6657 Peds Week 3 |Pediatric Primary Care Mastery Exam:
Immunizations, Infectious Disease, DTaP Components, Tetanus
Management, Pertussis Stages, Polio Prevention, Hib, Measles,
Mumps, Rubella, Varicella, HPV Vaccination, Meningococcal,
Pneumococcal, Influenza Updates, Stress Response, Trauma, PTSD,
Adverse Childhood Experiences, Depression, Bipolar Disorder, ADHD
Screening & Management, Stimulant Pharmacology, SSRIs, Anxiety
Disorders, Autism Spectrum Screening, Developmental Surveillance,
Transgender & Gender-Expansive Care, Puberty Blockers, Evidence-
Based Practice, Telehealth Integration, Primary Care Nurse
Practitioner Leadership & Coordination Exam Questions Verified and
Provided with Complete A+ Graded Rationales Latest Updated 2026
Vaccines
For live (MMR, varicella) vaccines, can be given on the same day but must wait 28 days after for next
vaccine
Can do non-live (dtap) after 2 weeks
DTaP: Diphtheria: corynebacterium diphtheriae
•Gram-positive bacillus
•Diphtheria can involve almost any mucous membrane.
•Incubation period of diphtheria is 2-5 days
•Thick blue gray membrane causes respiratory complications
•Antitoxin not FDA approved: CDC distributed
-Confirmation by culture/other issues
•Management:
-Erythromycin
-Penicillin G
,-Treat household contacts
DTaP - clostridium tetani
•Rare
-Related to rates of immunization
•Clostridium tetani (g neg)
-Not contagious
-Dirt, soil, manure
-Sx usually within 14 days
•Hypersensitivity, twitching, convulsion, spasms
-Clinical syndrome: bacteria produces toxin
•Interferes with neurotransmitters, blocking inhibitor impulse
•Management:
-See next slide
-Severe: Hospitalization
•Immediate treatment with human tetanus immune globulin (TIG)
Tetanus management - Fully immunized
Clean would - Vaccination with tetanus toxoid? = not required
Tetanus-prone wound - vaccination with tetanus toxoid? = no required
Tetanus-prone wound - human tetanus immunoglobulin? = only if high risk (i.e. heavy contamination
with material likely to contain tetanus spores and/or extensive devitalised tissue)
Tetanus management - primary immunization complete, boosters incomplete but up-to-date
Clean would - Vaccination with tetanus toxoid? = not required, unless second booster due imminently
,Tetanus-prone wound - vaccination with tetanus toxoid? = not required, unless second booster due
imminently
Tetanus-prone wound - human tetanus immunoglobulin? = only if high risk
Tetanus management - primary immunization incomplete or boosters not up-to-date
Clean would - Vaccination with tetanus toxoid? = required. arrange further doses at appropriate
intervals to complete immunization course
Tetanus-prone wound - vaccination with tetanus toxoid? = required. arrange further doses at
appropriate intervals to complete immunization course
Tetanus-prone wound - human tetanus immunoglobulin? = 1 dose of human tetanus immunoglobulin
injected at a different site from the toxoid
tetanus management - not immunized or uncertain immunization status
Clean would - Vaccination with tetanus toxoid? = required. arrange further doses at appropriate
intervals to complete immunization course
Tetanus-prone wound - vaccination with tetanus toxoid? = required. arrange further doses at
appropriate intervals to complete immunization course
Tetanus-prone wound - human tetanus immunoglobulin? = 1 dose of human tetanus immunoglobulin
injected at a different site from the toxoid
DTaP: Pertussis
Gram neg toxin-mediated disease (Bordetlla pertrussis)
Bacteria attach to cilia of respiratory epithelial cells and produce toxins that paralyze the cilia
Inflammation of the respiratory tract with interference in clearing of pulmonary secretions
Three stages: incubation 7-10 days
Catarrhal: 2 wks/ URI like symptoms
Paroxysmal: >15 attacks daily (up to 10 weeks) - classic inspiratory "whoop" cough. Also cyanosis, apnea,
gasping, gagging
, Covalescent: weeks! forecful cough, conjunctival hemorrhage, fever tends to be absent in all stages, dx
by nasopharyngeal culture, tx: macrolide (erythromycin is treatment of choice) alt: azithromycin,
bactrim, treat family contacts
Poliovirus
Eradication of polio in the U.S. in 1979 - and in every country of the world except for Nigeria, Pakistan,
and Afghanistan; recent increase (2021) including active cases in US
Virus: flu-like symptoms - targets brain and spinal cord and causing paralysis, elevated protein and WBCs
in CSF
IPV vs OPV (live) - higher incidence of vaccine associated paralytic polio
HIB
Haemophilus influenzae, type B
Respiratory droplet
Diseases: pneumonia, bacteremia, meningitis, epiglottitis, septic arthritis, cellulitis, otitis media
Decline in disease since 1987 (vaccine release)
Management: disease specific, during hospitalization (Cefriaxone)
Measles (Rubeola)
Measles = Rubeola
viral/respiratory
flu like symptoms
Koplik's spots: erythematous spots/white centers (mouth)
Maculopapular rash - face, descends down: trunk, becomes confluent
Complications: encephalitis, otitis media, pneumonia, exposure during pregnancy: miscarriage, pre
maturity, VLBW
Immunizations, Infectious Disease, DTaP Components, Tetanus
Management, Pertussis Stages, Polio Prevention, Hib, Measles,
Mumps, Rubella, Varicella, HPV Vaccination, Meningococcal,
Pneumococcal, Influenza Updates, Stress Response, Trauma, PTSD,
Adverse Childhood Experiences, Depression, Bipolar Disorder, ADHD
Screening & Management, Stimulant Pharmacology, SSRIs, Anxiety
Disorders, Autism Spectrum Screening, Developmental Surveillance,
Transgender & Gender-Expansive Care, Puberty Blockers, Evidence-
Based Practice, Telehealth Integration, Primary Care Nurse
Practitioner Leadership & Coordination Exam Questions Verified and
Provided with Complete A+ Graded Rationales Latest Updated 2026
Vaccines
For live (MMR, varicella) vaccines, can be given on the same day but must wait 28 days after for next
vaccine
Can do non-live (dtap) after 2 weeks
DTaP: Diphtheria: corynebacterium diphtheriae
•Gram-positive bacillus
•Diphtheria can involve almost any mucous membrane.
