Preventative Pediatrics Flashcards
What are high risk factors that should prompt initiation of statin therapy if lifestyle modification does not improve cholesterol? (7)
- Type 2 diabetes
- BMI > 97 percentile
- HTN requiring tx
- cigarette smoking
- chronic renal disease
- post renal/ heart transplant
- Kawasaki disease with current coronary aneurysm
What tetanus prophylaxis should be given to an adolescent (10-18 years) who requires tetanus toxoid containing vaccine as part of wound management?
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)
How many doses of Hib is required for a child aged 15-59 months who was not previously vaccinated?
1 dose
should receive 2 or 3 doses depending on manufacture at 2, 4 and 6 months old
How many doses of PCV13 (Prevnar) are required for a child aged 24-59 months of age who was not previously vaccinated?
1 dose
should receive 4 doses if less than 24 months old at 2, 4 and 6 months and then 12-15 months old
What vaccines must be administered intramuscularly? (4)
- hep B
- DTaP
- Hib
- PCV 13
What vaccine must be administered subcutaneously?
MMR and Varicella
IPV can be either
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?
28 days
if given before, can result in decreased efficacy & impaired immune response
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.
True
What is the oldest age a patient can receive their rotavirus vaccine?
8 months 0 days old
At what age and interval do children routinely receive their Hep A vaccination?
starting at 12-23 months old with 6 months between the 2 doses
What vaccines are not indicated for a child older than 5 years old whose immunization status is unknown or never started? (3)
- Hib
- Prevnar
- Rotavirus
What is the typical characteristics of varicella in previously vaccinated children (known as break through varicella)?
predominately maculopapular rather than vesicular, occurring anywhere, usually less than 50 lesions
Why are children given MMR and varicella as vaccinations separately during ages of 12-23 months old?
increased risk of fever and febrile seizures at 5-12 day postvaccination
What complication has been reported with the administration of Influenza or Menactra (MCV4) vaccinations?
Guillain-Barre syndrome
At what age, should a preterm infant weighing less than 2 kg receive their first HepB vaccine?
1 month of age (or hospital discharge if comes 1st)
prior to that, less chance of seroconversion
What vaccine is required to be stored frozen between -50 degress and -15 degress C?
Varicella
MMR can be frozen or refrigerated
What is the recommendations for PPSV23 vaccine?
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
Which patients should receive Menveo (meningococcal vaccine available for infants) starting at age 2 months? (4)
- HIV pts
- Sickle cell
- functional or anatomic asplenia
- complement deficiencies
(given at 2, 4, 6, and 12 months of age)
Treatment with what therapeutic agent requires administration of MMR and varicella vaccine to be delayed and for how long?
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)
What are contraindications for pertussis-containing vaccine?
- Encephalopathy within 7 days of previous vaccination
2. Anaphylaxis
What are contraindications for rotavirus vaccine? (2)
- History of intussusception
- SCID (Severe combined immunodeficiency)
- Anaphylaxis
What is the current recommendation for the use of pneumococcal vaccines in sickle cell patients?
PCV13 at 2, 4, 6 and 12 months of age
PPSV23 at 2 years old followed by 2nd dose 5 years later
What is the most common adverse effect of pertussis-containing vaccines?
extreme irritability and crying for an extended period of time (> 3 hours)
What is the most likely diagnosis of a pt presenting with whitish lines running across chalky-brown, discolored and pitted teeth?
Fluorosis (excessive fluoride)
- use rice grain size fluoride toothpaste after 1st tooth eruption
- use pea size fluoride toothpaste after 3 years old
What are the contraindications for varicella vaccination?
- Anaphylaxis
- Severe immunosuppression
- pregnancy (possible pregnancy in 4 weeks)
- IVIG
(can give varicella and MMR to HIV pts with Tcell count > 15%)
What is the recommendation for HPV vaccination in pt less than 15 years old?
start at 11-12 years old, 2 doses 6 months apart
What is the recommendation for HPV vaccination in pt older than 15 years old?
3 doses, 2nd dose 1-2 months after 1st, 3rd dose 6 months after 1st
What is the most frequently reported vaccine associated with post-vaccination syncope?
HPV vaccine
due to vasovagal
What is the typical sequence for eruption of primary teeth?
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)
What is a true contraindication to receiving the yellow fever vaccine?
Egg hypersensitivity/ allergy
What is the recommendation to increase the likelihood that an avulsed permanent tooth remains viable on way to dental office?
rinse with water, avoid holding by root, and transport in cold cow’s milk or holding it in place
When should routine blood pressure screening begin?
