Pediatric Examination and Board Review (164 page)

Dreyer ZE, Fernbach DJ. Neuroblastoma. In: McMillan JA, DeAngelis CD, Feigin RD, et al, eds.
Oski’s Pediatrics
:
Principles and Practice.
4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006.

Golden CB, Feusner JH. Malignant abdominal masses in children: quick guide to evaluation and diagnosis.
Pediatr Clin North Am.
2002;49:1369-1392.

Park JR, Eggert A, Caron H. Neuroblastoma: biology, prognosis, and treatment.
Pediatr Clin North Am.
2008;55(1):97-120.

Chapter 12

INFECTIOUS DISEASE

CASE 94: A 12-MONTH-OLD WITH DELAYED IMMUNIZATIONS

A 12-month-old boy is brought to your office for evaluation of a cough and runny nose. You note that this is the child’s first visit to your office. On questioning the child’s mother, she informs you that the infant has been seen by another physician 3 times since birth but now needs to change health-care providers since moving to a new city. After review of the child’s immunization record, you note that the child has received only one set of immunizations including diphtheria and tetanus toxoid, and acellular pertussis (DTaP) vaccine, inactive poliovirus vaccine (IPV), hepatitis B vaccine, and
Haemophilus influenzae
type b (Hib) conjugate vaccine at age 4 months. Two days later, he had fever recorded by the mother at 102.2°F (39°C). The mother is aware that her son is behind with immunizations, based on his age. She tells you that except for the 4-monthold visit, her son had cold symptoms like today’s symptoms, so immunizations were not administered.

On physical examination the child is alert and active. His height and weight are at the 10th percentile. The temperature is 100.4°F (38°C). Examination of the ears is normal. Clear rhinorrhea is present. Examination of both lungs and heart is normal. No hepatosplenomegaly is found.

SELECT THE ONE BEST ANSWER

1.
The most likely reason the infant is behind for age with immunizations is

(A) the mistaken belief that a minor illness with fever contraindicates immunization

(B) failure to show up for vaccination visits

(C) the boy has an undefined immunodeficiency

(D) he had a fever of 102.2°F (39°C) after the first set of immunizations

(E) he has an unimmunized household contact

2.
The infant receives DTaP-hepatitis B-IPV, Hib conjugate, pneumococcal conjugate vaccine, and measles, mumps, rubella (MMR) vaccines. The minimum interval before the next administration of a third dose of DTaP-IPV-hepatitis B vaccine should be

(A) 2 weeks

(B) 4 weeks

(C) 6 weeks

(D) 8 weeks

(E) 12 weeks

3.
The infant’s mother asks you whether her infant should receive influenza vaccine. All of the following are recommended to receive influenza vaccine during the autumn of each year before the start of influenza season except

(A) a 5-year-old girl with asthma

(B) an 18-month-old healthy boy

(C) a 3-year-old girl with allergic rhinitis

(D) a 16-year-old healthy adolescent girl

(E) no exceptions; all of the above should receive influenza vaccine

4.
The mother also asks you about meningococcal vaccine, which she remembers her older brother receiving before travel outside the country and wonders whether her infant should also receive that vaccine. You tell her that a conjugated meningococcal vaccine (MCV4) is licensed and indicated for all but one of the following

(A) a 2
¹
/
₂
-year-old child traveling to sub-Saharan Africa

(B) a 5-year-old child whose spleen has just been removed after trauma

(C) a 19-year-old college student living in an apartment rather than on-campus housing

(D) a 3-year-old child with sickle cell disease

(E) an 8-month-old child with human immunodeficiency virus (HIV) infection

5.
The mother tells you that she had never heard of the pneumococcal conjugate vaccine (PCV-13) that you also are recommending for her infant. Which of the following statements about Prevnar is true?

