Pediatric Examination and Board Review (98 page)

(A) airbags in the front seat should be disabled

(B) she should place her infant in the center of the backseat to avoid side airbags

(C) she should place her infant in the front to avoid backseat airbags

(D) she should place her infant next to the side airbag for protection

(E) none of the above are true

3.
Approximately what percentage of caregivers have installed their infant car seat correctly?

(A) 10%

(B) 30%

(C) 50%

(D) 70%

(E) 90%

4.
Which of the following is the safest choice in car seats for a 13-month-old 23-pound infant?

(A) rear-facing convertible car seat

(B) rear-facing infant car seat

(C) front-facing convertible car seat

(D) belt-positioning booster seat

(E) shield booster seat

5.
At what age is it acceptable for children to ride in the front seat with a passenger belt?

(A) 2 years

(B) 5 years

(C) 8 years

(D) 10 years

(E) 13 years

6.
In the event of an accidental ingestion, what is the best
first
recommended action that parents should take?

(A) go the emergency department

(B) administer syrup of ipecac

(C) administer activated charcoal

(D) call the poison control center

(E) perform the Heimlich maneuver

7.
At what age does the American Academy of Pediatrics generally recommend starting the regular use of sunscreen?

(A) 1 week

(B) 1 month

(C) 2 months

(D) 6 months

(E) 1 year

8.
A parent calls you from their vacation on the East Coast. This morning, their 7-year-old son found a tick on his leg that is still embedded. They are wondering how to get the tick off.

(A) put rubbing alcohol on it

(B) smother it with a cloth

(C) try to burn it off with a match

(D) pull it out with tweezers

(E) break the body off at the skin level

9.
At what temperature should household hot water heaters be set at or below to prevent accidental burns?

(A) 90°F

(B) 100°F

(C) 110°F

(D) 120°F

(E) 130°F

10.
What is the leading cause of death for all childhood age groups (1-21 years old) in the United States?

(A) suicide

(B) unintentional injuries

(C) malignancies

(D) homicide

(E) heart disease

11.
What is the leading cause of death among children younger than 1 year of age?

(A) congenital anomalies

(B) sudden infant death syndrome (SIDS)

(C) unintentional injury

(D) malignancies

(E) sepsis

12.
Who is the most likely person to be involved in a motor vehicle accident (MVA)?

(A) 17-year-old boy

(B) 17-year-old girl

(C) 25-year-old man

(D) 25-year-old woman

(E) none of the above

13.
By what percentage do helmets reduce the risk of bicycle-related traumatic brain injuries?

(A) 10%

(B) 25%

(C) 50%

(D) 75%

(E) 95%

14.
Which of the following would you
not
include in counseling a family on fire safety and prevention?

(A) replace their fire detector batteries every 6 months

(B) place portable heaters 1 foot or more from bedding

(C) store matches and other fire-starting materials out of reach

(D) inform them that smoke is more dangerous than the fire

(E) discontinue smoking

15.
Of these common myths regarding water safety and drowning, which is true?

(A) children don’t need life vests after they have learned to swim

(B) fences that surround pools won’t prevent a child from drowning

(C) drowning children make lots of noise like splashing and will be heard easily

(D) continuous supervision at pools is not necessary when life vests are used

(E) children can drown in several inches of water

16.
Which of the following will you counsel parents on regarding safety with lawn mowers?

(A) children should be at least 10 years old to use sit-down riding mowers

(B) use eye protection during mowing

(C) children must be at least 7 years old to use push-type mowers

(D) children older than 10 years can ride as passengers on sit-down mowers

(E) A, B, and C

17.
You get a call from a mother who is taking her child to the northern Midwest during late summer and is worried about her 1-year-old and 3-year-old getting West Nile virus. Which of the following statements would you use to counsel her on this disease?

