Vaccines
What is the difference between Dtap and Tdap?
Dtap has more diphtheria concentrate than Tdap
At what age should the initial vision screening occur?
20/400; maturity at age 4
In AOM with perforation what antibiotic should be given? topical or oral?
What is the earliest sign of respiratory distress in pediatric patients?
increased respiratory rate
Describe which patients are recommended to receive the Abrysvo RSV vaccine. If they do not receive it, what should the child receive?
Mothers between 32-37 weeks pregnant between September and january
Child should receive nirsevimab
What is the autism screening tool and at what ages should it be used?
M-CHAT; 18 and 24 months
What is the can't-miss diagnosis with leukocoria?
retinoblastoma
What age do you see the peak incidence of acute otitis media? What are the three most common pathogens?
6-18 months; s pneumonia, nontypeable H flu, moraxella
What is the most frequent cause of laryngeal problems in infants less than 6 months of age? How does it usually present?
laryngotracheomalacia; stridor when patient breathes too hard
Which vaccine may cause a hypotonic-hyporesponsive episode and a fever >105?
Dtap
What would constitute a positive risk factor screening for lead? What is the follow-up evaluation?
House built before 1978 or renovated in past 6 months, daycare or home; high risk area is >25% housing built before 1960 or >5% of children in the area have an elevated level
F/u is blood draw
Define the following
esotropia
exotropia
hypertropia
hypotropia
Esotropia- deviation towards the nose (medially)
Exotropia- deviation away from the nose (laterally/temporally)
Hypertropia- deviation upwards
Hypotropia- deviation downward
How does herpangina present? What is the treatment?
Vesicles with fever, difficulty swallowing, and dysphagia. Treatment is supportive as this is a viral infection
Describe classic croup symptoms and the most common cause. What are the aims of treatment?
Symptoms- nasal congestion, fever, barking cough
Cause- parainfluenza virus
Treatment is aimed at reducing airway inflammation
What kind of vaccine is Hib? How many times is it given and at what ages?
capsular polysaccharide (subunit/conjugate)
4 doses- 2, 4, 6, 12-18 months
Describe the hearing screening process for a pediatric patient with no risk factors
initial screen at birth, followed by periodic screens between the following ages
4-10
11-14
15-17
What are the treatments for chlamydial conjunctivitis and gonococcal ophthalmia neonatorum?
GON- IV/IM ceftriaxone, hospitalize for treatment and evaluation of disseminated disease
What does the described neck mass in a pediatric patient suggest?
- midline mass which moves with swallowing or protrusion of the tongue
- multiple small mobile masses along the anterolateral neck in a patient with known strep throat
- unilateral cervical posterior triangle enlargement, firm, contender
- thyroglossal duct cyst
-reactive lymphadenopathy to infection
- malignancy
A 6 year old patient presents with stridor, cough and high fever. Mother reports that the patient had recently recovered from a viral URI. What do you suspect? What is the treatment?
Suspect bacterial tracheitis, treat with Unasyn, 3rd gen cephalosporin, or clindamycin
What is oculorespiratory syndrome and which vaccine is it associated with?
Acute self-limiting syndrome of chest tightness, cough, facial swelling, and wheezing after the influenza vaccine. Self-resolving
At what age should screenings start for the following problems?
Hypertension
dyslipidemia
Substance use
Depression
Hypertension- 3 years old
dyslipidemia- between 9 and 11
Substance use- 11
Depression- 12
What is coloboma? What testing should be ordered in patients with this condition and why?
Keyhole or notch shape in eye. Order renal ultrasound because it can occur in a syndrome with renal problems
What are the criteria for consideration of tympanostomy tubes?
>/= 3 distinct and well-documented episodes in 6 months, or 4 or more episodes in 12 months with persistent middle ear effusion
What are the 3 indications for chest XR in a patient with asthma?
2. Chest pain, CV instability, or absent breath sounds
3. Poor response to treatment
Which vaccine(s) is/are contraindicated in the following scenarios?
Allergy to Baker's Yeast
Pregnant or Immunocompromised
Prior intussusception
Hypersensitivity to neomycin
GBSAllergy to Baker's Yeast- Hep B, maybe HPV if severe allergic rxn
Pregnant or Immunocompromised- Rotavirus, MMR, Varicella
Prior intussusception- rotavirus
Hypersensitivity to neomycin- IPV
GBS- meningococcal vaccine
What are the four screening questions for sudden cardiac death?
1. have you ever fainted, passed out, or had an unexplained seizure especially during exercise or in response to sudden loud noises?
2. Have you ever had exercise-related chest pain or SOB?
3. Has anyone in your immediate family or distant relatives died of heart problems or had sudden death before age 50?
4. Are you related to anyone with HCM, Marfan syndrome, ACM, LQTS, short QT syndrome, BrS, or CPVT, or anyone younger than 50 with a pacemaker? (I think this one just remember are you related to anyone with heart conditions or a pacemaker under 50)
What physical exam findings would cause you to suspect the patient has orbital cellulitis instead of periorbital cellulitis? What is the difference in treatment? When prescribing antibiotics, what three organisms should be covered?
Periorbital can receive antibiotics only, orbital requires admission and surgery
Cover: MRSA, strep pneumonia, Hib
What is Lemierre syndrome and how is it treated?
Infection of the pharynx caused by fusobacterium necrophorum, causes pharyngitis and jugular vein thrombophlebitis. Treated with IV antibotics (Unasyn, Zosyn)
What x-ray findings would you expect in patients with the following
Croup
Foreign body
Retropharyngeal abscess
Epiglottitis
RSV bronchiolitis
Croup- steeple sign
Foreign body- radio-opaque body, or hyperinflation on affected sign on expiratory film
Retropharyngeal abscess- retropharyngeal space at C2 is twice the diameter of the vertebral body (hopefully can just know its enlarged)
Epiglottitis- thumb sign
RSV bronchiolitis- hazy pattern/infiltrates, no consolidation