prevention Flashcards
What are the common findings of lead poisoning on X-ray?
Lead lines - calcification of bones
What is the common Blood smear finding in lead poisoning ?
Basophilic stippling
At what lead level do children require chelation?
45
What can be seen in lead levels 10-20?
Mild cognitive delay
What 4 things should be done if elevated capillary lead level?
Venous lead level
FEP level
Abdominal film
Long bone X-ray
When should tdap be given?
Age 11-12 or 5 years after receiving Td
What tetanus prophylaxis do you give if a child with unknown or incomplete immunization status has a clean wound?
Tetanus vaccine
What do you do if a child had a clean wound and received a tetanus vaccine > 10 years ago?
Tetanus booster
What do you do if a child with incomplete vaccination status presents with a dirty wound?
Tetanus vaccine + tetanus immune globulin
What do you do if a child presents with a dirty wound and has not had a tetanus vaccine in >5 years?
Tetenus booster
When does a child only require 3 doses of dtap during catch up vaccines?
If the first dose was given after 12 months of age
How much time is required between catch up doses of dtap?
At least 4 weeks between doses 1, 2 and 3 and 6 months between the 3rd and 4th dose
At what age is dtap no longer indicated ?
After 7 years old
What do you do if a pregnant teenager is due for her tdap?
Administer anyways
At what age can pediarix no longer be given?
7
What should be done for an infant born to a mother with unknown hepatitis status?
Hep B immunoglobulin and vaccine
How soon should premies less than 2 kg receive hep b vaccine ?
Within 30 days if mother negative
Within 12 hours if mother positive plus immunoglobulin
What are hep B requirements in the event of a needle stick?
If antibody positive - do nothing
If antibody negative - IG and full re vaccination
What is the most common subtype that causes meningococcal disease and why is this a problem?
More than half of meningococcal disease in infants is caused by B subtype which is not protected from with the vaccine!!!!
When can you give the mcv vaccine before the scheduled dose at age 11?
After age 2 if HIV, complement deficiency, asplenic or travel to endemic regions
How much time must lapse between doses one and two of MMR?
4 weeks
What do you do if a 10 month old who gets an MMR vaccine for travel?
Doesn’t count as series dose. Repeat after 12 months
What do you do if a child is less than 12 months and is exposed to measles?
If within 72 hours of exposure, give vaccine. If more than 72 hours after exposure give immunoglobulin
What are 2 side effects of the MMR vaccine ?
Fever within 12 days or rash
What are contraindications for MMR?
Severe allergy
Pregnancy
Severe immune compromised
Anaphylaxis to neomycin or gelatin
How much time must pass between receiving MMR vaccine and getting a PPD?
You can give them together but can not give ppd within 4-6 weeks after MMR
What are the only 2 vaccines with a contraindication with egg allergy?
Influenza or the yellow fever vaccine
What size patient is epipen junior good for?
Up to 30 kg
What are the rules for giving measles and varicella vaccine in HIV patients?
Measles can be given unless severely immunocompromised but varicella can not be given if immunocompromised at all
When is varicella immunoglobulin indicated (5 answers) and what drug is given with it?
Immunocompromised
Pregnant women
Premies <28 weeks
Premies without evidence of maternal immunity
Any infant with mother with new onset varicella - give with acyclovir
What is pcv13 and when is it given ?
Prevnar - ages 2,4,6 and 12 months
What is ppv23 and when is it given ?
23 valent pneumococcal vaccine for kids >2 y/o with chronic illness or asplenia
When should rotavirus vaccination be started by and when must it be completed?
First dose between 6 and 14 weeks
Must be completed by 8 months old
How much time must lapse between rotavirus vaccinations?
4 -10 weeks
What should you do if a child gets rotavirus infection before vaccination?
Continue with vaccination
When should hep A vaccine be given ?
Age 1 and then 6 months later
Who is at high risk for influenza and requires annual immunization?
Chronic metabolic/renal/cardiac dz, Asthma/pulmonary disease,
HIV
What should be done for hep A vaccination in traveling children?
If <1 year old give immune globulin
If >1 year old give hep A vaccine at least 4 weeks prior to departure
What are contraindications for hep A vaccine?
