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Pediatric Immunization Schedules and Common Illnesses: A Quick Reference Guide, Exams of Nursing

A concise overview of pediatric immunization schedules, including vaccines for hep a, hep b, dtap, tdap, hib, pneumococcal, rotavirus, polio, mmr, varicella, influenza, meningococcal, and hpv. It also covers common pediatric conditions such as otitis media, pneumonia, bronchiolitis, croup, viral gastroenteritis, and uti, detailing etiology, diagnosis, and management strategies. This resource is valuable for medical students and healthcare professionals seeking a quick reference guide on pediatric health. It includes key points on vaccine administration, adverse reactions, and treatment protocols for common childhood infections, making it an essential tool for clinical practice and exam preparation. The document emphasizes the importance of vaccination and early intervention in managing pediatric illnesses, providing a practical approach to pediatric care.

Typology: Exams

2024/2025

Available from 05/29/2025

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BOARDS- APEA PEDS EXAM|2025-2026|ACTUAL
EXAM WITH QUESTIONS AND ANSWERS|A+
Hep A Vaccine
- Routine immunization schedule for children at minimum age 1 yr
- 2 doses at least 6m apart
Hep B Vaccine
- 3 dose series
- #1: 0m
- #2: 1-2m
- #3: 6-18m after #1
DTaP Vaccine
- <7 yrs of age
- 5 dose series:
#1: 2m (minimum age 6 wks)
#2: 4m
#3: 6m
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BOARDS- APEA PEDS EXAM|2025-2026|ACTUAL

EXAM WITH QUESTIONS AND ANSWERS|A+

Hep A Vaccine

  • Routine immunization schedule for children at minimum age 1 yr
  • 2 doses at least 6m apart Hep B Vaccine
  • 3 dose series
  • #1: 0m
  • #2: 1-2m
  • #3: 6-18m after # DTaP Vaccine
  • <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

  • 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 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27- Hib (Haemophilus influenzae Type B)
  • #1: 2m
  • #2: 4m
  • #3: 6m
  • Oral polio no longer given in US MMR or MMRV
  • 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
  • Live attenuated vaccines must replicate to produce immunity
  • Fever, rash after live or attenuated immunizations represent a reaction to viral replication, not the vaccine
  • MMR and varicella are examples
  • Give them on the same day or at least 4 wks apart Live Attenuated Vaccines
  • Never give to children < 1 yr, pregnant women, or immunocompromised pts Varicella vaccine
  • Given at age 12-18m, booster 4-6yrs OR age 11-12yrs if child lacks a reliable hx of chickenpox infection
  • If given at age 13 yrs or later, 2 doses are required, at least 1mo apart Influenza Vaccine
  • Recommended annually ages >6m
  • Children <8 yrs receiving vaccine for first time need 2 doses separated by 4 wks
  • 1 dose annually for all people 9yrs and older Flu Vaccine Allergic Reactions
  • Egg allergy, hives: administer any flu vaccine appropriate for age and health

Spacing of Vaccines

  • A vaccine given 4 days prior to the scheduled time to receive it is considered a valid dose
  • A vaccine given 5 days prior to the scheduled time to receive it is considered an invalid dose and should be repeated Common conditions in peds
  • Otitis media
  • Pneumonia
  • Bronchiolitis
  • Viral gastroenteritis
  • UTI
  • Viral exanthems
  • Most childhood infections are viral and self-limited
  • Children often have nonspecific s/s w/ infectious illnesses: fussiness/irritability, stomach upset, poor appetite, lower-than-normal energy, maculopapular rashes

Otitis Media (OM)

  • etiology +guidelines
  • referral
  • AOM: best predictor is cloudy, bulging TM w/ impaired mobility
  • OM w/ effusion is fluid accumulation in the middle ear w/o evidence of infection
  • Pneumococcal conjugate vaccine (PCV7) has decreased incidence of AOM since 2000
  • Etiologic agents: Viral: RSV and influenza most common Bacterial: Streptococcus pneumonia (40-50%), H. influenza, Moraxella catarrhalis
  • Dx: bulging of the TM plus new onset ear pain and/or otorrhea
  • Considered severe if b/l, severe pain, or fever
  • Pain management w/ OTC meds
  • Abx vs. observation
  • 3 or more distinct and well-documented of episodes in a 6m period OR
  • 4 episodes in 12m OR

PNA: peds

  • Infection of the lung that may include the parenchyma, alveolar spaces, and/or interstitial tissue
  • Pna is commonly classified as CAP or nosocomial
  • Most common pathogen 6m-5y: viral
  • Most common bacteria: Strep pneumoniae
  • S. pneumoniae immunization: PCV13: 2, 4, 6, and 12-15mo PCV13 plus 23 for high-risk children >2yo
  • Infants are a vulnerable population, protect those at high risk PNA: peds assessment findings, diagnostics
  • Many nonspecific findings
  • Fever is inconsistent finding
  • Cough, malaise
  • Increased RR: most sensitive sign of confirmed pna CXR: infiltrates
  • May be normal in early pna, especially if dehydrated
  • No need for f/u x-ray if resolves as expected