(A) approximately 20% of those infected develop mild disease

(B) the incubation period is 3-14 days

(C) 1 in 150 who are infected develop severe neurologic disease

(D) encephalitis and meningitis are the most common complications of disease

(E) all of the above

18.
Which of the following statements regarding the prevention of West Nile Virus is(are) true?

(A) DEET (N,N-diethyl-3-methylbenzamide) should not be used for infants under 2 months of age

(B) the maximum acceptable concentration of DEET for children is 30%

(C) DEET should be applied before clothing is put on

(D) A and B

(E) A, B, and C

ANSWERS

1.
(D)
The AAP and the National Highway Traffic Safety Administration (NHTSA) recommend that infants remain in their rear-facing car seat in the backseat until they are 1 year of age and heavier than 20-22 pounds, and then for as long as possible thereafter. This is so the deceleration forces are distributed over the infant’s entire trunk during a crash. It is also to protect their incompletely ossified vertebrae and corresponding weak connecting ligaments from injury. For infants who reach 20 pounds before 1 year of age it is acceptable to change from an infant carrier seat (which typically only can fit infants <20-22 pounds) to a “convertible”-type car seat, which has the ability to face forward or backward as the age of the child dictates.

2.
(B)
In vehicles that have a front passenger airbag, infants must be in the backseat because riding in the front seat puts them in a direct path of the front airbag and can lead to fatality. When children start riding in the front seat (see answer to question 5), or for cars in which there is no backseat, several rules should be put into effect. Older children should be seated as far back as possible from the airbag. If a child is in a car seat of any type, the passenger airbag should be disabled. If an infant is rear facing in the front seat (in a 2-seater car, for example), the passenger air bag should be disabled. For the backseat, some cars come with side airbags. Because they are difficult to disable, it is best to center infant car seats in the back to avoid the side airbags.

3.
(B)
A study conducted for the NHTSA in the mid-1990s found that approximately 72% of child restraints were being used incorrectly. A recently completed NHTSA-sponsored study updates that research. Interestingly, rear-facing seats (infant and convertible) had the highest rate of misuse, approximately 84% for both. The NHTSA passed new regulations that require all passenger vehicles made after 2002 to be equipped with the LATCH system (Lower Anchors and Tethers for Children), which significantly reduces the complexity of installing a car seat.

4.
(A)
In general, as stated above, infants should be 20-22 pounds and 1 year of age to face forward. Convertible car seats are made to face forward or backward and vary in their weight limits. It is safest to keep infants facing backward for as long as possible, up to the rear-facing maximum weight limit indicated on the convertible car seat. Almost every convertible car seat on the market today has a rearfacing weight limit of 30 pounds. Booster seats are made for toddlers, and almost all have a minimum weight limit of 30-40 pounds. Information about any age, length, or weight parameters for a specific car seat should be affixed to the car seat.

5.
(E)
The NHTSA suggests all children 12 years and younger should ride in the back seat. Pediatricians should check the law in their state.

6.
(D)
Parents should be advised at preventive visits to always have the poison control center number nearby and to call there in case of accidental ingestions. The number is 800-222-1222. In 2003, the AAP reversed their position on the use of syrup of ipecac in the home. Because multiple studies did not show a difference in outcome in children on whom ipecac was used, and because activated charcoal is considered to be superior, most physicians prefer to treat ingestions in an emergency department setting with charcoal.

7.
(D)
In 1999 the AAP changed its policy from recommending against the use of sunscreen in infants under 6 months to not using it for that age group unless adequate clothing and/or shade are not available. In those instances, applying small amounts to areas like the face and hands is acceptable. Sunscreen should always be SPF 15 or greater and be reapplied after water exposure.

8.
(D)
Ticks must be removed as completely as possible. Grasping the part of the tick sticking out of the skin as close to the surface as possible and slowly pulling directly out most likely will aid in getting both the body and the head, which is buried underneath the skin. Old methods considered useful, including smothering with petroleum jelly or other substances, burning the tick off, or using rubbing alcohol, have not been proven to be as effective.

9.
(D)
At 160°F (71.1°C), a full-thickness scald burn can occur in less than 1 second. At 120°F (48.8°C), many minutes of exposure are required for the same injury.

10.
(B)
For the past 5 years, unintentional injuries (including MVAs, poisoning, drowning, falls, fire/burns, firearm injuries) have ranked as the number-one cause of mortality for all children older than 1 year of age.