Duke PA Pediatric Health Maintenance
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| What is the most common method of preventing infectious diseases available to practitioners | Immunizations
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| Name the 15 diseases against which US infants and children are vaccinated | Diphtheria, tetanus, pertussis, polio, measles, mumps, varicella, rubella, influenza, hepatitis A, hepatitis B, rotavirus, meningococcal meningitis, HPV and pneumococcal disease
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| What is DTap | Diptheria Tetanus and acellular pertussis, this is a vaccine for young children
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| What is Tdap | Tetanus diphtheria and pertussis, older child and adult vaccine
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| If you give someone a live vaccine how long do you need to wait before doing a TB skin test | It is ok if you do them at the same time. If you give the live vaccine first you have to wait 6 weeks for the TB skin test.
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| Vaccination or Immunization – the actual process of administering agent (toxoid, antitoxin or Ig) | Vaccination
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| Vaccination or Immunization – the process of inducing immunity which is active or passive | Immunization
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| Vaccination results in active or passive immunity | Active
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| What are the 5 types of vaccine | Live attenuated, inactivated, subunit, recombinant, conjugated
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| What is the purpose of an adjuvant (aluminium salts) in a vaccine | Enhance host response
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| How many doses of live attenuated vaccine does it usually take to confer immunity | Usually one
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| What are some examples of inactivated vaccines | Influenza (TIV), polio, hep A/B, diphtheria, tetanus, pneumococcal, meningococcal, HIB, HPV
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| What are some examples of live attenuated vaccines | Measles, mumps, rubella, MMR, varicella, yellow fever, rotavirus, influenza (LAIV)
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| What type of vaccine (recombinant, conjugate, subunit) – genes that code for a specific viral protein are expressed in another microbe (Hep B, HPV) | Recombinant
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| What type of vaccine (recombinant, conjugate, subunit) – vaccines for bacteria with polysaccharide capsules, linked to protein carriers (pneumococcal, HIB, meningococcal) | Conjugate
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| What type of vaccine (recombinant, conjugate, subunit) – produced from specific purified antigens (DTaP, Tdap) | Subunit
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| Most vaccines are administered by which route | IM
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| Currently most children receive __ vaccines between 0-18 years | 40
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| What is the reason children are vaccinated against hep A | children often have asymptomatic and or unrecognized infections and therefore play a major role in transmission of disease to adults
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| Hep A vaccine is recommended for all children at __ of age | 12 months
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| What is the reason children are vaccinated for hep B | chronic infection is more likely if infection is acquired early in life, 25% of HBV infected infants will die of related disease, transmission from child to child has been documented
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| HBV vaccine is recommended for all infants and unvaccinated children by age __ | 11-12 years
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| Reason to vaccinate against pertussis | Pertussis infections occur in infants and young children and is highly contagious
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| The Tdap vaccine is for __ | Adolescents/adults
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| The DTap vaccine is for __ | Children up to age 7
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| Adverse effects generally attributed to whole cell pertussis – have decrease dramatically with D Tap | High fever, unusual cry, seizures/rarely acute encephalitis
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| Reason for the HIB vaccine | Before vaccine availability HiB was the #1 cause of bacterial meningitis in children <5 with a high rate of neurologic problems. It was also a big cause of pneumonia, cellulitis, epiglottitis, and septic arthritis
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| Reason for the polio vaccine | Highly infectious, viral meningitis and paralytic polio
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| When were the Americas declared polio free | 1994
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| Reason for the Measles, Mumps and Rubella (MMR) vaccine | Few clinicians recognize measles, measles cause >1million deaths/yr worldwide, fetal rubella can result in devastating sequelae, the combined vaccine is more effective than individual components
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| Reason for varicella vaccine | Highly infectious, before vaccine complications accounted for more than 80% of the 10,000 annual hospital admissions, neonatal infections are particularly severe, infections in young adults can be life threatening
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| Reason for pneumococcal conjugate vaccine (PCV-7) | S. pneumo responsible for many cases of serious, invasive disease in children <5 yrs
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| Reason for rotavirus vaccine | Major cause of severe gastroenteritis in children 0-5 yrs (1/80 US infants hospitalized annually), highly contagious
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| LAIV is now approved for healthy kids as young as __ | 2 years
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| Do not immunize children <__ of age against influenza | 6 months
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| __ allergy may be a contraindication for influenza vaccine | Egg
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| Do not give LAIV to children <5 years of age with a history of __ | Wheezing
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| Why vaccinate against influenza | Highly contagious, 0-2 year olds at increased risk, children have highest attack rate
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| HPV vaccine (Gardasil) is recommended for __ | Females age 11-12 years
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| HPV vaccine (Gardasil) catch-up is recommended for __ | Females 13-26 years of age
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| Why vaccinate against HPV | HPV is now the most common STD in the US, prevalence is highest among sexually active females <25 years of age, infections occur early after onset of sexual activity, infection can lead to cervical cancer
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| What are the contraindications for vaccination | Severe allergic reaction, pregnancy (not all), known severe immunodeficiency, encephalopathy or other serious neurological sequelae after DTP or DTaP, influenza vaccine in patients with severe allergic reaction to eggs
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| What is the timing for pediatric office visits | 2-4 day, 1 month, 2 month, 4 month, 6 month, 9 month, 12 month, 15-18 month, 2 yr, Q yr
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| Measure head circumference every visit until __ | 2 years
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| When do formal vision tests begin (tumbling E’s, picture tests) | 3-4 years
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| __ month old should fixate on a face with eyes | 1
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| What is the minimally acceptable visual acuity for a 3-5 y/o | 20/40
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| What is the minimally acceptable visual acuity for a 6 y/o | 20/30
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| Ocular malalignment | Strabismus
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| Loss of vision due to disuse | Amblyopia
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| When is the hearing screen performed | Before discharge from the hospital
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| When are children screened for anemia | Minimum: 12-24 months, 4-6 yo, & once after onset of menses
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| When are children screened for lead | At least once between 12 and 24 months
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| Name the 7 disorders/conditions newborns are screened for in NC | Amino acid disorders (including PKU), fatty acid disorders, organic acid disorders, biotinidase deficiency, hypothyroidism, congenital adrenal hyperplasia, sickle cell disease
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| Most common cause of anemia | Iron deficiency
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| What are risk factors for anemia in children | Low birth wt, cow’s milk, anemic mother
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| Lead levels >__micrograms/dL is a medical emergency | 70
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| Lead levels >__micrograms/dL causes colic, nausea, myalgia, seizures, headache, anemia | 50
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| What is an acceptable level of lead | <10 micrograms/dL
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| Consider chelation at lead levels >__micrograms/dL | 25
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| At what age should children be screened for lead | Between 12 and 24
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| TB skin testing can be done as early as __ | 3 months
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| Cholesterol screening can be done as early as __ for those at risk | 2 years
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| What are risk factors for childhood hypercholesterolemia | Parent/grandparent with CAD or MI<55yo, parent cholesterol >240, overweight, evidence of insulin resistance
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| When should you put a child on cholesterol lowering medication (cholestyramine, colestipol) | >10 yo with LDL >190 after diet treatment
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| Children <__lbs should be in rear facing car seats | 20
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| Children __lbs should be in front facing car seats | 20-40
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| Children __lbs should be in booster seats | 40-60
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| Children >__lbs or __ft can be in a regular lap/shoulder belt | 60, 4
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| Vax administered SubQ | MMR, IPV, Varicella
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| Vax administered orally | rotavirus
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