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CMS 3 Peds 2 - Quizzes
Nova Orlando
192
Health Care
Graduate
04/16/2011

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Cards

Term
7 yo male presents complaining of a 1 month hx of red, well-demarcated plaques covered with dry, thick, silvery scales located on the extensor surfaces of extremities, scalp, and buttocks with large lesions located over pressure points of knees and elbows. Dx?
Definition
psoriasis
Term
treatment for psoriasis?
Definition
topical corticosteroids
Term
Pt education for psoriasis
Definition
daily exposures to small amounts of sunlight may improve psoriasis, but intense sun exposure can worsen symptoms and cause skin damage.
Term
12 yo male presents with what was thought to be a recalcitrant case of eczema, presents complaining of "dirty brown" scales that have migrated to his thighs, trunk, and buttocks. As a newborn, he had a collodion membrane at birth. Biopsy = increased granular layer and stratum corneum. Dx?
Definition
x-linked ichthyosis
Term
what future disease can develop in a pt who had a collodion membrane at birth?
Definition
lamellar ichthyosis
Term
This condition has thick warty scales with occasional blistering. The skin lesion are more prominent on the flexural surfaces. Dx, Tx?
Definition
Epidermolytic Hyperkeratosis.
Use fo keratolytics, lubricants, oral retinoids, antibiotics for secondary infection (staph aureus)
Term
Pt is highly involved in sports. He complains of itchiness and scaling of his feet. Dx?
Definition
juveinle plantar dermatosis - "sweaty sock syndrome"
Term
tx fo juvenile plantar dematosis
Definition
lubrication of feet, covering them at night and topical steroids in severe cases. Use of charcoal-impregnant foam insoles is helpful
Term
pt complains of dryness lips during the winter season. Dx?
Definition
lip licking eczema
Term
tx of lip licking eczema?
Definition
elidel and protopipc ointment (t-cell supprsesor). Try to avoid steroids on facial skin because it will cause hyper-vascularization, striae, and discoloration
Term
child complains of redness and itching around his waist in the distribution of his belt. dx?
Definition
irritant contact dermatitis.
Term
tx of irritant contact dermatitis?
Definition
topical steroids, avoid irritant
Term
what lesions are associated with recalcitrant atopic dermatitis?
Definition
lichenification
Term
how do you treat recalcitrant atopic dermatitis with lichenification?
Definition
1 week tapering couring of systemic corticosteroids beginning at 0.5 to 1.0 mg/kg/day. May add a hydrating agent like LacHydrin or an oral antihistamine for severe itching. Avoid irritant
Term
Condition caused by excessive sweating
Definition
tinea versicolor
Term
tx of tinea versicolor
Definition
topical antifungal or oral ketoconazole (1 time dose)
Term
infant patient presents with redness around the genitals, dx, tx?
Definition
candidal diaper dermatitis.
nystatin cream
Term
flat top violaceous papules along the shins...
Definition
lichen planus
Term
phenomenon of linaer lesions
Definition
koebner phenomenon at sites of previous trauma
Term
lesions developed after receiving an immunization
Definition
erythema multiforme
Term
MCC of erythma multiforme in children?
Definition
infections
Term
MCC of recurrent erythema multiforme
Definition
Herpes Simplex Virus
Term
tx for brown recluse spider bites
Definition
dapsone, it decreases the degree of tissue damage
Term
This child complains of itchiness that worsens at night. The lesions are located in the intertriginous regions of the hands and feet. Dx, tx?
Definition
scabies.
Permethrin cream - oral antipruritic lesions and topical steroids may be required. Never treat an infant with Lindane (KWell) due to neurotoxicity
Term
Child presents with complaints of an itchy scalp and nits. Other children in the classroom have the same complaints. Dx, tx?
Definition
head lice.
pediculicide - permethric 1% or 5% or ovide
Term
small round lesions that are dome shaped and appear on the child without any accompanyng sxs. dx?
Definition
molluscum contagiosum
Term
tx for molluscum contagiosum?
Definition
observation or aldara cream 5%
Term
child's lesions occurred about 6 months ago, now they are enlarged and contracted. tx?
Definition
intralesional steroid injections alone or in combo with surgical excision. May give mederma to decrease scar.
Term
a patient with juvenile xanthogranuloma may have manifestations in what other organ?
