R-R, VARI alive, VARI alive"
80
severe allergy to _____ is contraindication for MMR?
the mycins
81
what type of immunity is developed after contracting chickenpox?
active natural
82
8 month old should have what vaccines?
3 Hep B
3 RV
3 PCV
2 IPV
"for 8 months, 3 Boys Raced Perilously 2 INdiana"
83
immunocompromised adults require which type of vaccine?
inactivated
84
a 2mo got vaccines & mom calls 12h later. states infant has fever 101F. what is most likely cause?
PERTUSSIS immunization
85
what vaccine can be given to kids <7 if they cannot tolerate the pertussis component?
TD
86
complete primary dentition (20 teeth) is usually present btwn what ages?
30-36mo
87
safest place in car for all kids <13?
middle back seat
88
how long should kids stay rear facing?
as long as possible. til they max out height, weight indicated by carseat
89
what age would be sitting w a booster?
8-12yo
90
when can child use lap & shoulder belt?
when belt lies across middle of chest & shoulder. lap belt lies across upper thigh. child is tall enough to sit against back seat w knees bent over edge of seat without slouching. TYPICALLY 10-11YO
91
whats an indication child has outgrown booster seat?
shoulders are above top harness slots, tops of ears reach top of seat
92
when should carseats be replaced?
after moderate-severe car crash
93
crib bars should be no more than _____ inches apart?
2 & 3/8 inches
94
crib mattresses should have no more than ____ fingers fitting btwn mattress & side of crib?
2
95
when should you remove crib bumpers?
when child can push up
96
what temp should water heater be set at?
120
97
signs of hunger in infant?
sucking, rooting, fussing, hands in mouth, crying is late sign
98
signs baby is full?
closes mouth, turns head
99
if baby sleeps past 4h what should mom do?
wake baby to eat
100
how often should mom breastfeed baby per day?
8-12x
101
how many wet diapers do you expect to see in babies?
6-8 wet diapers
102
how many stools should babies have a day?
3-4x (1/2 amount of wet diapers)
103
what color poops do you expect from breastfed baby?
yellow/green, seedy, pasty
104
if mom is vegan or had gastric bypass what does she need to supplement?
b12
105
moms exclusively breastfeeding need to supplement?
vitamin D
106
first 6mo of life diet should be?
breastmilk or iron-fortified formula ONLY
107
how often should mom bottle feed?
2oz Q2-3h (20oz/day)
108
what is essential for mom to do while bottle feeding?
look at baby to promote bonding. dont prop bottle
109
normal stool color for formula-fed baby?
yellow-brown pudding
110
how should temp be checked?
rectal
111
what temp warrants eval?
100.4 or higher (especially in <3mo)
112
babies should always be placed on _____ to sleep
back. "put baby BACK to sleep"
113
cord clamp is removed after ____ hours?
24
114
how long does it take for stump to dry up and fall off?
10-12d
115
how should mom clean umbilical stump?
water, air dry, keep diaper below stump
| s/s infection = purulent drainage, foul odor, redness
116
circumcised babies need to keep what applied to wound for the first 24h?
petroleum gauze
117
how should mom care for circumcision?
clean with water, DOESNT NEED SOAP, monitor for infection
118
how long does it take circumcision to heal?
5-7d
119
T or F. pt must be given VIS before EVERY vaccine in a multi-dose series?
TRUE
120
pt has low-grade fever, runny nose, mild diarrhea. can they be vaccinated?
YES. mild illness is NOT contraindication
121
what medication is a reason to defer vaccination?
TAMIFLU
122
reasons to NOT receive vaccine?
chronic health condition (CA), weakened immune system (chemo, certain meds s/p transplant), prior severe allergic rxn to same vaccine
123
when is it ok for a child w cancer to receive a vaccine?
remission or 90d post chemo
124
how long should live virus vaccine be delayed if an immunoglobulin or blood product was given?
3-11mo
125
should a congenitally immunodeficient child be immunized with live vaccines?
Nooooooo
126
barriers to vaccines?
parental concerns, need for multiple visits, cultural differences, financial constraints
127
what type of immunity is developed in response to infection?
active
128
example of artificially acquired active immunity?
vaccines
129
T or F. active immunity is permanent
True
130
onset of active immunity is ?
