Preventive Pediatrics 2018 Flashcards
1
Q
Prenatal education should include
A
- breastfeeding
- newborn care and procedures at birth
- anticipatory guidance to decrease the risk injury and identify risk factors for child maltreatment
- prevention of smoking, alcohol intake and exposure to teratogens
- tetanus toxoid immunization for the mother
- maternal nutrition (include folic acid supplementation)
2
Q
Perfect first food for the newborn
A
Colustrum
3
Q
When should infants latch and start breastfeeding
A
First 30 minutes to 1 hour after delivery
4
Q
Optimal time of discharge of a healthy term newborn
A
Less than 48 hours after delivery
5
Q
Red flag signs for atopy
A
Any child with family Hx of asthma, AD, AR, drug/food allergy who presents with symptoms of 1 or more of the ff:
1. Respiratory symptoms: chronic cough with or without wheezing, shortness of breath, chest tightness, trouble sleeping due to coughing, fatigue, problems with feeding or grunting
2. Nasal symptoms: frequent sneezing, rhinorrhea, itchiness, nasal congestion
3. Ocular symptoms: bluish, brownish discoloration around both eyes, puffiness under the eyes, dryness and itchiness
4. Skin symptoms: dryness and itchines
5. GI symptoms: itchiness of the roof of the mouth and throat, colic, vomiting, stomah cramps, diarrhea and bloody stools
6
Q
If a child is <2 years old, measure
a. recumbent length
b. standing height
A
a. recumbent length
7
Q
If a child is 2 years or more and able to stand, measure
a. recumbent length
b. standing height
A
b. Standing height
8
Q
In general, standing height is _____ than recumbent length
A
0.7 cm less
9
Q
Reliable growth indicator even when the age is not known
A
Weight for length/height
10
Q
PNSP recommends routine BP measurement annually for all children
A
> 3 years of age or patients at risk
- children with obesity
- taking medications known to increase bp
-have renal disease
- has history if aortic branch obstruction or COA or diabetes
11
Q
Normotension for 1-13 years old
A
BP <90th percentile for age, gender and height percentile
12
Q
Normotension for 13 years old and above
A
120-129/80
13
Q
Stage 1 hypertension for 1-13 years old
A
BP >95th percentile to <95th percentile +12 OR BP 130-149/80-89 which lever is lower
14
Q
Stage 1 hypertension fir >13 years old
A
BP > 130/80 to 139/89
15
Q
Stage 2 hypertension for 1-13 years old
A
BP >95th percentile + 12 or >140/90 whichever is lower
16
Q
Stage 2 hypertension >13 years old
A
BP > 140/90
17
Q
States obligation to inform - any health care practitioner who delivers or assists in the delivery of a newborn in the Philippines shall prior to delivery inform the parents or legal guardian of the newborn of the availability nature and benefits of newborn screening
A
RA 9288 (article 3 section 54)
Newborn screening act of 2004
18
Q
Newborn screening should be ideally done ________ regardless of gestational age and clinical status
A
Immediately after 24 hours from birth
19
Q
Preterm (<37 weeks), LBW (<2000 g) and sick neonates (in NICU) may have a sample taken _______ but otherwise a sample should be taken _______ and a repeat screening should be collected st the ______
A
before 24 hours from birth if blood transfusion will be done;
After 24 hours from birth;
28th day of life
20
Q
eNBS available since
A
December 2014
21
Q
How many disorders is covered by eNBS
A
28 disorders
22
Q
States obligation to inform - any health care practitioner who delivers or assists in the delivery of a newborn in the Philippines shall prior to delivery inform the parents or legal guardian of the newborn of the availability nature and benefits of hearing loss screening among newborn or children 3 months and below
A
RA 9709
The universal newborn hearing screening and intervention act of 2009
23
Q
RA 9288
A
Newborn screening act of 2004
24
Q
RA 9709
A
Universal Newborn Hearing Screening and Intervention Act of 2009
25