Definition
eye
Term
who should a child diagnosed with juvenile xanthogranuloma be referred to? why?
Definition
ophthomologist, risk of hyphema
Term
pt with a hx of heavy sun exposure presents with a lesion which is increasing in size and varying in color. dx?
Definition
melanoma
Term
tx for melanoma?
Definition
STAT referral to dermatologist or oncology specialist.
Term
lesions consist of a flat topped papule, appear fairly aburptly, usually in a linear or sometimes swirled distribution along the lines of Blaschko. Can occur anywhere. Will resolve in 1-2 years.
Definition
lichen striatus
Term
tx of urticaria
Definition
antihistamines, block H1 receptors 1st line. ex. = diphenhydramine, hydroxyzine
Term
what is the causative agent for hand, foot, and mouth disease?
Definition
Coxsackie A & B
Term
tx for varicella
Definition
calamine lotion, oatmeal bath, atarac at bedtime. To prevent superinfection apply bacitracin to denuded lesions until scab forms.
Term
child has a fine pink-red maculopapular rash, you also note post-auricular LAD and Forchheimer spots on teh soft palate on the 1st day the rash appeared. Dx?
Definition
rubella caused by rubella virus (contagious 1 week before rash and 1 week after)
Term
normal appearance of rubella?
Definition
exanthem on the face which spreads to the trunk and limbs and usually fades after three days
Term
child has a lacy reticular rash that started on his tunk and then spread to his extremities. He also has reddened cheeks. A fever preceeded the rash by 2-3 days.
Definition
erythema infectiousum
Term
when is erythema infectiosum most contagious?
Definition
incubation period of 4-14 days
Term
what is the causative agent of erythema infectiousum?
Definition
Parvovirus B19
Term
discrete rose colored macules that start centrally on the trunk and spread to the face, scalp and extremities. Mom admits to an abrupt high fever 2 days prior to the rash. dx?
Definition
roseola
Term
causative agent of roseola?
Definition
HHV6
Term
Pt presents with a rash, cough, low-grade fever, and conjunctivitis. Rash is erythematous, and confluent starting at the head and moving caudally. Hands and soles are involved. Dx?
Definition
Rubeola - Nine-Day/ Red Measles/ "Ordinary Measles"
Term
what congent
Definition
Term
what congenital heart diseases require subacute bacterial endocarditis prophylaxis?
Definition
congenital/rheumatic heart disease (MCC of aortic stenosis), mitral valve prolapse, cyanotic congenital heart disease
Term
for what cardiac conditions is bacterial endocarditis prophylaxis recommended?
Definition
prosthetic valve/conduit, obstructive/regurgitant lesions, all dental procedures, GI/GU procedures, surgeries
Term
what congential heart conditions DO NOT require bacterial endocarditis prophylaxis?
Definition
isolated secundum ASD, surgical repair of ASD, VSD, or PDA (w/o residual and beyond 6 months of age), previous CABG, MVP without regurg, physiologic/ functional/ innocent heart murmurs, previous Kawasaki without valvular dysfunction, cardiac pacemakers and implanted defibrillators
Term
what vessels are involved in TOGA?
Definition
aorta, pulmonary artery, coronary arteries
Term
what is the MAJOR manifestations of Jones criteria?
Definition
polyarteritis, carditis, chorea, erythema marginatum, subcutaneous nodules
Term
what are the minor manifestations of Jones Criteria?
Definition
fever, arthralgia, previous rheumatic fever, elevated acute phase reactants, increasd ESR/CRP, leukocytosis, prolonged P-R interval
Term
what is the diagnosis of acute rheumatic fever based on? what are the rules?
Definition
Jones Criteria. Evidence of pervious strep pharyngitis infection + 2 major, or 1 major and 2 minor.
Term
what is the DOC for PDA?
Definition
indomethacin
Term
what condition is rarely seen in children?
Definition
restrictive cardiomyopathy
Term
4 lesions in Tetrology of Fallot
Definition
pulmonary stenosis, over-riding aorta, VSD, RVH
Term
DOC for bacterial endocarditis prophylaxis prior to dental procedure. Dose?
Definition
amoxicillin, 50 mg/kg
Term
cyantic lesions
Definition
All the T's + hypoplastic left heart syndrome.
