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The answer is E. Kernicterus occurs when the serum unconjugated (indirect) bilirubin becomes dangerously elevated (usually >25 mg/dL) in newborns. Symptoms include poor feeding, flaccidity, apnea, opisthotonos, and seizures; in severe cases, death may occur. Children who do survive may suffer hearing loss, seizures, and mental retardation. Risk factors include prematurity, blood incompatibilities, infection, and acidosis. Physiologic jaundice is the most common form of jaundice, and occurs in up to 50% of newborns. The condition is benign and usually resolves in 1 week. Most bilirubin levels peak in 3 to 5 days. The workup of a child with hyperbilirubinemia should include the following:
Careful history to detect risk factors and physical examination to rule out petechiae, hepatosplenomegaly, bruising, and signs of infection
Measurement of bilirubin levels
Complete blood cell count, reticulocyte count, and peripheral blood smear
Coombs' test
Typing of mother's and infant's blood
Thyroid function tests
Treatment for hyperbilirubinemia of newborns includes the following:
Increasing formula feedings for the infant will increase GI motility and frequency of stools, thereby minimizing the enterohepatic circulation of bilirubin.
Increasing frequency of breastfeeding. If the bilirubin continues to rise, switch from breast-feeding to formula for a few
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days until the bilirubin is 20 mg/dL) or hemolysis with anemia
In premature infants, kernicterus may occur with lower bilirubin levels
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days until the bilirubin is less then15 mg/dL (the mother should continue with breast pumping during this time)
Phototherapy, which helps degrade unconjugated bilirubin
Exchange transfusion for severe cases of persistent hyperbilirubinemia (usually >20 mg/dL) or hemolysis with anemia
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The answer is E. Otitis media usually results as a complication of an upper respiratory (viral) infection. It is particularly common in children between 6 months and 3 years of age. The most common etiologic agents include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella (Branhamella) catarrhalis. In newborns, Escherichia coli and Staphylococcus aureus are major causes. Viral causes include respiratory syncitial virus (RSV), parainfluenza virus, influenza virus, enteroviruses, and adenoviruses. Risk factors include attending daycare at or before 2 months of age, in daycare >30 hours/week; bottle-feeding; exposure to cigarette smoke; pacifier use; and Polynesian, Native American, or Alaskan/Canadian Eskimo descent. Low birth weight, young gestational age, and a family history of allergies or asthma are not significantly associated with an increased risk of acute otitis media.
Symptoms include earache, nausea, vomiting, diarrhea, hearing loss, and otorrhea. Fever may be present, but it may be absent in as many as 33% of those affected. Signs include bulging of the tympanic membrane with loss of the light reflex and normal landmarks as well as tympanic membrane immobility. Perforation and vestibular dysfunction may also occur. Diagnosis is based on clinical findings and requires the presence of fluid under pressure in the middle ear plus one sign of acute local or systemic illness. Eardrum motion is best assessed by looking at the pars flaccida in the superior part of the drum. A red drum with normal mobility is common in crying children and is not diagnostic of acute bacterial infection. The drug of choice for treatment is amoxicillin in patients who are not at increased risk of being infected with a drug-resistant organism. Complications include mastoiditis, labyrinthitis, conductive and sensory neural hearing loss, and meningitis
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The answer is E. Current recommendations for the diphtheria, pertussis, and tetanus immunization of young children state that DTaP is usually given at 2, 4, 6, and 12 to 15 months, with an additional dose at 4 to 6 years. The acellular pertussis form is preferred for all doses to help reduce the occurrence of side effects. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap adolescent preparation) is recommended at age 11 to 12 years for those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoid (Td) booster dose. Adolescents aged 13 to 18 years who missed the 11 to 12 year Td/Tdap booster dose should also receive a single dose of Tdap if they completed the recommended childhood DTP/DTaP vaccination series. Subsequent boosters are recommended every 10 years. Contraindications to the DPT vaccine include the following:
Previous anaphylaxis to the vaccine
Moderate or severe illness
Previous encephalopathy within 7 days after DPT injection
Progressive neurologic problem that is undiagnosed
Fever higher than 105°F after previous DPT
Continuous crying lasting 3 hours or more after previous DPT
Seizure within 3 days after previous DPT
Previous collapse, limp, or pale episode with previous DPT
Items 5 through 8 are relative contraindications and should be evaluated individually. The DTaP immunization should be given intramuscularly. A combined vaccine with DPT and Hib (Tetramune), which can be given at 2, 4, 6, and 12 to 15 months, is available.
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The answer is B. Baby-bottle tooth decay can occur after a child repeatedly falls asleep with a bottle in his or her mouth. It is more commonly seen in lower socioeconomic groups and can lead to major dental problems with the development of caries. Prevention should be aimed at educating the parents about this problem so that they can avoid bottle-feeding at bedtime
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The answer is B. If an infant weights less than2 kg at birth and the mother is antigen-negative, this infant should delay the first dose of hepatitis B vaccine until they have reached the chronological age of 1 month. If the mother is antigen-positive or if her antigen status is not known, the child should receive the first dose of hepatitis vaccine plus HBIG within 12 hours of birth, regardless of the infant's birth weight. If these infants weigh less than 2 kg at birth, this initial dose should not be counted toward completion of the hepatitis B vaccine series, and three additional doses should be administered beginning when the infant is 1 month of age
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thx for good questions ...
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Thanks for the great questions and explanations,
Good luck and God Bless.
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