Boards- APEA Peds Questions and Answers
2024
Hep A Vaccine - ✔✔ANSW✔✔..- Routine immunization schedule for children at
minimum age 1 yr
- 2 doses at least 6m apart
Developmental Dysplasia of the Hip (DDH) - ✔✔ANSW✔✔..- acetabulum (socket) too
shallow to properly hold the femoral head (ball), chronic dislocation
- ~4/1,000 births
- screen at newborn exam, at all health screenings, until age 9 mo or until child walks
independently
screening:
- birth to 3mo: Ortolani and Barlow maneuvers (hip instability), Galeazzi sign (shortening
femur), asymmetry of leg creases
- 3-12 mo: limitation of hip abduction in 90 degree flexion, femur shortening, asymmetry
of leg creases
imaging:
-u/s primary technique for assessing the morphology and stability of the infant hip up to
age 4-6mo
- xray limited in young infants, femoral head and acetabulum are cartilaginous and
unossified
Club foot - ✔✔ANSW✔✔..- deformity of the foot and ankle present at birth
- causes: neuro, idiopathic, underlying syndrome
- deformities in 2 planes may be present
- excess plantar flexion (equines) or dorsiflexion (calcaneus)
- excess medial (varus) or lateral (valgus) angulation
- talipes equinovarus most common
- REFER
Metatarsus Adductus - ✔✔ANSW✔✔..- foot has a kindey bean shape due to medial
deviation of the metatarsal bones
- heel bisector line is lateral
,Nursemaid's Elbow - ✔✔ANSW✔✔..- entrapment of the annular ligament at the elbow
joint
- caused by subluxation of the radial head due to arm pulling or twisting
- common elbow injury in 1 to 4 yo (falls while holding hands, swinging by arms)
- child holds arm straight at their side and refuses to bend it, no pain in this position
- flexion causes pain
mgmt: reduction:
1. hold child's arm in prone position
2. place hand under arm w. thumb on radial head
3. apply gentle traction away from child's body
4. supinate the forearm
5. flex the elbow
scoliosis - ✔✔ANSW✔✔..- defined as a curvature of the spine =>10 degrees
- slight curvature in spine may be clinically insignificant
- some spines become increasingly curved as child grows
- risk greatest during pubertal growth spurt
- uneven shoulder or hip height
- prominence of one shoulder blade or side of the rib cage
- lump in back when bending forward
- children should be examined while touching toes
osgood-schlatter disease - ✔✔ANSW✔✔..- aka osteochondiritis of the tibial tubercle
- anterior knee pain that increases over time
- swelling and tenderness where patella meets tibia
- common cause of adolescent knee pain
- usually unilateral, can be b/l
- overuse injury
- athletes 9-14yo who have undergone rapid growth spurt; jumping/pivoting sports
- natural course: 6-18 mo (until growth plate closes)
- continuation of activity as tolerated
- ice to painful areas
- analgesics for 3-4 intervals prn
- protective pad over tubercle
- pt/exercises: strengthen quads and keep hamstrings flexible
Hep B Vaccine - ✔✔ANSW✔✔..- 3 dose series
- #1: 0m
- #2: 1-2m
- #3: 6-18m after #1
DTaP Vaccine - ✔✔ANSW✔✔..- <7 yrs of age
- 5 dose series:
#1: 2m (minimum age 6 wks)
, #2: 4m
#3: 6m
#4: 15-18m (6m after #3)
#5: 4-6y (final dose >4y)
Tdap - ✔✔ANSW✔✔..- >7 yrs
- 11-12 yrs: Tdap booster- contains tetanus, diphtheria, and acellular pertussis
- Tdap can be administered regardless of last interval since the last tetanus- and
diptheria-toxoid- containing vaccine
- After Tdap, pts should receive Td booster 10y (routine)
Pregnancy and Tdap - ✔✔ANSW✔✔..1 dose Tdap during each pregnancy, preferably
in early part of gestational weeks 27-36
Hib (Haemophilus influenzae Type B) - ✔✔ANSW✔✔..- #1: 2m
- #2: 4m
- #3: 6m
- #4: 12-15m
- Unvaccinated at 15-59m: 1 dose
Pneumococcal conjugate vaccine (PCV) - ✔✔ANSW✔✔..- 4 dose series
- given at 2, 4, 6, and 12-15 mo
- minimum age 6 wks (PCV13), 2 yrs (PPSV23)
Rotavirus Vaccination - ✔✔ANSW✔✔..- Rotarix: 2-dose series at 2, 4mo
- RotaTeq: 3-dose series at 2, 4, 6 mo
- Do NOT start series on or after age 15 wks, 0 days
- Do NOT continue series after 8mo, 0 days
Polio (IPV only) - ✔✔ANSW✔✔..- 4-dose series at ages 2, 4, 6-18mo, 4-6 yrs
- administer final dose on or after 4th bday and at least 6m after previous dose
- IPV is not routinely recommended for US residents 18 yrs and older
- Oral polio no longer given in US
MMR or MMRV - ✔✔ANSW✔✔..- 2 dose series
- #1: 12-15m
#2: 4-6 yrs
- second dose of MMR may be given at any time, provided at least 1mo has elapsed
since 1st dose and both doses are given at age 12m or older
- Contraindicated if allergic to neomycin or gelatin
Immunity with Live Attenuated Vaccines - ✔✔ANSW✔✔..- Live attenuated vaccines
must replicate to produce immunity
- Fever, rash after live or attenuated immunizations represent a reaction to viral