Tetrology of Fallot
Tricuspid Atresia
Transposition of the Great Arteries
Truncus Arteriosus
Total Anomalous Pulm. Venous Connection
Term
acyanotic lesions
Definition
ASD, PDA, VSD, Pulmonary Stenosis, Aortic Stenosis, Coarctation of the Aorta
Term
list the acquired heart diseases (8)
Definition
Kawasaki, Rheumatic heart disease, congestive/ restrictive/ hypertrophic cardiomyopathy, myocarditis, pericarditis, infective endocarditis
Term
Pt allergic to PCN, what is the DOC for bacterial endocarditis prophylaxis prior to dental procedure? dose?
Definition
clindamycin, 20 mg/kg
Term
diagnostic criteria for Kawasaki disease...
Definition
fever > 5 days, plus 4 of 5 with other illness w/ similar signs being excluded.
1. polymorphous rash
2. bilateral conjunctival injection
3. mucuous memrane changes (diffuse injection, erythema/fissuring or lips, strawberry tongue)
4. acute, non purulent cervical LAD
5. extremity changes (erythema of palms/soles, indurative edema of hands/feet, membranous desquamation of the fingertip)
Term
tx for Kawasaki disease
Definition
main goal is to prevent coronary artery disease and to relieve symptoms.
Mainstay of tx = IV gamma-globulin (IVIG) at 2g/kg
Term
physical activity for a child at cardiac risk level 3
Definition
1st decade = no restriction beyond initial 6-8 weeks.
2nd decade = physical activity guided by stress testing every other year.
Competative contact athletics with endurance training is discouraged
Term
tx for rheumatic heart disease
Definition
bed rest.
abx = PCN to eradicate B-hemolytic strep
ASA for arthritic pain.
daily exam for development of carditis.
anti-inflammatory meds - corticosteroids.
symptomatic treatment.
Term
tx for hypertrophic cardiomyopathy
Definition
moderate restriction of activity negative inotropes (BB, CCB)
SBE prophylaxis
Defibrillator if at risk of sudden death
sx w/ subaortic obstruction = myectomy
Term
tx of dilated cardiomyopathy
Definition
management for CHF = digoxin, diuretics, rest.
anticoagulants to decrease the risk for thrombus formation
Term
tx of restrictive cardiomyopathy
Definition
bed rest, diuretics, inotropes (dopamine, dobutamine), digoxin, gamma globulin (2g/kg in 24 hrs), steroids, heart transplantation if not better.
Term
tx of cardiac tamponade
Definition
pericardiocentesis
Term
tx of cardiac tamponade
Definition
pericardiocentesis
Term
what are the systolic heart murmurs?
Definition
AS, PS, TR, MR, systolic clicks, ASD, VSD, ejection sounds
Term
what are the diastolic heart murmurs?
Definition
TS, MS, AR, PR, opening snap, S3, S4
Term
what murmurs are both systolic and diastolic?
Definition
venous hum, PDA, rubs
Term
explain MI in children
Definition
rare but could occur in children with anomalous origin of LCA, Kawasaki disease, congenital haert disease (presurgical/postsurgical), and dilated cardiomyopathy. MC the children have HTN, lupus, myocarditis, cocaine ingestion, and use of adrenergic drugs (Beta agonists for asthma, etc)
Term
what children should have lipid monitoring according to the AAP?
Definition
parents/grandparents with coronary atherosclerosis < 55 yo.
parents/grandparents with MI, angina, PVD, CVD, or sudden cardiac death < 55yo.
parent with elevated blood cholesterol level > 240 mg/dL.
unattainable parental hx with other risk factors such as smoking, diet high in saturated fats and cholesterol, or obesity.
Term
management for normal/borderline LDL
Definition
education and risk factor intervention including diet, smoking cessation, and exercise. Borderline - re-eval in 1 year.
Term
management for high LDL
Definition
examine for secondary causes (liver, thyroid, renal disorders), and familial disorders. Then initiate low fat, low cholesterol diet, and re-eval in 3 months.
Term
when should drug therapy be considered in children with dyslipidemia
Definition
children > 10yo after failure of adequate trial of diet therapy (6-12 months).
Term
DOC for children with high LDL
Definition
bile acid sequestrants
Term
what are the 5 innocent murmurs?
