ABFM + KSA CARE OF CHILDREN (NEW 2025/2026 UPDATE) QUESTIONS & ANSWERS |GRADED A|100% CORRECT

1. A healthy 2-month-old female is brought to your office for a well child visit. Which one of the following immunizations should be administered at this visit? A. Meningococcal conjugate B. MMR C. Oral poliovirus D. Rotavirus - ANSWER ANSWER : D Childhood immunizations have prevented many previously common communicable diseases, and the CDC's Advisory Committee on Immunization Practices regularly updates its recommendations. Rotavirus vaccine is administered in a three-dose series at 2, 4, and 6 months of age, and is the only one on this list that is appropriate for a 2-month-old child. A first dose of meningococcal vaccine is recommended at 11-12 years of age, with a second dose at age 16. MMR has been found to be efficacious only when given after 1 year of age. Because of the risk of inducing clinical polio with the live oral poliovirus vaccine, it is no longer recommended for routine childhood immunizations. Since 1999, parenteral inactivated poliovirus vaccine has been recommended instead. 2. You see a healthy 9-month-old infant for a well child examination. Which one of the following do you expect to find in the history that is typical for a child of this age? A. He has temper tantrums B. He participates cooperatively in dressing C. He passes a toy back and forth from one hand to another D. He has a 3-word vocabulary, not including "mama" and "dada" - ANSWER ANSWER : C As many as one in four children ages 0-5 are at moderate or high risk for developmental, behavioral, or social delays. The American Academy of Pediatrics (AAP) recommends that every well child visit include surveillance to identify children at risk for developmental delays. Surveillance includes eliciting parent's concerns; obtaining a developmental history; observing the child; identifying risks, strengths, and protective factors; sharing the clinician's findings; and recording these in the medical record. Surveillance is different from formal developmental screening, which the AAP recommends at the 9-, 18-, and 30-month well child visits to aid in early identification of developmental delays. The U.S. Preventive Services Task Force found insufficient evidence to recommend formal developmental screening in the absence of parent, caregiver, or physician concerns. When concerns are identified, the use of validated, standardized screening tests is recommended at specific ages. These might include the Ages and Stages Questionnaire, the Parents' Evaluation of Developmental Status, the Parents' Evaluation of Developmental Status-Developmental Milestones, or the Survey of Well-Being of Young Children. If results are abnormal, intervention or referral to early intervention services should be considered. While all children may not reach developmental milestones at the same time, development that does not happen within an expected time frame can raise concerns about developmental disorders, health conditions, or other factors that may negatively impact the child's development. In this specific case, passing a toy back and forth from one hand to another is consistent with a 9-month-old milestone. Temper tantrums generally do not occur in children under the age of 15-18 months. According to the CDC, participating coo A healthy, 3350-g (7 lb 6 oz) female is born at a birthing center at 8:00 p.m. Because of the family's financial circumstances and at the parents' insistence, the newborn is discharged with the mother the following morning at about 12 hours of life. A blood sample for mandated screening for genetic and metabolic disorders is collected before discharge. 3.Testing for which one of the following should be repeated in 1-2 weeks? A. Congenital adrenal hyperplasia B. Congenital hypothyroidism C. Galactosemia D. Phenylketonuria E. Sickle cell anemia - ANSWER ANSWER: D There are several genetic and metabolic diseases that can be detected by a simple blood test in the newborn period. It is important for family physicians who care for children to know about the detection of these diseases and how to interpret the laboratory results. Many of these screening tests are mandatory, with the specific number and type of tests specified by individual state laws. Testing for phenylketonuria (PKU) is mandated throughout the United States. PKU screening should ideally occur in newborns older than 24 hours and younger than 7 days. A normal result from a PKU sample taken at or before 12 hours of age does not rule out PKU because the child has not yet ingested enough dietary phenylalanine to raise the PKU level. Because some cases of PKU can be missed when the test is performed too early, the U.S. Preventive Services Task Force and the American Academy of Pediatrics recommend that a repeat specimen be obtained by 2 weeks of age in infants whose initial test was performed before they were 24 hours of age. All infants should be screened at the time of nursery discharge or transfer regardless of age. The results of testing for congenital adrenal hyperplasia, congenital hypothyroidism, galactosemia, and sickle cell disease are not time-sensitive, so repeat testing is not needed. 4. Which one of the following patients should receive further evaluation for developmental problems, assuming the finding is persistent? A. 10-month-old who cannot make a mark on a piece of paper with a crayon B. 15-month-old who does not point to an object he wants C. 2-year-old who cannot walk up and down stairs, with one foot on each stair D. 3-year-old who cannot catch a bounced ball most of the time - ANSWER ANSWER : B A 15-month-old child who does not point to an object he or she wants is clearly behind in abilities and needs to be evaluated further. This failure may be a cardinal sign of a difficulty such as pervasive developmental delay or autism spectrum disorder, especially when accompanied by other suggestive findings. A 10-month-old infant should be able to hold a crayon but would not be expected to make a mark on a piece of paper until 15 months of age. The ability to walk up and down stairs, with one foot on each stair, would normally be expected of a 3-year-old. Catching a bounced ball most of the time is an ability that should be achieved by age 4. Failure to perform this at age 3 should not cause concern. The ability of children to perform these various tasks is outlined in the Denver II Developmental Assessment and the Ages and Stages Questionnaire. 