2-4 weeks
131
passive immunity is short term or long term?
short term
132
how does a person get passive immunity?
given antibodies to a disease
133
how does passive immunity artificially occur?
injection of antibodies (gamma globulin- IVIG)
134
onset of passive immunity is? what is duration?
24h (immediate). 4-6mo
135
when a significant proportion of the population is vaccinated, what does this provide?
herd immunity
136
what specific population is herd immunity effective for?
the population who cannot safely receive vaccines (immunocompromised, etc)
137
when checking a newborns reflexes, what are you ensuring?
brain & nervous system function
138
how do you elicit the rooting reflex?
stroke corner of babies mouth, baby turns head & opens mouth
139
how long does ROOTING REFLEX last?
4mo (4 baby piglets rooting in the mud)
140
how do you elicit sucking reflex?
touch roof of mouth
141
when is sucking reflex fully developed?
36 weeks in utero (premies will have week suck)
142
how do you elicit moro reflex?
startle baby in response to sound
143
how long does MORO REFLEX last?
2 mo ("fool me twice shame on you")
144
what is TONIC REFLEX?
"fencing" head is turned to one side & extends that arm, opposite arm bends up at elbow (they look like a fencer "on guard")
145
how long does tonic reflex last?
5-7mo (fencing for 5-7 months)
146
how do you elicit grasp reflex?
stroke baby's palm
147
how long does grasp reflex last?
5-6mo ("baby grasps onto 5-6 fav toys)
148
how do you elicit stepping reflex?
hold upright with feet touching solid surface
149
how long does stepping reflex last?
about 2mo ("twostep")
150
when is developmental surveillance conducted?
EVERY PREVENTATIVE VISIT THRU CHILDHOOD
151
when is developmental screening conducted?
9, 18, 30mo
152
why is developmental surveillance important?
catch developmental disabilities
153
what are 3 things developmental surveillance & screenings promote?
healthy development, prevent delays, identify children w delays/disabilities EARLY
154
key components of developmental surveillance?
ask about child's learning, development, behavior
155
at what age should a child walk and at what age should you be worried they are NOT walking?
12mo, 18mo
156
when should thyroid hormone replacement start for infants with congenital hypothyroidism?
within 2 weeks of birth. at LEAST within first month
157
what labs are monitored in sickle cell screening?
hemoglobin & reticulocytes
| HGB's: FS, FSC, FSA (S>A)
158
what is the name of the test that confirms sickle cell?
hgb electrophoresis
159
should soluability test be used to confirm sickle cell?
no, they won't identify hgb variants except for S
160
what age group kids w sickle cell should be taking PCN prophylactically?
2mo-5y
161
what immunizations should be given for sickle cell kids?
PCV & polysaccharide vaccine
162
when do infants need to be referred to a dentist?
6m or 1st tooth, def by ONE YEAR
163
what common bacteria colonizes baby's mouth and increases risk of carries?
streptococcus mutans
164
when should all babies have a carries risk assessment done?
6mo
165
when should oral hygiene start?
birth. clean gums w moist cloth. when teeth erupt brush w soft toothbrush & fluoride toothpast
166
when should kids be weaned from the bottle?
12-18mo
167
child lifts head with good head control. age?
3mo
168
child has ulnar grasp. age?
3-5mo (uses 3-5 fingers)
169
when do kids start to show signs of dominant hand?
not before 1y. most 18-30mo
170
when do you stop measuring head circumference?
2y
171
when do kids typically start to stay on the same growth curve on the growth chart?
18mo
172
when should BP screening start?
3y if not high-risk
173
when can kids have first TB test?
3mo
174
most common cause of death in kids?
MVA
175
what is the most common initial symptom of sickle cell? occurs in up to 50% of children before age 3.
hand-foot syndrome (dactylitis)
176
along with prophylactic PCN, what other daily med is recommended for sickle cell kids?
oral hydroxyurea
177
what are some risks AW bilateral congenital hearing loss?
family hx, facial/cranial abnormalities, being in NICU >2d
178
at which point should a child switch from the harness system to a booster with the seat belt?