All infants born in hospitals in the Philippines shall be made to undergo newborn hearing loss screening _______ unless the parents or legal guardians of the newborn object to the screening
Before discharge
26
Infants who are not born in hospitals should be screened
Within 3 months after birth
27
In the event of a positive newborn hearing loss screening result, the newborn shall undergo audiologic diagnostic evaluation in a timely manner to allow appropriate follow up, recall and referral for intervention ______
Before the age of 6 months
28
Single most effective way of determining eye's health is through
Eye and vision screening test
29
PPS blindness prevention and vision screening asserts the following
- proper dietary supplementation
- measles immunization
- routine pediatric eye evaluation for all patients
30
Most common presenting signs of retinoblastoma
Leukocoria and strabismus
31
Mandates the creation of a national rabies prevention and control program
RA 9482 (Anti Rabies Act of 2007)
32
Criteria for screening retinopathy of prematurity
1. 32 weeks or younger
2. 1500g or lighter
3. >32 weeks and >1500g with a stormy medical course in the NICU
33
High risk infants should be referred to an ophthalmologist
1. Premature infants whose age of gestation or weight meets the criteria for screening of retinopathy of prematurity
2. Infants and children with metabolic disorders
3. Infants and children with medical conditions known to have associated eye problems (Down syndrome, idiopathic arthritis, neurofibromatosis)
4. Infants and children with history of squinting, head tilt or head turn
5. Children with history of visual difficulties
6. Family history of strabismus, amblyopia, congenital cataract, congenital glaucoma, retinoblastoma, ocular and systemic genetic disease
34
Visual acuity assessment for infants and preverbal children
Fixes and follows test - fixation behavior can be determined by using a toy, picture, or other interesting objects as a target, unoccluded eyes and with one eye occluded.
35
Visual acuity test for preschoolers who are not familiar with letters
LEA chart
36
Visual acuity test for literate children
HOTV chart
37
Children age 3 to 3 11/12 years old and below should be able to read at least
20/50 (10/25) or better
38
Children age 4 to 4 11/12 years old should be able to read at least
20/40 (10/20) or better
39
Children 5 years old and older are expected to read
20/30 (10/15)
40
Using LEA or its equivalent is preferably done at distance and near starting
3 years of age
41
Distance visual acuity should be tested ____ meters (_____ feet) or ____ (____ feet)
6 meters (20 feet); 3 meters (10 feet)
42
Reading distance should be tested at
34-40 cm (14-16 inches)
43
Iron supplementation for low birth weight infants
0.3 mL once a day starting at 2 months to 6 months
(Drops: 15mg elemental iron/0.6 mL)
44
Iron supplementation 6-11 months
0.6 mL once a day for 3 months
(15mg elemental iron/0.6mL)
45
Iron supplementation for children 1-5 years old
1 teaspoonful/5mL once a day for 3 months or 1 teaspoon/5mL once a week for 6 months
(30mg elemental iron/5mL)
46
Iron supplementation adolescent girls (10-19)
1 tab once a day
(Tablet containing 60mg elemental iron with 400mcg folic acid)
47
Vitamin A supplementation 6-11 months
1 dose of 100,000 IU - given anytime between 6-11 months (usually at 9 months during measles immunization)
48
Vitamin A supplementation children 12-59 months
1 capsule (200,000 IU) every 6 months
49
Zinc supplementation has beneficial rile in the prevention of
Pneumonia and diarrhea
50
Dewroming is recommended for all children aged
1-12 tears old
51
Deworming 12-23 months
Albendazole 200 mg single dose every 6 months
52
Deworming > 12 months
Mebendazole 500 mg single dose every 6 months
53
Deworming > 24 months
Albendazole 400 mg single dose every 6 months or
Mebendazole 500 mg single dose every 6 months
54
Deworming must not be done in children with
1. Severe malnutrition
2. High grade fever
3. Abdominal pain
4. Profuse diarrhea
5. Severe illness