Allergy to aluminum hydroxide and phenoxyethanol
In which patients should influenza vaccination be a priority? (5 answers)
Chronic pulmonary disease Symptomatic heart disease Sickle cell Immunosuppressive long term aspirin therapy
When should you start screening a patient for hypertension ?
Age 3 or children on stimulants
What is the definition of HTN?
> 95th % taken on 3 separate occasions (one month apart)
What is conductive hearing loss?
Anything that interferes with transmission of sound to the middle ear
What is the most common cause of conductive hearing loss?
Otitis media with effusion
What is the most severe cause of conductive hearing loss?
Atresia of the ear canal
What do you do if an infant fails newborn screening?
Refer to audiology prior to 3 months
What should you do if a child has any of the cholesterol risk factors ?
Non fasting cholesterol level
What do you do if screening for cholesterol shows cholesterol >170?
Repeat or check fasting lipids
What do you do if a child has a parent with cholesterol >240?
Check non fasting cholesterol
What are the 5 risk factors for children having high cholesterol?
Smoking HTN Physical inactivity Diabetes Obesity
What do you do in a child whose parent or grandparent has coronary atherosclerosis (MI, angina, stroke, sudden cardiac death before age 55)?
Fasting lipids
How should you treat a patient with fasting lipids >130?
Manage with diet
What do you do for a patient with LDL >190?
Medication (after diet trial)
What cholesterol levels are ideal for a patient with first degree relative with coronary atherosclerosis ?
<160
What are 4 medications and 3 diseases that increase risk for high cholesterol?
Steroids Anticonvulsants Beta blockers Alcohol Chronic liver or renal disease Hypothyroid Anorexia nervosa
In what 4 conditions should you consider hyperviscosity syndrome?
Twin twin transfusion
Delayed cord clamping
Down syndrome
Diabetic mother
What are 3 things that can occur with polycythemia?
Hyperviscosity syndrome
Hyperbilirubinemia
Hypoglycemia
What is the loss of visual acuity due to cortical suppression of vision in one eye?
Amblyopia
What is esotropia?
Inward turning of eye (form of strabismus)
What is the tendency for inward deviation when an eye is covered and then uncovered?
Esophoria
What refractive state is normal until age 3?
Hyperopia
What is the ability to see a moving target, follow it and then return to original gaze?
Optokinetic nystagmus
What eye reflex do infants have in the first few months ?
Optokinetic nystagmus
When do infant gain the ability to fixate on an object?
6 weeks
When do infants gain color perception ?
2 months
When do infants develop binocular vision with convergence?
3 months
What is the normal visual acuity of a newborn?
20/200
What is the visual acuity at age 1?
20/30
In what conditions is 5-10mm TB screen considered abnormal?
Close contacts
Positive X-ray
Immunosuppression
What should be done in a newborn with a mother who has active TB disease?
If negative cxr, treat with INH
If positive cxr, treat with triple meds
When does a child need prophylactic treatment for H. Flu after exposure?
Children not fully immunized or immunocompromised if household contact
When should children exposed to meningococcus receive prophylactic treatment ?
Household or preschool contacts
Direct exposure to secretions
Sat next to person on plane >8 hrs
At what temp should water heaters be set?
120 degrees F
What does UV A cause and when should it be a concern?
Drug induced photo sensitivity
The rays are constant throughout the day
What does UV B cause and when is it a concern?
Skin aging, burns and cancer
Strongest from 10a - 5 p
What are the rules to applying sunscreen?
At least SPF 15 applied 20 minutes before exposure
When should an infant be in a rear facing car seat?
Until age 2 or 20 lbs
How should rear facing car seats be positioned?
45 degree angle
Up to what height should children be in a booster seat?
4’9”
Why are bicycle Helmets important?
Reduce serious injury by 85%
What is the most effective preventative measure for preventing drowning?
4 sided fence with locked gate
What is the difference in growth and development in a children adopted from another country?
Children lose 1 month of linear growth for every 3 months in an orphanage
Developmental milestones should match linear growth
How should you medically assist an adolescent to quit smoking?
Nicotine replacement is NOT FDA approved so use caution. If unsuccessful, bupropion plus counseling is approved
5 Signs and symptoms of lead poisoning?
Headache, irritability, constipation, lethargy and microcytic anemia