5y. booster til 8 &/or 4'9".
179
hepatitis b immune globulin (HBIG) provides?
passive immunity
180
what vaccine should be referred for a child with progressive neurological disorders until they are stable?
DTAP
181
baby is born to HBsAG-positive mother. what should you do for baby?
give hep B immune globulin (HBIG)
182
people who have not HAD chickenpox or the vaccine and should be targeted to do so include?
daycare workers, >8yo HIV patients with CD4 count >200
183
pregnancy should be ruled out and prevented for 3mo with what vaccine?
MMR, MMRV
184
should a child ride in a carseat on an airplane?
yes
185
needle length for newborns?
5/8"
186
needle length for 1-20mo?
1" in thigh
187
needle length for 1y-18y?
1 & 1/4" in thigh
188
untreated PKU leads to?
intellectual disability
189
hep B should not be given to a person w a hx of anaphylactic rxn to?
bakers' yeast
190
most common route of Hep A transmission?
contaminated food or water
191
baby can roll from back-to-stomach. age?
6-7mo
192
when do they grasp cubes with raking motion?
3-5mo (ulnar grasp)
193
when to perform PKU screen for premature or ill infants?
7d
194
treatment for congenital hypothyroidism?
levothyroxine 10-15mcg/kg/day with serum monitoring done by 2w of life.
195
when is the latest confirmatory testing for sickle cell can be performed?
2mo
196
what can reduce the number of cariogenic bacteria? how often recommended?
CHG oral rinse, 3mo intervals
197
what is ankyloglossia?
tongue tie
198
parent edu for fluoride varnish?
don't brush teeth til next morning. soft foods.
199
when does separation anxiety start?
8-9mo
200
milestones: laughs, anticipates food on sight, turns from back-to-side. age?
3-5mo
201
milestones: walks backwards, begins to hop on 1 foot, uses prepositions. age?
30mo
202
understands 2-step command, carries & hugs doll, feeds self. age?
18mo
203
throws ball, seats self in chair, dumps pellets from bottle?
18mo
204
oldest a baby can receive their 1st RV vaccine?
<15w
205
what blood lead level is considered abnormal? at what level would chelation be indicated? what level is considered urgent?
> 5 = abnormal. >45 chelation. >70 URGENT
206
when does word "no" affect child?
6-8mo
207
what age can infant track object with BOTH eyes?
3mo
208
when are universal screenings for lead?
1 & 2y
209
what can excessive fluoride intake cause?
dental fluorosis or mottled enamel
210
children taking what dose of corticosteroids should NOT be given a live vaccine?
>20mg/day x14+d
211
when is flu vaccine given?
6mo then annually. <9 getting first vaccine should get 2 vaccines that flu season 1 month apart
212
when can children start receiving the the LAIV flu vaccine?
2y, under 2 must receive inactive
213
live virus admin?
can be given together. if NOT given together then MUST wait 4w
214
what is the difference btwn DTaP & Tdap?
Tdap has the booster dose of diptheria while Dtap is the initial immunization
215
what vaccines should be stored frozen?
varicella, MMR,
216
at what age do infants develop the concept of object permanence
9-12mo
217
what are the triad symptoms of ADHD?
impulsivity, innatention, hyperactivity
218
what subtype of ADHD do girls have a higher prevalence of? what about boys?
girls- innatention. boys-hyperactive
219
what does the AAP recommend regarding screen time?
