Exam 1: NU665A/ NU 665A (New 2024/ 2025
Update) Primary Care of Child II Guide| Qs
& As | Grade A| 100% Correct (Verified
Answers)- Regis
QUESTION
Measles exposure
Answer:
-The vaccine provides some protection if given within 72 hours of measles exposure
-Immunoglobulin within 6 days of exposure to measles infection prevents or modifies the
infection in susceptible individuals (younger than 1, children and adolescents with HIV infection
and children born to HIV-infected women whose own HIV status is unknown)
-During measles outbreaks or anticipated travel, immunization can begin as early as 6 months of
age but requires two additional vaccine doses at the routine recommended ages
QUESTION
Vaccine hesitancy
Answer:
-Acknowledge and respect the relationship between provider and patient
-Communicate a strong shared commitment with the parent to the health and well-being of the
child
-Listen to and query parents' reason for refusing or delaying vaccines; not all parents have the
same concerns
-Be familiar with misconceptions and controversies regarding vaccines and be prepared to
address them
-Emphasize the safety of vaccines, the extensive testing before licensure, and the postlicensure
safety programs. Explain serious consequences of not vaccinating
-Educate on the safety of multiple vaccines to be given at the same time. Mention that a healthy
infant/child immune system can fight off germs daily when playing, eating, breathing. The
number of antigens in the vaccines are much lower
,-Emphasize balance between risk and benefits of vaccination and that the risk associated with
diseases is greater than the risk of a serious adverse vaccine reaction. Vaccines have the same
effect on the immune system that the active disease does- without the morbidity and mortality
-Provide a VIS or other materials
-If they still refuse, document the discussion, note VIS was given, and have parent complete and
sign a vaccine refusal form; if will not sign, write a note on the form and have it witnessed by
staff and put in chart; flag the chart and revisit discussion at each visit; don't dismiss from
practice unless level of distrust or poor communication
QUESTION
Hip examination
Answer:
1. Galeazzi - can signal conditions that cause leg-length discrepancies; includes flexing the hips
and knees while the infant or child lies supine, placing the soles of the feet on the table near the
buttocks, and then looking at the knee heights for equality
-Positive if the knee heights are unequal
2. Barlow - assess for dislocation of a nondisplaced hip in an infant during the first month of life;
the infant should be unclothed and supine with knees flexed; the hip is flexed and the thigh is
brought into an adducted position while applying gentle downward pressure; the hip would slip
out of the acetabulum or can be pushed out of the socket; this is a positive; the dislocation is
palpable; the hip relocates after release
3. Ortolani - reduces a posterior dislocated hip and is performed gently to reduce a recently
dislocated hip; the infant is in a supine position with both knees flexed; the providers thumb is
placed near the lesser trochanter and the pad of the second finger is position on the bony
prominence of the greater trochanter; the leg is flexed at the hip and then abducted while pushing
up
-A palpable clunk as the femoral head is relocated is a positive; a high-pitched hip click may be
audible or felt at the end of abduction
4. Klisic test - an observational sign of hip placement; the PCP places the tip of the third finger
of one hand over the greater trochanter and the index finger of the same hand on the
anterosuperior iliac spine
-If the hip is dislocated, the trochanter is elevated and the imaginary line points halfway between
the umbilicus and the pubis
5. Trendelenburg sign - can be used to identify conditions that cause weakness in the hip
abductors; by having the child stand and raise one leg off the ground; if the pelvis drops on the
side of the raised leg, the sign is positive and indicates we
,QUESTION
Costochondritis
Answer:
-Common cause of chest pain in children and adolescents
-Inflammation of one or more of the costochondral cartilages that causes localized tenderness
and pain in the anterior chest wall
-Caused by trauma and unaccustomed physical effort
-Treatment - mild analgesia and NSAIDS to relieve discomfort and avoiding strenuous activity;
cough suppressants if cough is aggravating; stretching exercises and ice
-Not related to cardiac disease
QUESTION
Scoliosis
Answer:
-A lateral curvature of the spine; of more than 10 degrees
-Testing - standing AP and lateral radiographs of the entire spine; MRI to find the cause;
-Interventions - observation for curves less than 20 degrees, bracing, and surgery if they do not
respond to bracing and curves are more than 45-50 degrees
QUESTION
Developmental dysplasia of the hip
Answer:
-Anatomical abnormalities in which the femoral head and acetabulum are in improper alignment
and/or grow abnormally
-A hip examination should be done on children as part of their well-child supervision until the
child begins to walk
-Ortolani and Barlow in first month; other tests - Klisic and galeazzi after; ultrasound is
suspicious
-In the older infant - 6-18 months - may see limited abduction of the affected hip and shortening
of the thigh and a positive Galeazzi sign
, -Other symptoms include asymmetry of inguinal or gluteal folds, unequal leg lengths
-In the ambulatory child - positive Trendelenburg sign, marked lordosis or toe walking, painless
limping or waddling gait with child leaning to the affected side
-Management - restore the articulation of the femur within the acetabulum; most resolve
spontaneously by 6-8 weeks so close observation is recommended;
-Refer infant to orthopedist if the newborn exam is positive; follow up at 2 weeks with a
thorough hip exam - if positive or inconclusive - refer
-Treatment is a Pavlik harness for subluxation and reducible dislocations worn 24 hours a day
except for bathing, the 6-18 month old - closed manipulation or open reduction and a spica cast
-Annual or biannual radiographs to the point of skeletal maturity is recommended to evaluate for
late asymmetric epiphyseal closure
QUESTION
Tibial torsion
Answer:
-Twisting of the long bone along its long axis
-Congenital, developmental, or acquired
-Most common cause of in-toeing during the second year of life and is noted around 6-12 months
-In most causes it resolves by 8 years of age
-Signs - in toeing
-Refer to orthopedist if the problem is significant (TFA > 20 degrees by 3 years of age);
stretching exercises or external rotational splints; surgery for severe cases that persist into late
childhood and cause functional problems
QUESTION
Talipes Equinovarus (clubfoot)
Answer:
-The ankle is in equinus (foot in a pointed toe position), the sole of the foot is inverted as a result
of hindfoot varus or inversion deformity of the heel, and the forefoot has the convex shape of
forefoot adduction
-From environment and genetics
-AP and lateral radiographs are recommended with the foot held in a normal position
-Refer to an orthopedist upon diagnosis, ideally shortly after the infant is born, because the joints
are most flexible in the first hours and days of life
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