replication, not the vaccine
2024
Hep A Vaccine - ✔✔ANSW✔✔..- Routine immunization schedule for children at
minimum age 1 yr
- 2 doses at least 6m apart
Developmental Dysplasia of the Hip (DDH) - ✔✔ANSW✔✔..- acetabulum (socket) too
shallow to properly hold the femoral head (ball), chronic dislocation
- ~4/1,000 births
- screen at newborn exam, at all health screenings, until age 9 mo or until child walks
independently
screening:
- birth to 3mo: Ortolani and Barlow maneuvers (hip instability), Galeazzi sign (shortening
femur), asymmetry of leg creases
- 3-12 mo: limitation of hip abduction in 90 degree flexion, femur shortening, asymmetry
of leg creases
imaging:
-u/s primary technique for assessing the morphology and stability of the infant hip up to
age 4-6mo
- xray limited in young infants, femoral head and acetabulum are cartilaginous and
unossified
Club foot - ✔✔ANSW✔✔..- deformity of the foot and ankle present at birth
- causes: neuro, idiopathic, underlying syndrome
- deformities in 2 planes may be present
- excess plantar flexion (equines) or dorsiflexion (calcaneus)
- excess medial (varus) or lateral (valgus) angulation
- talipes equinovarus most common
- REFER
Metatarsus Adductus - ✔✔ANSW✔✔..- foot has a kindey bean shape due to medial
deviation of the metatarsal bones
- heel bisector line is lateral
,Nursemaid's Elbow - ✔✔ANSW✔✔..- entrapment of the annular ligament at the elbow
joint
- caused by subluxation of the radial head due to arm pulling or twisting
- common elbow injury in 1 to 4 yo (falls while holding hands, swinging by arms)
- child holds arm straight at their side and refuses to bend it, no pain in this position
- flexion causes pain
mgmt: reduction:
1. hold child's arm in prone position
2. place hand under arm w. thumb on radial head
3. apply gentle traction away from child's body
4. supinate the forearm
5. flex the elbow
scoliosis - ✔✔ANSW✔✔..- defined as a curvature of the spine =>10 degrees
- slight curvature in spine may be clinically insignificant
- some spines become increasingly curved as child grows
- risk greatest during pubertal growth spurt
- uneven shoulder or hip height
- prominence of one shoulder blade or side of the rib cage
- lump in back when bending forward
- children should be examined while touching toes
osgood-schlatter disease - ✔✔ANSW✔✔..- aka osteochondiritis of the tibial tubercle
- anterior knee pain that increases over time
- swelling and tenderness where patella meets tibia
- common cause of adolescent knee pain
- usually unilateral, can be b/l
- overuse injury
- athletes 9-14yo who have undergone rapid growth spurt; jumping/pivoting sports
- natural course: 6-18 mo (until growth plate closes)
- continuation of activity as tolerated
- ice to painful areas
- analgesics for 3-4 intervals prn
- protective pad over tubercle
- pt/exercises: strengthen quads and keep hamstrings flexible
Hep B Vaccine - ✔✔ANSW✔✔..- 3 dose series
- #1: 0m
- #2: 1-2m
- #3: 6-18m after #1
DTaP Vaccine - ✔✔ANSW✔✔..- <7 yrs of age
- 5 dose series:
#1: 2m (minimum age 6 wks)
, #2: 4m
#3: 6m
#4: 15-18m (6m after #3)
#5: 4-6y (final dose >4y)
Tdap - ✔✔ANSW✔✔..- >7 yrs
- 11-12 yrs: Tdap booster- contains tetanus, diphtheria, and acellular pertussis
- Tdap can be administered regardless of last interval since the last tetanus- and
diptheria-toxoid- containing vaccine
- After Tdap, pts should receive Td booster 10y (routine)
Pregnancy and Tdap - ✔✔ANSW✔✔..1 dose Tdap during each pregnancy, preferably
in early part of gestational weeks 27-36
Hib (Haemophilus influenzae Type B) - ✔✔ANSW✔✔..- #1: 2m
- #2: 4m
- #3: 6m
- #4: 12-15m
- Unvaccinated at 15-59m: 1 dose
Pneumococcal conjugate vaccine (PCV) - ✔✔ANSW✔✔..- 4 dose series
- given at 2, 4, 6, and 12-15 mo
- minimum age 6 wks (PCV13), 2 yrs (PPSV23)
Rotavirus Vaccination - ✔✔ANSW✔✔..- Rotarix: 2-dose series at 2, 4mo
- RotaTeq: 3-dose series at 2, 4, 6 mo
- Do NOT start series on or after age 15 wks, 0 days
- Do NOT continue series after 8mo, 0 days
Polio (IPV only) - ✔✔ANSW✔✔..- 4-dose series at ages 2, 4, 6-18mo, 4-6 yrs
- administer final dose on or after 4th bday and at least 6m after previous dose
- IPV is not routinely recommended for US residents 18 yrs and older
- Oral polio no longer given in US
MMR or MMRV - ✔✔ANSW✔✔..- 2 dose series
- #1: 12-15m
#2: 4-6 yrs
- second dose of MMR may be given at any time, provided at least 1mo has elapsed
since 1st dose and both doses are given at age 12m or older
- Contraindicated if allergic to neomycin or gelatin
Immunity with Live Attenuated Vaccines - ✔✔ANSW✔✔..- Live attenuated vaccines
must replicate to produce immunity
- Fever, rash after live or attenuated immunizations represent a reaction to viral
replication, not the vaccine