•Incubation period of diphtheria is 2-5 days
•Thick blue gray membrane causes respiratory complications
•Antitoxin not FDA approved: CDC distributed
-Confirmation by culture/other issues
•Management:
-Erythromycin
-Penicillin G
,-Treat household contacts
DTaP - clostridium tetani
•Rare
-Related to rates of immunization
•Clostridium tetani (g neg)
-Not contagious
-Dirt, soil, manure
-Sx usually within 14 days
•Hypersensitivity, twitching, convulsion, spasms
-Clinical syndrome: bacteria produces toxin
•Interferes with neurotransmitters, blocking inhibitor impulse
•Management:
-See next slide
-Severe: Hospitalization
•Immediate treatment with human tetanus immune globulin (TIG)
Tetanus management - Fully immunized
Clean would - Vaccination with tetanus toxoid? = not required
Tetanus-prone wound - vaccination with tetanus toxoid? = no required
Tetanus-prone wound - human tetanus immunoglobulin? = only if high risk (i.e. heavy contamination
with material likely to contain tetanus spores and/or extensive devitalised tissue)
Tetanus management - primary immunization complete, boosters incomplete but up-to-date
Clean would - Vaccination with tetanus toxoid? = not required, unless second booster due imminently
,Tetanus-prone wound - vaccination with tetanus toxoid? = not required, unless second booster due
imminently
Tetanus-prone wound - human tetanus immunoglobulin? = only if high risk
Tetanus management - primary immunization incomplete or boosters not up-to-date
Clean would - Vaccination with tetanus toxoid? = required. arrange further doses at appropriate
intervals to complete immunization course
Tetanus-prone wound - vaccination with tetanus toxoid? = required. arrange further doses at
appropriate intervals to complete immunization course
Tetanus-prone wound - human tetanus immunoglobulin? = 1 dose of human tetanus immunoglobulin
injected at a different site from the toxoid
tetanus management - not immunized or uncertain immunization status
Clean would - Vaccination with tetanus toxoid? = required. arrange further doses at appropriate
intervals to complete immunization course
Tetanus-prone wound - vaccination with tetanus toxoid? = required. arrange further doses at
appropriate intervals to complete immunization course
Tetanus-prone wound - human tetanus immunoglobulin? = 1 dose of human tetanus immunoglobulin
injected at a different site from the toxoid
DTaP: Pertussis
Gram neg toxin-mediated disease (Bordetlla pertrussis)
Bacteria attach to cilia of respiratory epithelial cells and produce toxins that paralyze the cilia
Inflammation of the respiratory tract with interference in clearing of pulmonary secretions
Three stages: incubation 7-10 days
Catarrhal: 2 wks/ URI like symptoms
Paroxysmal: >15 attacks daily (up to 10 weeks) - classic inspiratory "whoop" cough. Also cyanosis, apnea,
gasping, gagging
, Covalescent: weeks! forecful cough, conjunctival hemorrhage, fever tends to be absent in all stages, dx
by nasopharyngeal culture, tx: macrolide (erythromycin is treatment of choice) alt: azithromycin,
bactrim, treat family contacts
Poliovirus
Eradication of polio in the U.S. in 1979 - and in every country of the world except for Nigeria, Pakistan,
and Afghanistan; recent increase (2021) including active cases in US
Virus: flu-like symptoms - targets brain and spinal cord and causing paralysis, elevated protein and WBCs
in CSF
IPV vs OPV (live) - higher incidence of vaccine associated paralytic polio
HIB
Haemophilus influenzae, type B
Respiratory droplet
Diseases: pneumonia, bacteremia, meningitis, epiglottitis, septic arthritis, cellulitis, otitis media
Decline in disease since 1987 (vaccine release)
Management: disease specific, during hospitalization (Cefriaxone)
Measles (Rubeola)
Measles = Rubeola
viral/respiratory
flu like symptoms
Koplik's spots: erythematous spots/white centers (mouth)
Maculopapular rash - face, descends down: trunk, becomes confluent
Complications: encephalitis, otitis media, pneumonia, exposure during pregnancy: miscarriage, pre
maturity, VLBW