6. Previous hypersensitivity to antihelminthic drug
55
Mass treatment with ______ for areas endemic with filiariasis
Diethylcarbamazine citrate and albendazole for children 2 years and above
56
First dental visit should be done
First tooth eruptuin and no longer than 12 months
57
Use of flouride containing toothpaste as primary preventive measure
Twice daily
58
Recommended flouride toothpaste 6 months to less than 2 years old
1000 ppm, twice daily, smear (2.5 mm, 0.125 g)
59
Recommended use of flouride toothpaste in children 2 to 6 years old
1000 ppm, twice daily, pea size (5mm, 0.25 mg)
60
Recommended use of lfouride toothpaste in children 6 years and above
1500 ppm, twice daily, full length of bristle (10-20mm) 0.5-1.0 g
61
Children at moderate caries risk shoukd receive a professional fluoride treatment
At least every 6 months
62
Mothers must be encouraged to exclusively breastfeed up to
6 months and continued on up to 2 years old and beyond
63
Allow the baby to suck _______ minutes per breast to extract foremilk and hindmilk
25-30 minutes per breast
64
Empty the breadt around _______ to ensure adequate milk supply
8 - 10 times a day
65
Recommended breastmilk storage period in room temp >25 C
1 hour
66
Recommended breastmilk storage period in room temp <25 C
4 hours
67
Recommended breastmilk storage period in room temp refrigerator 4 C
8 days
68
Recommended breastmilk storage period in freezer of a 1 door ref
2 weeks
69
Recommended breastmilk storage period in freezer of a 2 door ref
3 months
70
Recommended breastmilk storage period in deep freezer with constant temp of -20 C
6 months
71
Complimentary feeding start pureed foods at
6 months
72
Introduce finger foods around
8 months of age
73
Introduce lumpy or chopped foods at
10 months of age
74
Introduce table food at
12 months of age
75
Frequency of complimentary feeding for 6-8 months
2-3x a day
76
Frequency of complimentary feeding for 9-24 months
3-4x a day
77
How to introduce conplimentary feeding
- begin with one new food at a time to be given for 3 days
- start with lugaw, cereal, fruits and vegetables one to 2 teaspoons a day
- pureed food at 6 months
- finger food at 8 months
- lumpy or chopped food at 10 months
- table food at 12 months
- offer a variety of food
- avoid drinks with low nutrient value (sweet beverages)
- do not add salt to the infant's diet BEFORE 1 year of age
-give supplements of iron, zinc, calcium and vitamin B12 if diet is primarily plant based
- practice responsive feeding
-feed sliwly and patiently
- do not force feed
-make feeding a pleasurabke experience
78
Age appropriate physical activities for chcikdren and adolescents for
60 minutes daily or on most days of the week
79
States that the head of any public or private hospital, medical clinic and similar institution, as well as attending physician and nurse, shall report either orally or in writing to the dswd the examination and/or treatment of a chikd who appears to have suffered abuse within 48 hours from knowledge
RA 7610 (Anti child abuse law)
80
Best studied effect of lead is
Cognitive impairment
81
CBC at least once between the following intervals for those at risk of IDA
6-24 months, 2-6 years, 10-19 years
82
Philippine society of adolescent medicine specialists recommends a CBC
at each stage of adolescence
83
Annual health screening of adolescents for sexually active females should include
Vaginal wet mount and PAP smear
84
Sexually active males must undergo serologic test for
Syphilis
85
Both male and female sexually active adolescents should have annual
Non culture test for gonorrhea and chlamydia
86
PPD is considered positive if
> 5 mm in the presence of history of close contact with a known ir suspected case of tb, clinical findings suggestive of th, chest xray suggestive of tb, immunosuppressed condition
>10 mm in the absence of above factors
87
EINC sequence
Immediate and thorough drying
Early skin to skin contact between mother and newborn
Nonseparation of newborn and mother