Definition
Stills murmure, Pulmonary ejection murmur, pulmonary flow murmur, venous hum, carotid bruit
Term
common age for Stills murmur
Definition
3-6 yo, occasionally in infants
Term
common age for a pulmonary ejection murmur?
Definition
8-14 yo
Term
common age for pulmonary flow murmur?
Definition
premature and full term infants. Disappears by 3-6 months of age.
Term
common age for venous hum
Definition
3-6 yo
Term
common age for carotid bruit?
Definition
any age
Term
what is the phsyiologic factor that causes development of Eisenmenger syndrome?
Definition
complication of uncorrected congenital heart anomalies that produce L to R shunting. Increased pulmonaryr resistance develops over time reversing the L to R shunt to a R to L shunt = cyanotic.
Term
causative agent of EBV/Mono
Definition
epstein barr virus
Term
causative agent of erythema infectiosum?
Definition
Parvovirus B19
Term
causative agent of roseola
Definition
HHV6
Term
causative agent of rubella?
Definition
RNA - rubella virus
Term
causative agent of hand-foot-mouth disease?
Definition
Coxsackie A & B
Term
causative agent of Kawasaki disease?
Definition
febrile illness of unknown etiology
Term
causative agent of Scarlet Fever
Definition
Group A streptococcus
Term
fever, mild malaise, adenopathy, DA, sore throat, coryza.
discrete, pink-red, fine, maculopapular eruption begins on face and spreads cephalocaudally to a generalized rash in 24 hrs then fades and clears completely in 72 hrs. Forchheimer spots.
Definition
Rubella
Term
peak incidence of rubella
Definition
late winter and early spring
Term
can rublla cross the placenta?
Definition
YES!
Term
affects children 6-36 months. Sxs = abrupt rise in temperature, anorexia, irritability. rash = erythematous, maculopapular exanthem after fever subsides, rose-pink macules that begin on the trunk and spread rapidly to the extremities, face, neck, and scalp.
Definition
roseola (exanthem subitum)
Term
highly contagious. fever, malaise, dry cough, coryza, conjunctivitis. Koplik spots appear on buccal mucosa (bluish white dots surrounded by red halos)
Definition
Rubeola
Term
communicable disease characterized by abrupt onset of fever and posterior pharyngeal ulcers
Definition
herpangina
Term
most common viral cause of pharyngitis
Definition
adenovirus
Term
secondary infections acquired by varicella patients
Definition
pneumonia, secondary bacterial infection (superinfection)
cellulitis, osteomyelitis, septic arthritis, encephalitis, acute cerebellar ataxia (clears in 24-72 hr), Reye's syndrome, hepatic failure, progressive varicella, DIC
Term
diseases with fever prodrome that develop a rash (8)
Definition
rubella, rubeola, varicella, scarlet fever, lyme disase, RMSF, Kawasaki, Gianotti Crosti Syndrome
Term
Know vaccine schedule and when it it no longer necessary to give certain vaccines
Definition
Term
irreversible focal bronchial dilation, usually accompanised by chronic infection and associated with diverse conditions, some congential or hereditary
Definition
bronchiectasis
Term
most common cause of bronchiolitis
Definition
RSV
Term
what treatments should be avoided in bronchiolitis patients?
Definition
corticosteroids, sedatives.
Antibiotics should only be used if there is an underlying bacterial infection.
Term
when is a PPD considered positive without risk factors? for members of high-incidence populations? for HIV+ or other immunocompromised patients?
Definition
no risk = 15mm
high risk = 10 mm
immunocompromised = 5 mm
Term
definitive test for TB
Definition
sputum culture
Term
tx for LTBI
Definition
asx pt with +PPD = INH, consider pyridoxine (Vit B6).
isoniazid may cause liver toxicity, monitor LFT's monthly
Term
tx for active TB
Definition
short term hopsitalization wiht INH + rifampin, consider pyrazinamide.
Term
first line tx for child in respiratory distress (tachypnea, rales, crackles, nasal flaring)
Definition
admit! commonly placed in atmosphere of cool, humidified oxygen to relieve hypoxemia, and reduce insensible water loss from tachypnea
Term
most common cause of pneumonia in the first several years of life
Definition
RSV
Term
definitive diagnosis of viral pneumonia
Definition
bacterial sputum
Term
tx for viral pneumonia
Definition
minimal supportive treatment required.
