A parent brings in a 5-year-old boy being treated for acute lymphocytic leukemia (ALL). He states a friend who is staying with them at their home has just come down with chicken pox. Your patient has not had chicken pox or received immunization with varicella vaccine.What is the appropriate treatment?
Answer(s): E
Children with chicken pox may be infectious for 1 or 2 days before the appearance of the rash. Once skin lesions have crusted, the patient is no longer infectious. Susceptible individuals can contract chicken pox from patients with zoster. In the cases of both chicken pox and zoster, transmission is thought to occur by the respiratory route rather than by direct contact. The virus can travel long distances in the air and remain viable. Transmission from one hospital patient to other susceptible hospitalized patients has been reported to occur through air vents. VZIG should be given within 3 or 4 days of exposure to varicella-susceptible individuals who are immunocompromised.
A young mother claims that her 4-week-old child sleeps best on his stomach. You tell her that the safest sleep position for infants is which of the following?
Answer(s): A
Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS). Since the 1992 American Academy of Pediatrics (AAP) recommendation that infants be placed to sleep on their backs, the frequency of prone sleeping has decreased from 70 to 20%, and the SIDS rate has decreased by >40%. Side sleeping has a slightly higher SIDS risk than supine but is still safer than the prone position. Other risk factors include maternal smoking, soft bedding, overheating, younger maternal age, prematurity, low birth weight, and male gender. Rates among African Americans and Native Americans are two to three times the national average. The issue of bed sharing or cosleeping is controversial. There are reports of overlying by adults leading to suffocation, especially when the adult uses drugs or alcohol. Bed sharing with multiple family members may be hazardous; there is increased risk of overlying, entrapment, rolling into prone position, and use of soft sleeping surfaces. Some studies show that infants have more arousals and less slow-wave sleep during bed sharing; however, there is no epidemiologic evidence that bed sharing is protective.
You receive a call from the parents of a 1 year old who is due for his well-child visit next week. They have just received a letter from their daycare center that an employee has hepatitis A. Which of the following is the best treatment plan?
Children, especially those in daycare, commonly are infected with the hepatitis A virus.Unlike adults, children most often are asymptomatic. Frequently, outbreaks of hepatitis A in a daycare center are not recognized until a daycare worker or parent of an attendee becomes ill. Immunization against hepatitis A virus is now routinely recommended because of this. After exposure both immune globulin and vaccine should be given to the unvaccinated individual.
A5-year-old child was hit in the right eye by a toy. He is rubbing at his eye, which is watering profusely. There is a small abrasion at the corner of the eye. He is mildly photophobic, but his pupils are equal, symmetric, and reactive to light and accommodation. His vision is normal.Which of the following is the most appropriate next step in the management of this patient?
Superficial corneal injuries expose underlying layers causing pain, photophobia, tearing, and decreased vision. Irrigation is recommended only if a foreign body is suspected. Abrasions are detected by instilling fluorescein dye and inspecting the cornea using blue-filtered light. Treatment consists of frequent applications of topical antibiotic ointment until the epithelium is healed. The use of a patch does not accelerate healing, and if improperly applied, may abrade the cornea. Referral to an ophthalmologist should be considered if there are significant changes in vision, or signs of deeper or more penetrating injury which often result in papillary bnormalities.
A 9-month-old male is in for a well-child checkup. He is greater than 90th percentile for height, and he weighs 25 lbs. He no longer fits in his infant car seat, which is only recommended for use by children under 20 lbs.Which of the following is the safest car seat option for him?
Answer(s): C
The AAP recommends that children should face the rear of the vehicle until they are at least 20 lbs and 1 year of age to reduce the risk of cervical spine injury in the event of a crash. Infants who weigh 20 lbs before 1 year of age should ride rear facing in a convertible seat or infant seat approved for higher weights until 1 year of age. A car seat should never be placed in the front passenger seat.
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