School-Age Children Leik

Question 1

Still’s Murmur

Answer 1

A benign systolic murmur that is described as having a vibratory or musical quality.

Becomes louder in supine position or with fever. Minimal radiation. Grade I or II intensity.

Most common in school-age children.

Usually resolves by adolescence

Question 2

Top Causes of Death

Age 1 to 24 Years (Toddlers to Young Adults)

Answer 2

accidents or unintentional injuries

Question 3

Hypertrophic cardiomyopathy

Answer 3

Sudden cardiac death

Question 4

Atlantoaxial instability (Down syndrome, juvenile
rheumatoid arthritis)

Answer 4

Instability between C1 and C2

Question 5

Marfan syndrome with aortic aneurysm

Answer 5

Aortic aneurysm risk: Lens eyes displacement, joint

hypermobility

Question 6

Ehlers–Danlos syndrome (vascular form)

Answer 6

Cerebral or cervical artery aneurysm, spondylolisthesis,

joint hypermobility

Question 7

Acute rheumatic fever with carditis

Answer 7

Worsens condition, heart inflamed

Question 8

Mitral valve prolapse, especially if significant mitral

valve pathology

Answer 8

Sudden cardiac death

Question 9

Fever

Answer 9

Heat stroke

Question 10

Age 5-14 years - top causes of death

Answer 10

Accidents or unintentional injuries
Cancers
Developmental and genetic conditions

Question 11

Immunizations 4- 6 years

Answer 11

Administer vaccines: Measles, mumps, rubella (MMR); varicella, inactivated poliovirus vaccine (IPV); and diphtheria, tetanus, acellular pertussis (DTaP)

If history of chickenpox and documented on chart by health provider, does not need varicella.

If child is 7 years or older, give Tdap instead of DTaP.

Question 12

Immunizations Middle School - age 11-12 years

Answer 12

Tdap booster

Meningococcal conjugate vaccine/Menactra (MCV4)

Human papillomavirus (HPV) vaccine/Gardasil

Question 13

HPV vaccine

Answer 13

HPV vaccine is now indicated for both girls and boys. Need a total of three doses of vaccine.
Gardasil used for both genders.

Question 14

Age 13 to 14 years (or older):

Answer 14

Give Tdap if did not receive it at age 11 to 12 years

Question 15

If no history of varicella immunization (or the disease),

Answer 15

then give the varicella vaccine.

Question 16

If child did not complete hepatitis B series (fewer than three doses),

Answer 16

administer hepatitis B booster. Do not restart hepatitis B series.

Question 17

Meningococcal Vaccines

Answer 17

Administer Menactra or Menveo vaccine first dose age 11 to 12 years. If missing, catchup age is 13 to 15 years. Booster (second dose) at age 16 years.

Also used for first-year college students (living in dorms) and people with asplenia, functional asplenia (sickle cell), splenectomy, HIV infection, complement deficiencies,
and others at higher risk.

Question 18

Primary Series of Vaccination: Missing or Not Done

After Seventh Birthday (Never Been Vaccinated)

Answer 18

Td (three doses primary, then every 10 years); substitute Tdap for one dose of Td (once in a lifetime)

IPV (three doses)

Hepatitis B (three doses)

MMR (two doses)

Varicella (two doses) if no history of chickenpox

HPV (three doses; give if younger than age 26 years)

Question 19

Immunizations: Age 10 and older

Answer 19

see following cards

Question 20

Hepatitis B

Answer 20

Total of three doses over 6 months. If missing a booster, give until total of three doses. Do not repeat series.

Question 21

Measles, mumps, rubella

MMR

Answer 21

Give second dose (if needs to catch up). Live virus precautions.

Question 22

Varicella

Answer 22

Give second dose (if needs to catch up) if no proof of varicella. Live virus precautions.

Question 23

Tetanus

Answer 23

Give Tdap at age 11 to 12 years (or older if missed this dose). Replace one Td booster with Tdap.

Question 24

Hepatitis A

Answer 24

Needed for high-risk groups (homosexuals) and endemic areas (certain areas of southwestern United States).

Question 25

Influenza

Answer 25

Needed annually after age of 6 months.

Question 26

Human papillomavirus

Answer 26

Indicated for boys and girls. Give first dose at age 11 to 12 years. Catch-up dose at age 13 years if missed. Gardasil: Need three doses. Give second dose 1 to 2
months after first dose. Give third dose 6 months after the first dose.

Question 27

Meningococcal

Answer 27

First does at age 11 to 12 years. Give booster at age 16 years. Meningococcal conjugate vaccine (MCV4) needed for all college freshmen living in
dormitories.

Question 28

6 Years Old (Kindergarten)

Gross Motor

Answer 28

Copies a triangle (copies a diamond at age 7)
Ties shoes
Rides a bicycle

Question 29

Age 7 to 11 Years (Middle Childhood)

Answer 29

Freud classified this age group under the “latency stage.”

The major task for this age group is to succeed in school and to interact with their peer group. May have a “best” friend(s).

Starts to think of the future. Some girls may start puberty at age 8 years.

According to Piaget, this age group is in concrete operations stage (early abstract thinking starts at about
age of 11 years).

Question 30

Functional Constipation (Encopresis)

Answer 30

Rome IV criteria diagnosis of functional constipation in children (age 4 years or older; criteria are slightly different for infants and toddlers up to 4 years of age).

Must meet two (or more) of the criteria at least once per week (for at least 1 month).

• History of withholding of stool
• History of painful or hard bowel movements
• History of large-diameter stools that may obstruct the toilet
• Presence of large fecal mass in rectum
• Two or fewer defecations in toilet per week
• At least one episode of fecal incontinence per week (thin fluid with feces that bypasses a
• large stool mass and leaks around it); ask patient whether fecal soiling of underwear
• Up to 80% of children with functional fecal incontinence may also have constipation (Sood, 2017).
• Order a plain film (x-ray) of the abdomen to check for retained stool.

Question 31

All 11- to 12-year-old children should be vaccinated with single dose of quadrivalent meningococcal vaccine (MenACWY)

Answer 31

brand names are Menactra or Menveo.

Question 32

Immunizations are needed at age 11 to 12 years

Answer 32

Tdap
HPV
MCV4

Question 33

Child at age of 11 years is at

Answer 33

“early abstract” thinking stage (Piaget).

Question 34

HPV vaccine (Gardasil):

Answer 34

Know that youngest age group for vaccination is 9 years.

Question 35

457. About one third of children in the United States are considered obese. Which of the following methods is an appropriate intervention for obese school-aged
     children?
     A) Severe restriction of dietary carbohydrates
     B) Increase physical activity and outdoor play
     C) Prescribe appetite suppressants
     D) Over-the-counter herbal weight-loss pills

Answer 35

B) Increase physical activity and outdoor play Lifestyle changes, such as increasing physical activity and spending more time outdoors, are appropriate
recommendations for children. Consider referral to a registered dietician for dietary recommendations and counseling. Participation in an exercise program designed for children (if available) is also appropriate. Severe caloric and/or carbohydrate restriction is not recommended for this age group.