Immunizations
Milestones
Screening
Dx
Grab Bag
100
Baby A is at the Dr's office for her 1 yr WCC. What vaccines will she be receiving today?
MMRV, PCV, HepA, +/- Hib
100
Baby C is being seen for his WCC. He is cooing and turns his head to mom's voice. He is smiley and able to hold toys. He can roll over but unable to sit. How old is he?
What is 4 mos
100
Recommended Age groups for screening for Autism, and what is the tool called.
Bonus- What score is considered high risk?
What is 18 and 24 mos, MCHAT
High risk= >8 points
100
You are seeing a 10 day old ex 38 wk infant. He is 10% below his BW, primarily BF, and you note yellowing of his ictera. What is this called and what will you tell the parent?
What is breastmilk jaundice, benign self-limiting condition possibly due to genetic difference (UGT1A1) with resolution by 12 wks of age.
100
You are seeing a newborn for their 1st outpatient WCC. Their parent is concerned about this rash.
What is this called and what causes it?
Milia, benign newborn skin condition caused by retention of keratin within the dermis.
200
It's Flu Season! You are seeing a 7 mos old infant, what are you recommendations for the influenza vaccine?
They are eligible to receive starting at 6 mos, and must receive 2 vaccines (at least 4 wks apart) the first time getting immunized (up until 8 y/o).
200
Baby H has a WCC. He is able to say Dada and Mama and sit unsupported. He is crawling and cruising. He has not mastered pincer grasp yet. How old is he?
What is 9 mos
200
At what age do you start screening for depression?
At 12 y/o + PHQ-2 is validated, if positive use PHQ-9
200
You are the resident in the NBN and are seeing a female infant who was just born. What are the criteria for DDH screening, and when is US recommended?
Risk factors:
- breech presentation in 3rd trimester, females with pos family hx, positive Ortolani test, improper swaddling
US recommended at 6 wks of age or XR hip/pelvis at 4 mos
200
You are the sole pediatrician at a community hospital attending a newborn delivery. Following a stat C-section for a 35wk old infant, he is found to have a RR of 60.
What is this condition called and what are the proposed mechanisms for this occurring?
TTN. Caused by failure of adequate lung fluid clearance at birth, resulting in excess lung liquid. The liquid fills the air spaces and moves into the extra-alveolar interstitium, where it pools in perivascular tissues and interlobar fissures.
- ENaC channels--> With the onset of labor, maternal epi and glucocorticoids activate the ENaC -->osmotic gradient is created which allows chloride and water to follow and be absorbed
- vs lung inflation (PEEP)
300
This vaccine has increased risk of febrile seizures
What is MMR
300
Baby P is seen for a WCC. He is able to walk and run but unable to jump off ground with 2 feet. He can scribble but not draw lines. He can use at least 25 words and engages with others for play. How old is Baby H?
What is 18 mos
300
What is the validated screening tool recommended by the AAP for substance use, and what does the acronym stand for?
CRAFFT (Car–Relax–Alone–Forget–Family and Friends–Trouble)
300
You are seeing a 9 yr old Pt in your clinic. They are complaining of throat pain and fever and have this new onset rash. What is this called and what is the tx for condition?
Scarlatiniform rash
Amox low dose (50mg/kg/d) split BID x 10 d
300
You are seeing a 1yr Female with fever. U/A pos for 3+ LE, Nitrites and bacteria.
What is first line tx and what are the indications for imaging (if any).
Keflex
- US for Children <2 y/o with first febrile UTI. OR children with hx of kidney anomalies
- US for children of any age with two or more febrile UTIs
- VCUG for children with 1 febrile UTI AND abnormalities on US OR Temp >39C and Cx with organism other than E coli OR poor growth/HTN
400
Baby A is 2 mos old, what vaccines will she be receiving today and what is the name of the combo vaccines she could be eligible for (name the parts!)
Rota, PCV 20, IPV, Hib, DTaP +/- HepB
Vaxelis- DTaP, Hib, HepB, IPV
Pediarix- DTap, HepB, IPV
Pentacel- DTaP, IPV, Hib
400
Baby D is being seen for WCC. She can tell you a story that is 75% understandable. She is able to eat by herself and use scissors. She has a tricycle but cannot skip. How old is Baby D?
What is 3 years
400
You are seeing a 7 y/o boy in clinic for concerns of ADHD. What form will you give to the parent/school, and what are 4 other common comorbidities this screening tool assesses?
Vanderbilt form, also screens for oppositional-defiant disorder, conduct disorder, anxiety, and depression.
400
You are seeing a 2.5 yr old for concern for AOM. Please describe the treatment, stratification and duration of tx.
Amoxicillin high dose 90 mg/kg/d split BID
for <2 y/o, 10 days. Also 10 days for TM perforation or recurrent AOM
for >/= 2 y/o, no hx of TM perf or recurrent AOM- 5-7 days
other nuances: if severe sx's (T 39C and pain x 48 hrs), with findings on exam, always tx. if no temp/pain with findings, recc obs
400
You see a child at your clinic with this rash. At what number is there assoc with increase in risk, and what areas would you be most concerned about?
Hemagiomas >5, hepatic and airway most concerning
500
At what age are pts eligible for the HPV vaccine and what are the age cut-offs for dose/ series?
Pts can receive Gardasil as young as 9 y/o. If start series before 15 y/o, only need 2 doses. If 15 y/o or older for initial vaccination then will require 3 doses.
500
You are seeing a 30 mos old for his WCC. Mom states that he speaks in 2-3 word sentences. He plays with his peers but is having a tough time with toilet training. He runs well and tends to fall.
What developmental domain is he behind in?
Gross Motor- should be able to run well without falling, walking up steps with alternating feet
500
You are seeing a newborn for 2 wk WCC, at what age do you start screening mom for PPD and until when?
AAP recommends that birth parent should be screened for depression at the 1-, 2-, 4- and 6-month well-infant visits. (Ie Edinburgh PostPartum depression scale)
500
You just saw a 3 yr old for a WCC. Lab results come back with lead level of 45.
What is the treatment? And what is the counseling/advice you give to parents?
Chelation tx (oral with Succimer preferred), Tox consult! +/- hospitalization if environmental exposure.
Testing other children in same household. Contacting DPH, lead abatement.
Lead can be found in:
- house made prior to 1977, paint!
- surfaces/dirt. Wash hands before eating, minimize playing in dirt or on dirty floor. Clean all surfaces and floors with mops.
- herbal/folk medicine
- toys/ makeup/ pottery from other countries outside US