Term
tx for bacterial pneumonia
Definition
DOC = azithromycin, amoxicillin, augmentin, doxycycline, clarithromycin
Term
in hospital tx of bacterial pneumonia
Definition
3rd generation cephalosporin, vancyomycin
Term
CXR findings in tuberculosis
Definition
cavitation, apical or subapical cavitary infiltrates.
MC findings in children are isolated hilar or mediastinal adenopathy, segmental hyperinflation or atelectasis, alveolar consolidation, interstitial densities, pleural effusion or cavitation.
Term
future complications for a 5 yo with cystic fibrosis?
Definition
life threatening lung infections (pseudomonas), obstruction of the pancreas (malabsorption), 95% of men are sterile,
Term
acute inflammation of the tracheobronchial tree, generally self limited, and with eventual complete healting and return of function
Definition
acute bronchitis
Term
best tx for bronchogenic cysts
Definition
antibiotic management
Term
best test for child presenting with abdominal distention, emesis, and failure to pass meconium
Definition
sweat chloride test, > 60mEq = positive.
normal = 10-35 mEq
Term
MC presenting symptom of cystic fibrosis
Definition
acute or persistent respiratory symptoms
Term
most obvious difference between viral and bacterial pneumonia
Definition
bacterial = abrupt onset
Term
confirmatory dx of a child with allergies
Definition
percutaneous skin test, AKA scratch/prick test
Term
causative factors for IgE response (4)
Definition
oral allergy syndrome, GI anaphylaxis, acute urticaria/angioedema, anaphylaxis
Term
correct non-pharmacological management of avoiding food allergies in children
Definition
avoidance of allergens, delay introduction of foods, elimination diet
Term
child with coughing, SOB, and wheezing. Wheezes daily at school and PEF 75%. Tx?
Definition
moderate asthma = B2 agonist, inhaled corticosteroid
Term
pt with asthma presents with chronic wheezing x 1 week. Pt has daily maintenance with inhaled albuterol. Which is the first line med to control the wheezing episode once albuterol has been tried?
Definition
long acting beta agonist with combo inhaled steroid (advair)
Term
what's the safest approach for managing a child who complains of itchy eyes and watery nose with sneezing?
Definition
avoid offending agents, antihistamines
Term
when should an inhaled steroid be added to the asthma regimen?
Definition
moderate persistent asthmatics
Term
technique of running the thumb down the medial surface of the tibia - gives a more interpretable response in infants and toddlers because it avoid stimulation of a plantar flexion or withdrawal response
Definition
Oppenheimer Technique
Term
MCC of tuberous sclerosis
Definition
seizures
Term
what skin lesions are seen with tuberous sclerosis?
Definition
cutaneou lesions in all ages -
ash-leaf macule, facial angiofibroma, sebaceous adenoma, subungual/periungual fibromas, shargeen patch
Term
astrocytoma of the retina on or about the optic nerve head. Refractile, yellowish, mulinodular cystic lesions
Definition
mulberry tumor nodular
Term
round or oval gray-yellow glial flat patches found centrally or peripherally. Unless near the macula they are not of clinical significance.
Definition
Hamartomas (phakomas)
Term
2 retinal lesions associated with tuberous sclerosis
Definition
mulberry tumor nodular, hamartomas (phakomas)
Term
3 cardinal manifestations of Sturge-Weber Syndrome
Definition
vascular malformation/port wine stain,
ipsilateral leptomeningeal angiomatosis with associated intracranial calcifications,
mental retardation and ipsilateral ocular complications.
Term
cerebral disturbances caused by abnormal electrical discharges that may be manifested as an impairment or loss of consciousness, abnormal motor activity, behavioral abnormalities, sensory disturbance, or autonomic dysfunction
Definition
seizure (convulsion)
Term
characterized by 2 or more reccurent seizures that are not provoked by a metabolic or toxic disturbance or by an acute insult.
Definition
epilepsy
Term
type of seizure that affects one area in one hemisphere of the brain
Definition
partial seizure (focial) or Jacksonian seizure
Term
types of simple partial seizures (4)
Definition
motor, sensory, autonomic, and psychic
Term
difference between simple and complex seizures
Definition
complex seizures = impaired consciousness
Term
seizure that affects both sides of the brain
Definition
generalized
Term
most common seizure disorder in childhood
Definition
febrile seizures.
