Preventative Peds Flashcards
Is the inactivated influenza vaccine (IIV) safe to administer during pregnancy?
Answer
Yes
Explanation
IIV is recommended and considered safe during any stage of pregnancy. Pregnancy increases the risk of complications and hospitalization from influenza. Pregnancy is a contraindication to administration of all live-virus vaccines, including the live attenuated influenza vaccine. IIV is not a live-virus vaccine and is only rarely associated with major systemic reactions. Mild systemic symptoms, such as fever, nausea, lethargy, headache, myalgia, and chills, can occur
An adolescent receives MMR and experiences joint pain 10 days after the vaccination.
What component of the vaccine is likely responsible for this?
Rubella
Explanation
Adverse events of MMR include:
Tenderness/warmth at the injection site (common)
Fever to 103.0° F ([39.4° C ] in 5–15% of recipients)
Febrile seizures (in 1:3000–3400 recipients)
Transient rash occurring 6–12 days after MMR (in 5% of recipients)
Transient thrombocytopenia (in 1:22,000–40,000 recipients)
In adolescents, joint pain (arthralgia [secondary to the rubella component]) 7–21 days after MMR (in up to 25% of recipients); transient arthritis is reported in up to 10% of recipients
What is the cut-off age for giving a DTaP?
Answer
< 7 years of age
Explanation
Do not give DTaP to children ≥ 7 years of age. After that, Tdap is recommended at 11–12 years of age, followed by a Td or Tdap booster every 10 years thereafter. Children 7–10 years of age who have not completed their primary immunization schedule should receive a single dose of Tdap; if additional tetanus and diphtheria toxoid doses are required, use Td or Tdap. Children who receive Tdap at 7 through 9 years of age may receive the standard Tdap booster at 11 or 12 years of age. Children who received Tdap at 10 years of age do not require the 11–12 year old dose
Within hours of his 1st DTaP vaccination, a 2-month-old boy became irritable and had a febrile seizure with a temperature of 104.8°F (40.5°C).
Do these reactions represent an absolute contraindication to additional doses of DTaP?
No
Explanation
Absolute contraindications to additional doses of DTaP include a history of encephalopathy (e.g., prolonged seizures, coma, altered mental status) within 7 days of dosing or an immediate anaphylactic reaction with a previous dose. Precautions to additional doses of DTaP include Guillain-Barré syndrome within 6 weeks after receiving a tetanus toxoid-containing vaccine; moderate or severe acute illness with or without a fever (until resolution); a history of an evolving or progressive neurologic disorder (delay vaccination until neurologic status is stable or the disease process is clarified). More serious and rare adverse effects following DTaP include a hypotonic-hyporesponsive episode; temperature > 104.8°F (40.4°C); febrile seizures; brachial neuritis; and entire limb swelling following the 4th or 5th vaccine in the series.
A 10-year-old’s permanent tooth is knocked out while playing in the back yard. The mother calls you and asks you what to do. She is not able to reimplant the tooth because the child is uncooperative. You get in touch with a dentist on call, who will meet them soon at his office.
You tell her to bring the tooth in what common household liquid?
Cold milk
Explanation
If the tooth cannot be reimplanted, it should ideally be kept in Hank’s Balanced Salt Solution (HBSS) or Save-A-Tooth solution. If these are not available, then cold milk, followed by saliva, physiologic saline solution, or any available isotonic solution is best. Survival of an avulsed permanent tooth is inversely related to the amount of time spent out of the oral cavity; survival rates are close to zero after 1–2 hours. Avulsed primary teeth should not be reimplanted because of the risk of injury to the developing tooth bud.
What is the only live vaccine given before 12 months of age?
Answer
Rotavirus vaccine
Explanation
All other vaccines given before 12 months of age are either killed or recombinant. RV5 (RotaTeq) is orally administered at 2, 4, and 6 months of age; RV1 (Rotarix) is orally administered at 2 and 4 months of age. The 1st dose of either vaccine must be given at 6 weeks through 14 weeks, 6 days of age. The minimum interval between doses is 4 weeks; all doses of rotavirus vaccine must be administered by 8 months, 0 days of age.
A 24-month-old boy is taken into emergency protective custody due to medical neglect. His immunization record states that he received hepatitis B (HepB) vaccine at birth; at 2 months of age he received a combination vaccine (DTaP-HepB-IPV), Hib, and PCV13.
Do one or more of the vaccine series need to be restarted in this patient because he was last vaccinated > 1 year ago?
Answer
No
Explanation
A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Therefore, this patient has already received 2 doses of HepB and 1 dose each of DTaP (diphtheria, tetanus, acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus influenzae Type b), and PCV13 (13-valent pneumococcal conjugate vaccine). The number of catch-up doses required and the minimal interval between doses varies by vaccine and the age of the patient at the time catch-up is initiated. Give this child:
1 dose each of HepB, Hib, and PCV13,
4 doses of DTaP (1 dose now, another dose in 4 weeks, another in 6 months, and a final dose at 4–6 years of age), and
3 doses of IPV (1 dose now, another dose in 4 weeks, and a final dose at 4–6 years of age).
All infants should have a hearing screen by no later than what age?
