The Shots
Growth & Development
ID
Potpurri
Screen & Act
100
HPV vaccination schedule
If starting <15yo, 2-dose series, 6 months apart
If starting at 15yo or older, 3-dose series (0, 1-2 months, 6 months)
100
When does birth weight double, triple, and quadruple?
Doubles by 4 months
Triples by 12 months
Quadruples by 24 months
100
Treatment of erythema migrans in a 7 year old
1st line: 10 days of oral doxycycline *in children of any age this is 1st line*
*2nd line: 14 days of amoxil or cefuroxime
100
When do you start routine BP screening?
3 years old, performed at every well visit
*at every visit if: premie <32 weeks, NICU stay, heart disease, steroids, solid organ transplant, systemic illness
100
When do we formally/objectively screen for autism and what do we use?
2020 AAP guidelines recommend M-CHAT (Modified Checklist for Autism in Toddlers) for all children at ages 18 and 24 months and PRN if parental concerns
200
What is the guideline regarding administration of MMR to patients with HIV?
HIV-infected children should receive MMR in the absence of severe immunosuppression (i.e. CD4+ percentage >= 15% for at least 6 months at any age)
*this also applies to varicella immunization
200
When does birth length increase by 50%, double, and triple?
50% increase by 1 year
Doubles by 4 years
Triples by 13 years
200
Treatment of this intensely pruritic rash, itches more at night
Topical permethrin 5% cream from the neck-down (include scalp on infants) left on for ~8 hours. Repeat in 1 week.
200
What is the recommended hot water heater temperature?
Less than or equal to 120 degrees F (or 48.9 degrees C)
200
What legal act is designed to provide special services to children who are disadvantaged (i.e. living in poverty, English as a 2nd language)?
Every Student Succeeds Act (ESSA)
*replaced the No Child Left Behind Act
300
A 5-day-old ex-33-week boy is in the NICU doing well, medically stable. Birth weight was 1.8 kg. Mother was HbS Ag-negative. When can he get his 1st dose of hepatitis B vaccine?
At hospital discharge or at 1 month chronological age, whichever comes first
*By 1 month chronological age, all medically stable preterm infants, irrespective of initial birth weight or gestational age, respond with seroconversion rates similar to those with birth weights >2 kg or born at term
300
What is the most common cause of toilet training refusal?
A strong-willed child
300
Children with cochlear implants are at increased risk of infection from what pathogen?
Strep pneumo
*Remember they especially need their shots: 3 PCV doses by age 2, followed by PPSV23 at last 8 weeks after previous dose of PCV (unless they have received 1 or more doses of PCV20)
300
After receiving MMR vaccine, when can a patient have a tuberculin skin test performed and why?
4-6 weeks later because MMR suppresses TST reactivity
300
What is the high-risk cutoff level for lead screening?
greater than or equal to 3.5 mcg/dL
400
Which vaccine(s) must be stored frozen (-50C to -15C aka -58F to 5F)?
Which vaccine(s) can be stored in either a freezer or refrigerator?
Varicella-containing vaccines (i.e. monovalent varicella, MMRV)
MMR
400
Describe the pattern of both growth velocity and bone age in each of the following conditions: constitutional growth delay and familial short stature.
Constitutional growth delay: Normal growth velocity, delayed bone age
Familial short stature: Normal growth velocity, normal bone age
400
Children with h/o congenital rubella have a much higher risk of what disease?
Type 1 diabetes
*triggers autoimmune destruction of pancreatic beta cells
400
Do not give live virus or bacterial vaccines to anyone receiving what dose of prednisone and for what duration?
Greater than 2 mg/kg (or 20 mg max) of prednisone, either daily or every other day, for >14 days
400
Vanderbilt forms screen for what conditions?
Inattentive/hyperactive-type ADHD, oppositional defiant disorder (ODD), conduct disorder, depression/anxiety
500
A recently adopted unimmunized 4yo girl presents for 1st well check. She was adopted from orphanage in Mexico and has a h/o splenectomy due to blunt abdominal trauma following a motor vehicle accident. What regimen(s) are appropriate for prevention of invasive pneumococcal disease?
For children 24-71 months of age who have received <3 previous doses of PCV13, PCV15, or PCV20 before age 2: One dose of PCV20 followed 8 weeks later by 2nd dose of PCV20
OR
2 doses of PCV15 separated by 8 weeks, followed by 1 dose of PPSV23 8 weeks after 2nd dose of PCV15; would then need PPSV23 (or a first dose of PCV20) 5 years after first dose of PPSV23
500
What syndrome does a patient with these features have?
- breast buds at age 5
- irregular rash on her back
- abnormal XR of her bones
McCune-Albright syndrome: triad of precocious puberty, fibrous dysplasia of skeletal system, irregular "coast of Maine" cafe au lait macules
500
What is the next best step in management of a neonate found to have Citrobacter growing in their CSF?
Immediate CT or MRI of the head to look for brain abscess (~occurs in 75% of Citrobacter meningitis cases)
*gram negative bacillus, treat with 3rd gen cephalosporin or aminoglycoside
500
What are the main clinical features of Eagle-Barrett syndrome?
This is prune belly syndrome
Abdominal musculature deficiency + GU anomalies
500
Describe 3 differences between IEP vs 504 plan.
IEP: Ensures students ages 3-21 with disabilities have the right to appropriate free public education, must meet any of 13 eligibility criteria and can then access specialized instruction, accommodations, and related services
504: Allows equal access to education in a general education setting, no specialized instruction or change to education services, must have documented impairment (i.e. medical, developmental, emotional) that limits at least 1 major life activity; modifies environment (i.e. ramps, handrails, extra time, sitting closer to front), legal required to have annual eval, +federal funding