preventative Flashcards
previously unvaccinated child, age 8, what do you give to protect against tetanus?
Tdap
>age 7
clean contaminated wound, but pt has received less than 3 tetanus vaccines
Tdap (if older than 7)
clean contaminated wound, pt has received 3 tetanus vaccines, but last vaccine was over 10 years ago… what do you give?
Tdap
OR Td if already received Tdap in the past
dirty contaminated wound, but pt has received less than 3 tetanus vaccines
tetanus immunoglobulin
or IVIG if TIG not available
also vaccinate!
dirty contaminated wound, pt has received 3 tetanus vaccines, but last vaccine was over 5 years ago… what do you give?
Tdap
OR Td if already received Tdap in the past
when do you give hep B immunoglobulin?
- if mother is infected with HepB (HBsAg positive) or unknown status in the newborn’s first 12 HOL*
- also to unvaccinated people and infants after needle stick or contaminated blood exposure
*also will need routine immunizations
when do you test for hepatitis in babies born to positive mothers?
test at 9-12 mos
**remember these kids need HBIG in first 12 HOL, then regular vaccine timeline
What do you do for a child who was exposed to a needle stick of contaminated blood with hepatitis, but they are previously vaccinated and Ab positive
nothing
What do you do for a child who was exposed to a needle stick of contaminated blood with hepatitis, they are previously vaccinated, but they are Ab negative
treat them as being unvaccinated
HBIG and vaccinate
what vaccine cause syncope?
meningococceal
what is the treatment for measles?
IF child is at least 6 months- you can give the measles vaccine if it is within 72 hours of exposures
if you are outside the 72 h window you can give measles IG
what are contraindications to giving the MMR and varicella vaccines? (3)
1- severe allergy (neomycin, gelatin)
2- pregnant
3- severely immunocompromised
contraindications to rota vaccine? (3)
1- h/o intussuception
2- SCID
3- allergy
what vaccines do you need to worry about in children with egg allergy
yellow fever
flu (if egg allergy is severe)
what should water heaters be set at to prevent burn?
120 degrees F
adolescents are most likely to drown where?
fresh water
what vaccines are given subQ (4)
1- MMR
2- varicella
3- MMRV
4- IPV
rest IM
at what age do you not need to immunize with HiB for catch up?
5
ppx for child <1 y/o going to Hep A endemic area
passive immunization with immunoglobulin 4 weeks prior to travel
ppx for child >1 y/o going to Hep A endemic area
vaccine
what is a common side effect of the MMR vaccines
high fever (>103) within 12days that can last for 1-2 days can also have rash (5%)
what are the live vaccines?
LIVE! Small Yellow Chickens get Sabrin's & MMR! - small pox - yellow fever - varicella - oral polio (sabins) - MMR & rota
can you give the MMR and a PPD at the same time
YES
but if you give MMR without PPD, then you need to wait 4-6 wks to place PPD as the MMR can suppress tuberculin activity after a few days
you diagnose a child with varicella - who would you give acyclovir or VariZIG (Ig) to? (5)
1- immunocompromised + unimmunized
2- pregnant + unimmunized/neg Ab
3- hospitalized preemie (>28wk) whose mom lacks immunity
4- all hospitalized preemies <28 wks
5- newborn infants whose mother contracted varicella 5 days before birth-2 days after birth
when can you give a child on chemo live vaccines?
3 months after you stop chemo
except can give varivax to children in remission from ALL because benefit outweighs risk
you diagnose an immunocompetent child >1 y/o with varicella, what do you do to treat
give varicella vaccine if it’s within 72 hours of exposure
at what age do you not need to immunize with pneumococcal vaccine for catch up?
5
when do you need to receive 2 doses of the flu vaccine?
the first year you receive the vaccine if you are age 6mo-8ys
at what age do you screen of HTN
3yrs
at what age do you screen for cholesterol
9-11 yrs
younger (5-9) if risk factors- family hx or high risk condition
when do you use a rear-facing car seat?
<2 yrs or <20 lbs
position at a 45 degree angle
what is the safest seat in a car
middle seat
at what age can a child sit in the front seat
13
__% of bicycle-related deaths are d/t head injuries
helmets reduce serious injuries by __%
75%
85%
what % of households have guns
30%
what vaccines contain eggs (3)
influenza and yellow fever and MMR
no a CI to giving flu
what vaccines contain gelatin (2)
MMR and varicella
what vaccine has component of streptomycin/neomycin(4)
OPV and IPV
neomycin- MMR and varicella
what is the optimal water fluoridation content
0.7 ppm
how much fluoride supplementation is needed for a child less than 3
6 mos-3yrs
give 0.25 mg only if water fluoridation is <0.3 ppm
how much fluoride supplementation is needed for a child less than 6
3-6yrs
give 0.5 mg if water fluoridation is <0.3 ppm
give 0.25 mg if water fluoridation is 0.3-0.6 ppm
how much fluoride supplementation is needed for a child older than 6
give 1 mg if water fluoridation is <0.3 ppm
give 0.5 mg if water fluoridation is 0.3-0.6 ppm
what is the most common cause of mortality in kids <1
congenital anomalies
what teeth erupt first
central incisors
then lateral incisors, canines, first molars, second molars
what do you consider in a child with one central incisor
congenital panhypopituitarism
midline defect
what lab tests are indicated for a immigrant child in the US
CBC lead G6PD Hgb electrophoresis TSH
crouzon syndrome
brachycephaly, exophthalmos, maxillary hypoplasia, short beaked nose, intracranial anomalies
apert syndrome
brachycephaly, high cranium, wide-set eyes, midface hypoplasia, choanal stenosis, nasopharyngeal airway, obstruction, symmetrical extremity syndactyly
when do you perform and US if you are concerned for developmental dysplasia of the hip
- any questionable exam
- 4-6 wks in girls with breech positioning >34 weeks GA (even if nl exam)
when do you get an xray in a child with scoliosis
scoliometer measurement >6-7 degrees
when do you do bracing for scoliosis
30-39 degree curve
when do you (definitely) do surgery for scoliosis
> 50 degrees
at what age do children need to receive 2 flu vaccines
previously unimmunized children ages 6 mos- 8ys
what is used for Hib chemoprophylaxis?
eradicates nasopharyngeal carriage of Hib and dreduces risk of developing invasive disease and/or transmission
*Rifampin 20 mg/kg (max 600) qd x4d
who should receive Hib chemoprophylaxis?
- all household contacts with >/= 1 unimmunized or underimmunized contact <4ys
- all household contacts with child <12 mo who has not completed primary series
- all household contacts with immunocompromised contact <18 y/o
- index pt tx with regimen other than ctx who is <2 y/o
- index pt tx with regimen other than ctx who lives with a child <4 who is underimmunized or immunocompromised
- close contact in childcare/preschool who spent >4h with index pt for >5/7 days prior to dx
what is the definition of what dose of steroids makes CI for child to receive MMR and varicella vaccines
> 2mg/kg/d (max 20) for at least 14d
which vaccines contain egg antigen
flu (proceed with vaccine)
MMR (proceed with vaccine)
which vaccine contains streptomycin
IPV
which vaccines contain neomycin
IPV, MMR, varicella
which vaccine contains polymyxin B
IPV
which vaccines contain casein
DTaP, Tdap
immunize and observe if severely milk allergic
which vaccines contain gelatin
MMR, varicella, MMRV, influenza