5.A 30-year-old female who is hepatitis B surface antigen (HBsAg)-positive gives birth to a 2800-g (6 lb 3 oz) male. Which one of the following is essential in the care of this newborn during his first 12-24 hours of life? A. A hepatitis profile B. Adefovir dipivoxil (Hepsera) C. Hepatitis A vaccine D. Hepatitis B immune globulin and hepatitis B vaccine - ANSWER ANSWER: D Approximately 1000 new cases of perinatal hepatitis B infection are identified in the United States each year. Mother-to-child transmission is responsible for more than one-third of chronic hepatitis B virus infections worldwide. Prevention of perinatal hepatitis B depends on the timely administration of appropriate postexposure immunoprophylaxis to infants born to mothers who are hepatitis B surface antigen (HBsAg)-positive or whose hepatitis B status is unknown. The risk of perinatal transmission among infants born to HBsAg-positive mothers is as high as 90% without immunoprophylaxis, which has been shown to be 85%-95% efficacious for preventing mother-to-child transmission. The American Academy of Pediatrics endorses the recommendation of the CDC's Advisory Committee on Immunization Practices (ACIP) that all newborn infants with a birth weight ≥2000 g (4 lb 7 oz) receive hepatitis B vaccine by 12-24 hours of age. Infants born to mothers who are HBsAg-positive or whose HBsAg status is unknown should receive hepatitis B vaccine and hepatitis B immune globulin in separate limbs within 12 hours of birth. The dosing and administration of these do not require adjustment for birth weight. Infants who receive appropriate immunoprophylaxis may breastfeed immediately after birth. The schedule for subsequent doses of the vaccine depends upon the infant's birth weight. If the birth weight is ≥2000 g, the second and third doses should be given at 1 and 6 months of age, respectively. For infants who weigh <2000 g, three additional doses are required and should be given at 1, 2-3, and 6 months of age, or at 2, 4, and 6 months of age. Since this is prophylactic, treatment of the infant for an active infection with an antiviral medication such as adefovir dipivoxil is unnecessary. A hepatitis profile to check for HBsAg 6. Exclusively breastfed infants have higher rates of which one of the following? A. Leukemia B. Obesity C. Otitis media D. Rickets E. Sudden infant death syndrome - ANSWER ANSWER: D The benefits of breastfeeding are numerous, including reductions in a number of infectious diseases, such as otitis media, respiratory infections, bacterial meningitis, bacteremia, diarrhea, necrotizing enterocolitis, and urinary tract infections. The rates of other adverse health outcomes are also reduced, including sudden infant death syndrome in the first year of life, type 1 diabetes, lymphoma, leukemia, overweight, obesity, hypercholesterolemia, and asthma. Studies have shown that up to 96% of children who have rickets were breastfed, as the small amount of vitamin D in breast milk is inadequate for preventing this condition in infants or children. While development of rickets requires the severe vitamin D deficiency seen in less wealthy countries, cases are still diagnosed in the United States. Subclinical vitamin D deficiency is more prevalent in breastfed infants, and it can be associated with complications of insufficient bone density in later life. The American Academy of Pediatrics recommends that all breastfed infants receive 400 IU of oral vitamin D drops daily, beginning the first few days of life and continuing until the infant's daily intake of vitamin D-fortified formula or milk is at least 500 mL. On a routine examination an otherwise healthy 4-month-old male is found to have a flattened right occiput, with the right ear slightly anterior to the left ear. The child's posterior fontanelle is closed and the anterior fontanelle is open, measuring 2.5×2.0 cm. No other abnormal findings are noted on examination. 7.The most likely cause of this deformity is A. craniosynostosis B. esotropia C. sleeping on his back D. torticollis, or "wry neck" - ANSWER ANSWER: C The prevalence of deformational plagiocephaly, or positional head flattening, has been increasing steadily since the early 1990s when the "Back to Sleep" campaign began recommending that infants be placed on their backs for sleep to prevent sudden infant death syndrome. Positional skull deformities are generally benign and reversible, decreasing in frequency in proportion to increasing age. These do not require surgical intervention, as opposed to craniosynostosis, which can result in neurologic damage and progressive craniofacial distortion. Routine evaluation of the skull in newborns and infants includes palpation of the sutures, evaluation of the posterior and anterior fontanelles, and palpation of the sternocleidomastoid muscles to detect torticollis. An abnormal fontanelle or a raised firm edge along the sutures can indicate the possibility of craniosynostosis, a relatively rare condition in which the sutures close too early. The posterior fontanelle may be closed at birth and is usually closed by 2-4 months of age. The anterior fontanelle usually is open until at least the fourth month, and commonly until 2-2½ years of age. Children may hold their head in an abnormal position if they have severe esotropia, creating either real or perceived changes in skull growth. A lump in the sternocleidomastoid muscle may indicate that the child has had either hemorrhage or scarring into that muscle, which can result in torticollis and deformity of the skull as the sternocleidomastoid muscle pulls on that side of the head. In most cases, positional plagiocephaly can be treated with a combined approach of physical therapy and repositioning, which is more effective than repositioning alone. A custom-fitted cranial molding orthosis (helmet) designed to relieve pressure on the flattened side should only be used in th You are seeing a 12-month-old healthy female for a routine well care visit. Her mother had an uncomplicated pregnancy, and the birth history and newborn nursery period were also without complications. She has been seen for all age-appropriate well child visits and is up to date on immunizations. Her growth and development have progressed normally since birth and she is in the 50th percentile for height and weight.