Early breastfeeding
88
Minimum criteria for dischcarging newborns before 48 hours
-uncomplicated antepartum, intrapartyn and postpartum courses for the mother and newborn
-vaginal delivery, singleton, completed 37 weeks AGA
- normal and stable VS during the preceeding 12 hours
- has urinated and passed at least one stool
- has documented proper latch, milk transfer, swallowing, infant satiety and absence of nipple discomfort
- normal PE
- no evidence of significant jaundice in the first 24 hours of life
-educability and ability of the parents to care for their child
- must folloe up within the next 48 hours
89
Screening for scoliosis for females
10-12 years
90
Screening for scoliosis for males
13-14 years
91
Psychosocial assessment using HEADSSSS frequency
Annual
92
Alcohil, tobacco and drug substance use assessment using CRAFFT
Annual
93
Depression screening using PH-Q 9
Annual starting at 12 years old
94
Developmental surveillance should be done
Every well child visit
95
Process by which a health care professional recognizes the children who may be at risk of developmental and behavioral conditions
Developmental surveillance
96
Developmental screening should be done at
9, 18 and 30 months then yearly thereafter
97
Provess of administering a standardized took designed to identify children who are at risk for developmental and behavioral disorders
Developmental screening
98
At ___ and ___ months, an ASD specific screening tool (MCHAT) should be routinely administered
18 and 24 months
99
Dose of BCG for < 12 months of age
0.05 mL
100
Dose of BCG for > 12 months of age
0.1 mL
101
BCG is given at the ______ within the first ______ of life.
Earliest time after birth
Within first 2 months of life
102
PPD is recommended prior to BCG vaccination for infants and children > 2 months if
1. Congenital TB
2. History of close contact to known or suspected infectious TB cases
3. Clinical findings suggestive of TB
103
Administer the first dose of monovalent HBV
All newborns > 2kgs within 24 hours of life
104
For infants born to HbsAg (+) mothers
Administer HBV and HBIG (0.5mL) WITHIN 12 hours of life.
HBIG should bot be administered not later than 7 days of age if not immediately available
105
For infants born to mothers witth unknown HBsAg with birthweight > 2 kgs
Administer HBV within 12 hours of birth and determine the mother's HBsAg ASAP.
If HBsAg (+) administer also HBIG nt later than 7 days of age
106
For infants born to mothers with unknown HBsAg with birthweight < 2 kgs
Administer HBIG in addition to HBV within 12 hours of life
107
For preterm infants born to HBsAg (-) mothers and medically stable, 1st dose of HBC may be given
30 days of chronological age regardless of weight and this can be counted as part of the 3 dose primary series
108
For preterm infants <2 kgs
1st dose received at birth is not counted as part of vaccine series. Additional 3 HBV doses are needed
109
How many doses of DTP should be given
5 dose series at 2, 4, 6, 14, and 18 months and 4 through 6 years
110
Primary series of IPV consist of
3 doses
111
Last dose of rotavirus should be administered not later than
32 weeks of age
112
Monovalent human rotavirus vaccine is given as
2 dose series
113
Pentavalent human bovine rotavirus vaccine is given as
3 dose series
114
Primary vaccination with PCV consists of ___ doses with an interval of at least _ weeks plus a booster dose given _ months after the last dose
3 doses;
4 week interval;
6 months after 3rd dose
115
Healthy children 2 to 5 years old who do not have previous PCV vaccination may be given
1 dose of PCV 13 or
2 doses of PCV 10 at least 8 weeks apart
116
Trivalent influenza vaccine is given
IM or SQ
117
Quadrivalent influenza vaccine is given
IM
118
Influenza vaccine is given at a minimum age of
6 months
119
Dose of influenza vaccine is ___ mL for children 6 - 35 months
0.25 mL
120
Dose of influenza vaccine is ___ mL for children 36 months - 18 years
0.5 mL
121
Annual influenza vaccination should begin in _____