CBC w/ diff: can be differentiate viral vs bacterial pna

  • If bacterial: left shift (^ segs/bands) and usually WBC >15, PNA: peds management Bacterial:
  • High-dose amoxicillin (90mg/kg/d) first line; consider amox-clav or 3rd-gen cephalosporin if recent AB exposure
  • If type 1 rxn to pcn, then macrolide (clindamycin) Symptomatic Management:
  • Fluids
  • Antipyretics
  • Rest
  • Hospitalization/oxygen if respiratory distress Bronchiolitis: peds +ass't findings, dx/management
  • Laryngotracheitis: inspiratory stridor, barking cough, hoarseness
  • Viral croup most common 6m-3y
  • Self-limited: fever, congestion, cough usually 3 days
  • Steeple sign = tapering of upper trachea on AP X-ray
  • Spasmodic croup occurs night Viral Gastroenteritis
  • One of the most common infectious diseases in humans Presentation:
  • 3 watery/loose stools in 24h

  • Vomiting, fever, abd pain may be present
  • S/S last < 1-2 wks Gastroenteritis
  • Most common cause: viruses
  • Rotavirus, norovirus
  • Incidence of rotavirus decreased since vaccine
  • Fecal-oral route is most common mode of transmission
  • Best prevention = hand washing

Degree of Dehydration

  • Most common complication of gastroenteritis
  • Severity = degree of dehydration Best measures of dehydration:
  • Weight loss
  • Prolonged capillary refill
  • Loss of skin turgor
  • Increased and deep respiratory pattern Dehydration
  • Mild to moderate dehydration = 3.9% los; severe = 10% or more
  • Pulse: Mild: normal, mod: rapid, severe: rapid and weak
  • Systolic BP: Mild: normal, mod: normal to low, severe: low
  • RR: normal, deep/increased rate, deep/increased rate
  • Mucosa: sticky, dry, parched
  • Anterior fontanel: normal, sunken, very sunken
  • Eyes: Normal, sunken, very sunken
  • Skin turgor: normal, reduced, tenting

Avoid antidiarrheal agents

  • anti motility drugs (loperamide): potential paralytic ileum, delay transit time (prolong illness)
  • Kaolin pectin (may reduce water loss): can be considered but evidence does not support
  • probiotics/prebiotics: evidence is inconsistent
  • diarrhea >7 days
  • severe dehydration
  • immunocompromised
  • inability to tolerate PO rehydration
  • clinical judgement Pediatric UTI
  • anatomic abnormalities: not common but must be ruled out
  • bowel or bladder dysfunction: withholding maneuvers, incontinence, constipation very common cause
  • vesicoureteral reflex (VER): retrograde passage of urine from bladder to upper urinary tract: very common cause (40%) First Pediatric UTI
  • aggressive treatment (w/in 72h) to prevent pyelonephritis and renal scarring
  • need specimen, get culture, treat empirically
  • always cover for E. coli (most common pathogen) E. coli: Consider 2nd, 3rd-gen cephalosporin (cefixime, cefdinir, ceftibuten) if no GU abnormalities
  • Duration 3-5 days if afebrile, 10 days if febrile High resistance to amoxicillin and cephalexin
  • 50% resistant to amoxicillin, ampicillin
  • Can use cephalexin if low risk of renal involvement and low community resistance rate Imaging for ped UTI Renal and bladder u/s (RBUS):
  • AAP recommends for all infants 2-24m for 1st febrile UTI or any age w/ recurrent febrile UTIs
  • UTI w/ family hx of renal or urologic dz, poor growth, or hypertension Voiding cystourethrogram:
  • Maculopapular "brick red" rash
  • Starts on head and neck, spreads centrifugally to trunk and extremities Fifth disease (Erythema infectious):
  • "Slapped cheek" rash
  • Lacy, macular rash Rubella:
  • Maculopapular rash
  • Looks like measles rash
  • Remarkable lymphadenopathy; macule on soft palate (Forchheimer spots) Roseola (Exanthem subitem):
  • High fever for 2-4 days, then abrupt cessation of fever w/ appearance of maculopapular rash but not on face Chickenpox:
  • Vesicular lesions on erythematous base
  • Appear in crops

Scarlet fever:

  • Exotoxin rash secondary to Group A Strep infection
  • Sandpaper like rash that ultimately desquamates Peds: many other rashes
  • Rocky Mountain Spotted Fever
  • Secondary syphilis
  • Group A Strep rash
  • Ampicillin rash (secondary to mononucleosis)
  • Kawasaki disease
  • Shingels (herpes zoster)
  • Mycoplasma (maculopapular) A 4yo pt presents w/ a lacy, macular rash and fever. What this might be? Erythema Infectious (Fifth Disease)
  • caused by Parvovirus B
  • lacy, macular rash