MCC = URI from viral infection
Term
minimum workup for febrile seizure
Definition
fasting glucose, calcium, magnesium, serum electrolyte levels
Term
tx of febrile seizure
Definition
control fever, reassurance, they will resolve on their own.
Term
seizures occuring without identifiable cause in a patient with cognitive impairment or with neurological deficits
Definition
cryptogenic epilepsy
Term
examples of cryptogenic seizures
Definition
West's syndrome, Lennox-Gastaut syndrome, Mesial-temporal lobe epilepsy, neocortical focal epilepsy
Term
examples of idiopathic seizures
Definition
childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, epilepsy with grand mal, benign focal epilepsy of childhood, autosomal dominant frontal lobe epilepsy, primary reading epilepsy
Term
seizures occuring without an identifiable cause in a patient with entirely normal findings on neurologic exam and of normal intelligence. Benign partial epilepsy of childhood and juvenile myoclonic epilepsy
Definition
idiopathic (genetic) epilepsy
Term
defintive diagnosis of cerebral palsy
Definition
not made until a child is 1 year old (or 15-18 months if premie). POSTER
Posturing and abnl movement patterns.
Oropharyngeal problems
Strabismus
Tone (increased or decreased)
Evolutional responses (persistent reflexes)
Reflexes - increased DTR's
Term
subtypes of cerebral palsy
Definition
hemiparesis, spastic diplegia and quadriplegia, athetoid or ataxic cerebral palsy, hypotonic cerebral palsy
Term
MC hereditary neuromuscular disorder
Definition
Duchenne Muscular Dystrophy
Term
which types of MD follows a milder and more protracted course?
Definition
Becker Muscular Dystrophy
Term
symptoms of both types of muscular dystrophy
Definition
Gowers sign, trendelenburg gait, respiratory muscle involvement, scoliosis, pseudohypertrophy, cadriomyopathy, intellectual impairment, epilepsy, myalgias and muscle spasms.
Term
labs/tests used to dx muscular dystrophy
Definition
serum CK, muscle biopsy = diagnostic, specific molecular genetic dx is possible.
Term
medical sign that indicates weakness of proximal muscles, namely those of the lower limg. Describes a pt that has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength
Definition
Gowers sign
Term
an abnormal gait associated with a weakness of the gluteus medius. It is characterized by the dropping of the pelvis on the unaffected side of the body at the movement of heelstrike on the affected side.
Definition
Trendelenburg gait
Term
second most common muscular dystrophy in the US, epilepsy is not common.
Definition
myotonic muscular dystrophy (Steinhart disease)
Term
birth defect in which one or more of the vertebrae fail to form properly in the fetus during the first trimester of pregnancy. No sac or protrusion of the spinal cord
Definition
spina bifida occulta.
Term
imaging studies for spina bifida occulta
Definition
Xray, US (before age 3), CT, MRI, myelography, spinal tap to r/o meningitis in children with sinuses.
Term
spinal cord stays within spinal canal, but meningeal sac protrudes through the opening in the vertebrae but are nevertheless well covered by skin
Definition
meningocele
Term
sac or cyst includes not just the coverings of the spinal cord but also the cord's nerve roots and often the cord itself, bulging out and often not covered by skin
Definition
myelomeningocele
Term
which is more common, meningocele or myelomeningocele?
Definition
meningocele
Term
12 month old presents for WCC. He was given MMR at 9 months, do you repeat it at 12?
Definition
the MMR given before 12 months does not count, repeat at 12 months
Term
4 yo presents for WCC, allergic to eggs. Can they get MMR? flu vaccine?
Definition
MMR = yes
Flu = no
Term
Pt is due for 12 month vaccines (MMR/VZV/Hib/HepA) you decide to give a PPD due to high risk. How should this be done?
Definition
MMR and PPD are either given simultaneously or 1 month apart to prevent false positive
Term
6 yo presents for WCC and has only had 3 Hib vaccines, do you complete the series?
Definition
no, catch up is only done through 59 months of age.
Term
15 month old was exposed to measles yesturday, what do you do?