February but may be given throughout the year
122
BCG is given
Intradermally
123
Hepatitis B vaccine is given
Intramuscularly
124
PentaHib is given
Intramuscularly
125
IPV is given
Intramuscularly
126
Rotavirus vaccine is given
Per orem
127
PCV is given
Intramuscularly
128
Measles vaccine is given
Subcutaneously
129
Measles vaccine is given at the age of
9 months, but as early as 6 months in cases of outbreaks
130
Japanese encephalitis vaccine is given
Subcutaneously
131
Minimum age of giving JE vaccine
9 months
132
Children 9 months to 17 years old should receive JE vaccine
1 primary dose followed by a booster dose 12-24 months after the primary dose
133
Individuals 18 years and older should receive JE vaccine
Single dose only
134
MMR vaccine is given
Subcutaneously
135
Minimum age of giving MMR
12 months of age
136
Recommended doses of MMR
2 doses, 2nd dose usually given 4-6 years of age but may be given at an earlier age with a minimum of 4 weeks interval between doses
137
Varicella vaccine is given
Subcutaneously
138
Minimum age of giving varicella vaccine
12 months
139
Recommended doses ot varicella vaccine
2 doses
140
Hepatitis A vaccine is given
IM
141
Minimum age of giving HAV
12 months
142
HPV is given
IM
143
Recommended doses for HPV in children 9-14 years old
2 dose series of bivalent, quadrivalent or nonavalent given at 0 and 6 months
144
Recommended doses of HPV in 15 years old above
3 dose series of bivalent, quadrivalent or nonavalent at 0, 2, 6 months
145
Td/Tdap is given
IM
146
For children who are fully immunized, Td booster is given
Every 10 years
147
For fully immunized pregnant adolescents with TDap, administer
1 dose of Tdap vaccine during 27 to 36 weeks AOG regardless of previous Td or Tdap vaccination
148
For unimmunized pregnant adolescents with TDap, administer
3 dose Td vaccine following a 0-1-6 month schedule.
149
For unimmunized pregnant adolescents with TDap, administer
3 dose Td vaccine following a 0-1-6 month schedule.
150
Hib conjugate vaccine is given
IM
151
For chikdren <= 5 years old who received a Hib vaccine dose during or within 14 days of starting chemotherapy or radiation treatment
Repeat dose of Hib vaccine at least 3 months after completion of therapy
152
For children who are hematopoetic stem cell transplant recipients revaccination with Hib vaccine
3 doses given 4 weeks apart, starting 6-12 months after transplant is recommended regardless of vaccination history
153
Unimmunized children >=15 months and undergoing elective splenectomy should be given
1 dose of Hib containing vaccine at least 14 days before the procedure
154
Unimmunized children 5-18 years ild with either anatomic or functiinak asplenia (including sickle cell disease) or HIV infection, should be given
1 dose of Hib vavcine
155
Tetravalent meningococcal vaccine is given
IM
156
Meningococcal vaccine is indicated for those at high risk for invasive disease such as
Persistent complement component deficiencies ( inherited or chronic deficiencies in C3, C5-9, properidin, factor D, factor H), anatomic/functional asplenia, HIV, travelers to or resident of areas where meningococcak disease is hyperendemic
157
Minimum age for MCV4-D (meningococcal vaccine)
9 months
158
Rabies vaccine is given
IM or ID
159
Rabies preexposure prophylaxis
Intramuscular regimen: PVRV 0.5 mL or PCECV 1 mL given on days 0, 7, 21, or 28
Intradermal regimen: PVRV or PCECV 1 mL given on days 0, 7, 21 or 28
160
In the event of subsequent rabies exposure, those who have completed 3 doses of preexposyre prophylaxis regardless of the interval between exposure and last dose of the vaccine will require
Only booster doses given on day 0 and 3. No need to give immuneglobulin
161
Typhoid vaccine is given
IM
162
Minimum age of giving typhoid vaccine and revacinnation every
2 years old with revaccination every 2-3 years
163
Cholera vaccine is given
Per orem
164
Minimum age of giving cholera vaccine
12 months as a 2 dose series 2 weeks apart