At 3 years of age
What is the routine recommendation for the meningococcal (MCV4) vaccine?
1st dose at 11-12 years old, 2nd dose at 16 years old
single dose if initial dose given at 16 or older
At what age is DTaP not recommended?
7 years or older
should receive Tdap
What is the potential adverse effect of giving the pnemococcal (PCV13) and trivalent inactivated influenza vaccine simutaneously?
Febrile seizures during the initial 24 hours after vaccines
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.
True
MMR vaccine given earlier can suppress reactivity to TST
When does visual acuity reach the adult level of 20/20?
by 3-5 years old
What is the treatment for labial adhesions?
Topical estrogen cream BID
(side effect of breast bud formation transient)
(peaks at 12-24 months of age)
What is the recommended duration between dose 1 and dose 2 of varicella?
at least 3 months
1 month if older than 13 years old
what is the recommendation for MMR vaccination for infants less than 12 months old traveling abroad to endemic area?
all infants 6-11 months should receive at least 1 MMR vaccine
(still require 2 doses of MMR after 12 months of age)
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?
9 years old
What test modality is the most accurate and specific regarding sensorineural hearing loss, especially following meningitis?
Auditory brainstem response (ABR)
What is the recommended catch-up schedule for a patient who has never received pertussis/ tetanus containing vaccine?
Tdap followed by Td in 4 weeks followed by 2nd Td 6 months later
what is the contraindication for the Rotarix (live, oral human attenuated monovalent rotavirus) vaccine?
Anaphylactic allergy to latex
Is it safe to administer the varicella vaccine to nursing mothers without evidence of immunity regardless of the age of their infant?
Yes (does not transmit into breastmilk)
do not give to pregnant women
When can children move from booster seats to standard seat blets?
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)
What are the first permanent teeth to erupt?
1st molars (known as the 6 year molars) or the lower central incisors
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?
Varicella vaccine administration within 3-5 days of contact
as long as older than 12 months
What are the recommendations for routine cholesterol screening?
universal screening at 9-11 years old and again at 17-21 years old
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?
at least 4 weeks after steroids complete
What is the appropriate needle size for an intramuscular vaccination?
1 inch for 4 month old thigh
1.5 inch for 120 kg deltoid muscle
How often should sexually active adolescents be screened for gonorrhea and chlamydia?
yearly
what is the recommended varicella vaccination schedule for an unimmunized child older than 13 years old?
2 doses at least 4 weeks apart
How long should a patient remain in a forward facing 5 point harness carseat?
until exceed the weight and height limitations of the carseat, then transition to booster seat
What vaccines are contraindicated for pregnant women?
Live attenuated vaccines
MMR, Varicella, live influenza
What are contraindications for flu mist?
1) asthma/ reactive airway
2) pregnancy
3) diabetes
4) immunocompromised
5) chronic heart disease
6) chronic renal disease
What is the typical time period that the MMR vaccine is not effective if patient receives IVIG?
2 weeks prior to IVIG and up to 11 months after IVIG
What is the possible risk of given a patient younger than 4 years old Proquad (MMRV)?
febrile seizures
What is the recommendation regarding Polio vaccination for patients traveling to country with active polio cases for longer than 4 weeks?
5th Polio dose if last dose was over 1 year ago
What vaccination is contraindicated for individuals who live with severely immunocompromised individuals?
live attentuated Influenza
When should an MMR or Varicella vaccine be given if a patient is on high dose ( greater than 2 mg/kg/day) of prednisone?
At least 4 weeks after completing prednisone treatment
What is the potential complication related to breastfeeding a preterm infant without supplementation?
hypoproteinemia (low protein due to rapid growth and high protein demand)
What is a possible adverse reaction that can occur with the Dtap vaccination?
prolonged period of crying and inconsolable state for more than 3 hours
what are the 2 requirements for a passing CCHD test?
1) oxygen saturation of 95% or above
2) 3% or less difference between upper and lower extremity
what is the preferred test to assess for TB in patient under 2 years old?
TST
What is the best initial step in management for patient under 4 years old who had direct contact with TB positive person?
start latent TB infection treatment (despite negative TB screen) and repeat screen in 10-12 weeks (if negative, then can stop tx)
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?
single dose needed
What is the recommended catch-up vaccination schedule for patients older than 24 months of age who have not had a prior prevnar vaccine?
single dose needed
What is the minimum age at which only 1 dose of Influenza vaccine is recommended in children who have not been previously vaccinated?
9 years old