Definition
if previously vaccinated they should be immunized.
if no vaccines given, you should vaccinate within 72 hrs of exposure. Immunoglobulin may be given within 6 days of exposure
Term
do parents have the right to refuse immunizations? can you dismiss them from the practice?
Definition
yes they have the right to refuse, as far as dismissal....follow your clinics protocol
Term
12 month old due for immunizations, your clinic is out of VZV, what do you do?
Definition
defer the vaccine for this visit and administer on a future visit up to 15 months or catch up from 18-23 months
Term
4 yo pt, you can't read the dates on his previous 2 Hep B shots, what do you do?
Definition
attempt to find the actual medical record, if you can't, go ahead and give the third, the series is not re-started due to delay.
Term
who has priority for flu vaccines?
Definition
pts with asthma and sickle cell disease
Term
can you give a 4 month old the RV series?
Definition
no, the maximum age to start the series is 14 weeks, 6 days
Term
2 yo vomits most of his RV dose, what do you do?
Definition
do not order another dose, count the dose as #1, continue the series as usual.
Term
15 month old chlid presents for WCC, DTaP was given at 2, 4, 6, 12 months. Do you need to repeat dose #4?
Definition
no dose #4 can be given as early as 12 months as long as it's 6 months after dose #3.
Term
5 yo child presents for WCC, IPV dose #3 was given at 4 yo WCC. Should you order a 4th dose at this visit?
Definition
no, the child does not get a 4th IPV after the age of 4
Term
child presents for shots, had a low grade fever yesturday. Pt is feeling well today, is well hydrated, and is responding well to her surroundings. Can you give the shots?
Definition
yes
Term
15 yo presents and wants to know if she is a candidate for teh HPV vaccine?
Definition
yes, boys and girls age 9-26 are cadidates. No evidence of protection against previous infection.
Term
20 mo presents for shots and has a rash all over her trunk and the extensor surfaces of her extremities, can you give the shots?
Definition
no, child is considered "ill"
Term
21 yo presents before attending college. Never had chicken pox nor been vaccinated. What do you do?
Definition
give 2 VZV shots separated by 4 weeks.
Term
10 yo asthma patient needs flu vaccine for this season. He has never been vaccinated in the past. Do you give 2 or 1 dose?
Definition
one dose
Term
who gets 2 doses of the flu vaccine?
Definition
first time vacinees from 6 months - 8 yo
Term
16 yo who recieved Td before entering 7th grade would like the Tdap vaccine, can you give it?
Definition
yes, Tdap can be given regardless of the interval since the last Td
Term
child age 7-10 yo hasn't recieve DTaP immunizations, can a dose of Tdap be given as part of the primary series?
Definition
yes, Tdap can be substituted for any dose in the series, preferably dose #1
Term
18 yo needs to be UTD on her immunizations before attending college, what immunizations are recommended?
Definition
menactra, varicella, HPV, MMR, PPV, Hep A, Tdap, IPV, influenza
Term
what immunizations CANNOT be given to a 16 yo pregnant patient?
Definition
live virus vaccinations: LAIV, MMR, VZV, BCG, Vaccinia, Zoster
Term
12 yo male traveling to India for the summer to visit family. How would you handle this patient? what shots must he have?
Definition
make sure his immunizations are UTD. You may need to send him to the Health Department Epidemiology Clinic so they can determine exact vaccine needs for endemic diseases in the area he will be visiting.
Term
3 day old pt presents to the clinic having recieved Hep B #1 at birth in a remote hospital. Mom's Hep B status is unknown. How would you handle this patient?
Definition
Determine Mom's HBsAg status ASAP, if +, administer HBIg no later than 1 week after birth
Term
12 yo has not received the chicken pox vaccine, 3 yo sibling developed the varicella rash 2 days ago. What do you do for the 12 yo?
Definition
apply VZV #1 toda and in 3 months repeat the series
Term
what lab tests are ordered to determine if a pt has receieved the Hep B series?
Definition
HepBsAg titers
Term
what population groups CANNOT get the LAIV?
Definition
pregnant, asthmatic/RAD, CV, and pulmonary disease patients
Term
60 yo male with PMHx of herpes zoster. Is he a candidate for the Zoster vaccine??
Definition
yes, he may receive 1 dose of Zostavax.
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