1 month of age
Explanation
Universal hearing screening should ideally be completed before newborns are discharged from the hospital but no later than 1 month of age in all infants. Screening is usually performed with auditory brainstem response testing (ABR), which measures how CN 8 responds to sound. You can also use otoacoustic emissions analysis (OAE), which measures sound waves made in the inner ear as an echo in response to sound. The AAP Early Hearing Detection and Intervention Program recommends screening by no later than 1 month of age, diagnosis of hearing loss by 3 months of age, and entry into early intervention services by 6 months of age.
What are the first teeth to typically emerge?
Mandibular central incisors
Explanation
Tooth eruption rates and locations may vary greatly, but the first tooth typically erupts by 5–10 months of age. The lower anterior teeth (mandibular incisors) emerge first, followed by the upper opposing teeth (maxillary incisors), the upper lateral incisors, and then the lower lateral incisors. The first molars, cuspids (canines), and finally the second molars then follow. There are 20 baby teeth, all of which have generally erupted by 30–33 months of age. Girls tend to develop their teeth earlier than do boys, and Black children earlier than White children.
At what age(s) is the meningococcal conjugate vaccine (MCV4) recommended for individuals without a medical condition that places them at increased risk for meningococcal disease?
11–12 years of age; booster dose at 16 years of age
Explanation
MCV4 vaccines (Menactra and Menveo) each contain serotypes A, C, Y, and W-135. A single dose of either vaccine is recommended at 11–12 years of age, with a booster at 16 years of age to enhance protection during the period of highest risk (i.e., patients 18–23 years of age—especially college freshmen). Adolescents who receive their 1st dose at 13–15 years of age should receive a booster dose at 16–18 years of age; 1 dose should be administered to previously unvaccinated college freshmen prior to school entry. Menactra and Menveo are also licensed for high-risk infants and children but with different administration schedules.
During blood pressure (BP) measurement, what is the recommended position of the patient and appropriate cuff size to minimize the risk of an inaccurate reading?
Seated with legs uncrossed; cuff covers ≥ 2/3 length of the upper right arm and wraps ≥ 3/4 of the arm circumference
Explanation
BP is best measured with the child sitting, the right arm held at heart level. The bladder of the blood pressure cuff should cover at least 2/3 the length of the upper arm and wrap around at least 3/4 of the arm circumference (thus, the cuff itself often overlaps). A cuff that is too small will yield an inaccurate and artificially elevated reading. The cuff should be inflated to 20 mmHg above the loss of the radial pulse and then deflated at 2–3 mmHg/second. The 1st sound heard is a tapping sound, known as Korotkoff sound 1, which is recorded as the systolic blood pressure. The level at which all sound disappears is Korotkoff sound 5, which is the measured diastolic pressure.
At what age(s) is fasting or nonfasting screening, with total and high-density lipoprotein cholesterol (HDL-C) levels, universally recommended for children and adolescents?
Once between 9 and 11 years of age and once between 17 and 21 years of age
Explanation
The AAP recommends fasting or nonfasting screening for hyperlipidemia in all children and adolescents in these age groups, regardless of risk factors. If non-HDL-C ≥ 145 mg/dL and/or HDL-C < 40 mg/dL, then get 2 fasting lipid panels and average the results. In the absence of risk factors, routine lipid screening is not recommended in children 2–8 years of age or 12–16 years of age.
According to the 2020 AAP Bright Futures guidelines, at what age should routine screening for anemia be performed in all children?
Answer
9-12 months of age
Explanation
The Bright Futures/AAP guidelines recommend routine hemoglobin testing in children 9–12 months of age. The guidelines also recommend a schedule of ongoing risk assessments for iron deficiency anemia in all infants at all well-child evaluations from 4–36 months of age, and annually thereafter throughout childhood and adolescence. More frequent testing is recommended for children identified as high risk (e.g., premature, low birth weight, exclusively breastfed without iron supplementation after 4–6 months of age, history of poverty and food insecurity, strict vegan diets, eating disorders, malabsorption disorders).
What is the only vaccine currently recommended at birth?
Hepatitis B
Explanation
Administer single-antigen HepB vaccine to all newborns within 24 hours of birth. Administer a 2nd dose at 1–2 months of age (minimum interval of 4 weeks). Administer the 3rd dose at 6–18 months of age. The 3rd dose must be administered at least 8 weeks after the 2nd dose and at least 16 weeks after the 1st dose. The 3rd dose in the series should be administered no earlier than 24 weeks of age. Administration of 4 doses is acceptable when a combination vaccine containing HepB is used after the birth dose.
At what age should routine blood pressure (BP) screening begin in healthy children with no coexisting medical condition predisposing to hypertension (HTN)?
3 years of age
Explanation
BP should be measured in children < 3 years of age with a coexisting medical condition predisposing to HTN (e.g., history of prematurity, very low birth weight, neonatal complications requiring intensive care/umbilical lines, congenital heart disease, recurrent UTIs, chronic renal disease or renal malformations, family history of congenital renal disease). Normal BP is defined as both systolic and diastolic blood pressure < 90th percentile for age (< 120/< 80 mmHg in adolescents ≥ 13 years of age).