none under age 2, over age 2 only 2h/d
220
newborn universal screenings:
hearing, bilirubin, PKU, congenital hypothyroidism, sickle cell, CHD
221
3-5d universal screenings
hearing, blood confirmations
222
1 & 2 month universal screenings (they're the same)
hearing & blood if not done. MATERNAL DEPRESSION
223
4 month universal screening
MATERNAL DEPRESSION
224
6 month universal screenings
MATERNAL DEPRESSION, oral health, VERIFY early intervention for hearing
225
9 month universal screenings
DEVELOPMENTAL SCREEN
| oral health
226
12 month universal screenings
ANEMIA
LEAD
oral health
227
15 month universal screenings
oral health
228
18 month universal screenings
DEVELOPMENTAL SCREEN
AUTISM SPECTRUM DISORDER SCREEN
oral health
229
2 year universal screening
AUTISM SPECTRUM DISORDER
LEAD
oral health
230
2.5y (30mo) universal screening
DEVELOPMENTAL SCREEN
| oral health
231
3y universal screening
VISION (use HOTV or LEA)
| oral health
232
4y universal screening
HEARING
VISION
oral health
233
vaccine schedule DR HIP mnemonic
Birth: B for Hep B
2m: B DR HIP (hepB, dtap, rv, hib, IPV, pnuemo)
4m: DR HIP (dtap, rv, hib, IPV, pneumo)
6m: B IN DR HIP (hepB, influenza, dtap, hib, IPV, pneumo)
12-18m: MAD HPV (MMR, hepA, dtap, hib, IPV, varicella)
4-6y: VARI DIM (varicella, dtap, IPV, MMR)
234
flu vaccine stuff
starts at 6m, goes until forever. if you're under 9y and you've never had it you get 2 that year, 1 month apart.
contras = egg allergy
SE's: fever, malaise, myalgia
RISK FOR febrile seizures when given w pneumo)
235
MMR vaccine stuff
ITS ALIIIIIIIVE.
contras: PREGNANCY, high-dose steroids, immunocomp, LATEX, NEOMYCIN, GELATIN
SE's: FEBRILE SEIZURE, transient thrombocytopenia, encephalitis
236
IPV stuff
contras: PREGNANCY, mod-severe illness w or w/o fever, allergy to POLYMYXIN B, NEOMYCIN, STREPTOMYCIN
SE's: uncommon
237
PVC13 stuff
contras: mod-severe illness w or w.o fever
| SE's: SITE RXN, fever, irritability, sleep changes, SEIZURES when given w flu vaccine
238
HiB stuff
nada. well tolerated. no contras.
239
Dtap stuff
contra: NEUROMUSCULAR dxs until clarified
| SE's: INCONSOLABLE CRY, fever, hypotonic-hyporesponsive episodes
240
RV stuff
ITS ALIIIIIIIVE. contras: mod-severe acute gastroenteritis, hx INTUSSUSCEPTION, severe combined immunodeficiency (SCID), LATEX ALLERGY
241
hep B stuff
contras: serious yeast allergy
| SE's: uncommon
242
hep A stuff
contras: PREGNANCY, mod-severe illness
| SE's: SITE rxn, HA, loss of appetite
243
varicella stuff
ITS ALIIIIIIVE. contras: PREGNANCY, febrile seizures, T cell abnormalities, allergy to gelatin, neomycin.
SE's: site rxn
244
vaccines to defer for moderate-severe illness
moderate-to-severe like a hangover
"IPA beers"
IPV, PCV13, hepA
245
vaccines cause minor site rxn
"A Painful Vaccine To Me"
| hepA, PCV13, varicella, tdap, meningicoccal
246
vaccines to defer for neuro issues/febrile seizure
"Mental Defects Matter"
| MMR, Dtap, mening
247
vaccines w no rxns
"Baby is Happy"
| hepB, IPV, HiB
248
1-2mo milestones (per Hay)
```
LIFTS & holds head
turns SIDE-BACK
follows objects with eyes
drops toys
alerts to voice
recognizes parents
vocalizes
smiles spontaneously
```
249
3-5mo milestones (per Hay)
```
ulnar grasp
reaches (2 hands) & bring to mouth
raspberry sounds
sit w support
laughs
anticipates food on sight
turns BACK-SIDE
```
250
6-8mo milestones (per Hay)
```
sits alone for short period
reaches w one hand
scoops first then uses thumb
"bye-bye"
passes object hand-to-hand
babbles
ROLLS back-stomach
inhibited by "NO"
```
251
9-11mo milestones (per Hay)
```
stands alone
imitates pat-a-cake & peek-a-boo
thumb & index to pick up pellet
uses furniture to walk along
follows 1-step commands
```
252
12mo milestones (per Hay)
```
walks alone
"mama/dada"
PINCER GRASP
releases cube to cup after demonstration
gives toys when asked
builds 2-cube tower
points to desired object
says 1-2 other words
```
253
18mo milestones (per Hay)
```
3-4 cube tower
throws ball
seats self in chair
dumps pellet from bottle
walks up & down stairs WITH HELP
says 4-20 words