(A) PCV-13 can protect children against up to 23 different serotypes of
Streptococcus pneumoniae

(B) a 12-month-old infant should only receive a single dose of the vaccine

(C) infants of very low birthweight (≤1500 g) should be immunized at a chronological age of 6-8 weeks

(D) the serotypes in the vaccine account for about two-thirds of the serotypes that cause invasive disease in children younger than 6 years in the United States

(E) the vaccine should not be administered to a 7-year-old healthy child or part of a catch-up regimen

6.
Management of a preterm infant lighter than 2000 g at birth who is born to a mother who is hepatitis B surface antigen (HBsAg) positive includes all but

(A) hepatitis B vaccine within 12 hours of birth

(B) Hepatitis B immunoglobulin (HBIG) within 12 hours of birth

(C) immunization with 4 vaccine doses of hepatitis B vaccine including the dose given at birth

(D) check anti-HBs antibody and HBsAg at 9-15 months of age

(E) check anti-HBs antibody 1-2 months after the last dose

7.
Hepatitis A vaccine is recommended for which of the following situations?

(A) an 11-month-old girl traveling with her family to India

(B) a 4-year-old girl from Oklahoma entering preschool

(C) a 12-year-old adolescent boy exposed to hepatitis A virus (HAV)-contaminated food 4 weeks ago

(D) a 24-year-old male pediatric resident working in a hospital setting

(E) a newborn infant of an HAV-infected mother

8.
An 8-year-old girl sustains a large laceration contaminated with dirt after falling from her bike. Her mother can’t recall how many doses of tetanus toxoid her daughter has received. Management of tetanus prophylaxis in this situation of unknown history of prior doses of tetanus toxoid includes

(A) adult-type Td

(B) tetanus immune globulin (TIG)

(C) tetanus and diphtheria (Td) toxoid vaccine and TIG

(D) Hib conjugate vaccine containing tetanus toxoid and TIG

(E) Tdap (acellular pertussis vaccine)

9.
A number of different licensed acellular pertussis vaccines contain one or more immunogens derived from
Bordetella pertussis
organisms. The antigen that is common to all of the US-licensed acellular pertussis vaccines includes

(A) pertussis toxin (PT)

(B) filamentous hemagglutinin (FHA)

(C) fimbrial proteins (agglutinogens)

(D) pertactin (outer membrane 69-kDa protein)

(E) lipopolysaccharide endotoxin (LPS)

10.
Acellular pertussis vaccine contained in DTaP is appropriate to administer in the following circumstance

(A) a 5-year-old girl who has received DT vaccine at 2, 4, and 6 months of age and DTaP vaccine at 12, 18, and 24 months of age

(B) a 24-year-old adult working in a hospital experiencing a pertussis outbreak

(C) a 3-year-old unimmunized boy

(D) a 6-month-old infant girl with seizures poorly controlled with anticonvulsant therapy

(E) an 11-year-old adolescent girl with an unknown history of prior pertussis immunization

11.
An outbreak of measles is occurring in a large urban city in the United States. Measles vaccine can be administered to children as young as

(A) 4 weeks

(B) 4 months

(C) 6 months

(D) 9 months

(E) 12 months

12.
Which of the following is a contraindication to the administration of the (live virus) measles vaccine

(A) history of egg allergy

(B) history of allergy to chickens or feathers

(C) an 8-year-old girl with HIV with evidence of moderate immunosuppression with a CD4 percentage of 16

(D) a 12-month-old child with a family history of seizures

(E) immune globulin intravenous (IGIV) given 6 months ago for treatment of Kawasaki disease

13.
A mother of a 2-year-old child receives MMR vaccine and subsequently finds out that she was pregnant when the vaccine was administered. The following statement about rubella vaccine and pregnancy is true

(A) receipt of rubella vaccination during pregnancy is an indication to terminate the pregnancy

(B) immune globulin (IG) should be administered to the pregnant woman

(C) immunizing the mother’s 2-year-old child places the mother at risk for rubella infection

(D) no cases of congenital rubella syndrome have been reported in women who have received rubella vaccine during pregnancy

(E) serologic testing for rubella should be done routinely before immunization in all postpubertal women

14.
All of the following individuals do not require rubella immunization except

(A) a woman in the third trimester of pregnancy

(B) a woman born in 1953 with no history of previous rubella vaccine

(C) a 13-year-old adolescent girl with a previous clinical diagnosis of rubella

(D) a 6-year-old boy who received 2 doses of MMR vaccine at age 2 and 3 years

(E) a 2-year-old child receiving induction cancer chemotherapy

15.
Exposure to all of the following animals is an indication of postexposure prophylaxis with rabies vaccine and rabies immune globulin (RIG) except

(A) raccoons

(B) woodchucks

(C) skunks

(D) squirrels

(E) bats

16.
You are asked about the safety of IPV by the mother of a 12-month-old infant. You should tell her that