ABFM CKSA (2023 -2024 ) EXAM CORRECTLY ANSWERED. A 3-year-old child who has not previously received any vaccines is brought to the local health department and diagnosed with measles. Children and staff were exposed to the sick child about 48 hours prior to diagnosis at the day care facility that the chil d attends. Which one of the following should be given the MMR vaccine as postexposure prophylaxis? A. An otherwise healthy 9 -month -old child who is up to date on all age -appropriate immunizations B. A 5 -year-old child with asthma who received a second dose of MMR 2 weeks ago C. A pregnant 24 -year-old day care staff member who received two doses of MMR as a child D. A pregnant 36 -year-old day care staff member who had one dose of MMR vaccine last year when starting work at the day care facility E. A 52 -year-old nurse who works part time at the day care facility and received two doses of MMR as an adult Correct Answer -ANSWER: A Measles outbreaks are becoming more common and the CDC has outlined who should receive postexposure prophylaxis with the MMR vaccine. To be effective as postexposure prophylaxis the vaccine must be administered within 72 hours of exposure. Infants <12 months of age are considered to be at high risk for complications from measles and should receive postexposure MMR vaccine, although intramuscular immunoglobulin is also an option. Children who are otherwise fully vaccinated do not need additio nal prophylaxis. People who are pregnant cannot receive the MMR vaccine due to fetal risk, but they should receive intravenous immunoglobulin if they do not have evidence of immunity. Health care workers only need to be given the MMR vaccine as prophylaxis if they did not receive two doses previously. A 4-month -old female is brought to your office by her mother for a well child visit. The mother tells you about some red patches on the child's cheeks and legs that do not seem to bother the infant. She says that the patches sometimes appear very irritated and improve with occasional lotion use but keep coming back. The mother has not noticed any signs of illness. An examination reveals a well appearing infant with normal growth, development, and vital signs. You note slightly rough, erythematous patches on both cheeks and her chin, as well as on her thighs. Which one of the following would be most appropriate at this time? A. Twice -daily application of a fragrance -free moisturizer with a high lipid -to-
water ratio B. Twice -daily application of a low -potency topical corticosteroid C. Application of a topical calcineurin inhibitor for the facial lesions and a low -
potency topical corticosteroid for the other areas D. Correct Answer -ANSWER: A This infant has skin findings that are consistent with atopic dermatitis, a common skin condition that typically presents in the first year of life with erythematous patches or plaques. In young children, the distribution of the rash is most commonly seen on the face, scalp, trunk, and extremities. In older children, the flexural surfaces are more affected. The first -line treatment is liberal use of fragrance -free emollients, at least 1 -2 times per day. Emollients with a high lipid -
to-water ratio are the mo st effective; ointments have the highest ratios, followed by creams and then lotions. A low -potency topical corticosteroid is an appropriate treatment for more significant flares that are not controlled by emollients. Topical calcineurin inhibitors are not approved for use in children <2 years of age. Allergy testing is not recommended for the routine evaluation of atopic dermatitis. A specialty referral is not necessary for straightforward atopic dermatitis but is recommended for patients with a poor response to appropriate first -line treatment, severe or recurrent skin infections, significant psychosocial problems due to atopic dermatitis, an uncertain diagnosis, or uncontrolled facial atopic dermatitis. A 4-year-old male is brought to your office by his maternal aunt, who is his new guardian. She is concerned that he is exhibiting problems with behavior and attention. On examination you note long, wide, protruding ears, an elongated face, and frontal boss ing. Which one of the following is the most likely cause of these dysmorphic features? A) Angelman syndrome B) Fragile X syndrome C) Klinefelter syndrome D) Marfan syndrome E) Prader -Willi syndrome Correct Answer -ANSWER: B The prepubescent male child with fragile X syndrome can be recognized by large ears, an elongated face, macrocephaly, or frontal bossing. Other features of fragile X syndrome include increased risk for chronic otitis media, esotropia, hyperextensible finge r joints, high -arched palate, low muscle tone, and, occasionally, seizures. This presentation can be subtle in young children, with an average age at diagnosis of 8 years. After puberty, a prominent jaw and macro -
orchidism are characteristic. Behavioral as pects seen may include poor eye contact, excessive shyness, anxiety, hand flapping, hand biting, aggression, tactile defensiveness, attention deficits, hyperactivity, impulsivity, hyperarousal to sensory stimuli, and autism spectrum disorder. Facial dysmorphic features associated with Angelman syndrome include microbrachycephaly, maxillary hypoplasia, a large mouth, and prognathism. Prepubescent boys with Klinefelter syndrome do not have facial dysmorphic features. They appear similar to prepub escent boys with normal karyotypes. Although a child with Marfan syndrome has an elongated face, the frontal bossing and large ears are not characteristic of that condition. Facial dysmorphic features associated with Prader -Willi syndrome include a narrow distance between the temples, almond -shaped eyes, and a thin upper lip. A 4-year-old male is brought to your office by his mother for a well child examination. The patient has no significant medical history. The mother has noted that the child has developed new skin lesions over the past few weeks, first appearing on the left arm, with a new lesion behind the right knee. There have been no new detergents or skin or hair care products introduced in the household, nor any changes made in the patient's diet. The child does not have pruritus. The examination reveals a temperature o f 37.2°C (99.0°F), a pulse rate of 80 beats/min, and a blood pressure within normal limits. The examination is unremarkable except for non -erythematous flesh -colored, dome -shaped papules with a central indentation that are located on the left lower arm and popliteal fossa. Which one of the following would be most appropriate for the initial management of this common condition? A. Observation only B. Consistent u Correct Answer -ANSWER: A Molluscum contagiosum is a common disease during childhood that can also occur in adolescents and adults. It is caused by a poxvirus and is uniquely characterized by flesh -colored, dome -shaped papules with central umbilication, most commonly on the trunk, axilla, popliteal or antecubital fossae, and crural folds. If lesions are asymptomatic and not inflamed, the initial treatment is observation, with most lesions resolving spontaneously within 2 -12 months. If the lesions are inflamed or pruritic, then topic al corticosteroid treatment, chemical treatment with cantharidin, podofilox 0.5% solution, curettage, or cryotherapy may be indicated. Atopic dermatitis (eczema) is initially treated with emollients and by avoiding frequent hot baths. Antifungal cream would be appropriate for tinea corporis but not for molluscum contagiosum. Verruca (warts) are commonly treated with paring, followed by to pical salicylic acid or cryotherapy.