follows 2-step commands
carries & hugs doll
feeds self
```
254
24mo milestones (per Hay)
```
short phrases (2+words)
kicks ball
6-7 cube tower
points to named objects or pictures
2-foot jump
stand on 1 foot
uses pronouns
verbalizes toilet needs
puts on simple garment
turns single pages
domestic mimcry
```
255
30mo milestones (per Hay)
```
walks backwards
hops on 1 foot
uses prepositions
copies circle crudely
points to objects described by use
refers to self as "I"
holds crayon in FIST
helps put things away
carries on convos
```
256
3y milestones (per Hay)
```
holds crayon w FINGERS
builds 9-10 cube tower
3-cube bridge
copies circle
gives first & last name
rides tricycle
dresses w supervision
```
257
3-4y milestones (per Hay)
```
climbs stairs with alternating feet
buttons/unbuttons
answers questions w plurals, personal pronouns, verbs
places toy properly as instructed (in, on, under, etc)
draws circle when asked to draw person
knows own sex when asked
gives full name
draws circle on own
feeds self
takes of shoes & jacket
```
258
4-5y milestones per Hay
```
runs & turns without losing balance
can stand on 1 leg for 10s
buttons & laces (doesn't tie)
counts to 4
able to give 2 of something by direction
draws a person as a head, 2 appendages, possibly 2 eyes, NO TORSO IS THE IDEA HERE)
knows days of the week
answers questions appropriately
copies a + sign in imitation
self toilets (may need help wiping)
plays outside at least 30m
dresses self except for tying
```
259
PKU
phenylketonuria (PKU). autosomal recessive trait.
test at birth. state mandated.
dx = 240-1200 uM (4-20 mg/dL) but pterin levels normal
tx = if consistenly >360uM (6mg/dL) then treat w R-tetrahydrobiopterin & diet
untx = intellectual disability, hyperactivity, seizures, light complexion, eczema
MUST be tested by 2nd week of life if done <24h
260
congenital hypothyroidism
MUST BE SCREEN SHORTLY AFTER BIRTH.
dx: T4 & TSH. abnormals confirmed by venous sample (baby blood draw is usually heel stick)
tx: start hormone replacement asap
untx: thick tongue, large fontanels, poor muscle tone, hoarseness, umbilical hernia, jaundice, intellectual retardation
261
sickle cell
**sickle cell anemia & sickle B0 thalassemia =
ONLY hgbs S, F, A2
tx: PCN daily 2mo-5y
**sickle B+ thalaseemia = hgb S > hgb A & A2
**sickle hbg C = equal amts hgb S & C (but quantity of S
slightly > C)
DX GOLD STANDARD = hgb electrophoresis, HPLC, DNA analysis (NOT SOLUBILITY TESTS)
262
passive immunity per Dr Townsend
A person is given antibodies to a disease rather than producing them through his or her own immune system. This is short term immunity through introduction of antibodies to a disease. Can occur naturally as in the passage of antibodies from the mother to the fetus during pregnancy or artificially acquired through injection of antibodies such as gamma globulin. Onset is within 24 hours of the dose and duration is about 4-6 months.
263
active immunity per Dr Townsend
resistance developed in response to infection with an agent resulting in antibody production. Active immunity is usually permanent. Can be either naturally acquired through exposure and infection with the disease or artificially acquired through immunization. Onset is 2-4 weeks and duration is years to lifetime
264
Herd Immunity per Dr Townsend
This occurs when a significant portion of the population is vaccinated and that provides a portion of immunity for those that have not developed immunity.The population (herd) helps prevent disease in the unprotected population. The herd protects those who can not safely get vaccinations. Generally 90 -95% of the population should be to be vaccinated to have effective Herd immunity.
265
Vaccines for Children program
The Vaccines for Children (VFC) program is designed to help overcome cost as a barrier to childhood vaccination that can be a barrier for some. Under insured children must visit a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) to receive the covered vaccines.
266
permanent molars erupt at approximately what age?
12y
