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ABFM CARE OF CHILDREN QUESTIONS AND ANSWERS2023
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ABFM CARE OF CHILDREN QUESTIONS AND ANSWERS2023
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ABFM CARE OFCHILDREN
QUESTIONS AND
ANSWERS2023
A 30-year-old female who is hepatitis B surface antigen (HBsAg)-positive gives birth to a
2800-g (6 lb 3 oz) male. Which one of the following is essential in the care of this
newborn during his first 12-24 hours of life?
A. A hepatitis profile
B. Adefovir dipivoxil (Hepsera)
C. Hepatitis A vaccine
D. Hepatitis B immune globulin and hepatitis B vaccine - Answers-ANSWER: D
Approximately 1000 new cases of perinatal hepatitis B infection are identified in the
United States each year. Mother-to-child transmission is responsible for more than one-
third of chronic hepatitis B virus infections worldwide. Prevention of perinatal hepatitis B
depends on the timely administration of appropriate postexposure immunoprophylaxis
to infants born to mothers who are hepatitis B surface antigen (HBsAg)-positive or
whose hepatitis B status is unknown. The risk of perinatal transmission among infants
born to HBsAg-positive mothers is as high as 90% without immunoprophylaxis, which
has been shown to be 85%-95% efficacious for preventing mother-to-child transmission.
The American Academy of Pediatrics endorses the recommendation of the CDC's
Advisory Committee on Immunization Practices (ACIP) that all newborn infants with a
birth weight ≥2000 g (4 lb 7 oz) receive hepatitis B vaccine by 12-24 hours of age.
Infants born to mothers who are HBsAg-positive or whose HBsAg status is unknown
should receive hepatitis B vaccine and hepatitis B immune globulin in separate limbs
within 12 hours of birth. The dosing and administration of these do not require
adjustment for birth weight. Infants who receive appropriate immunoprophylaxis may
breastfeed immediately after birth.
,The schedule for subsequent doses of the vaccine depends upon the infant's birth
weight. If the birth weight is ≥2000 g, the second and third doses should be given at 1
and 6 months of age, respectively. For infants who weigh <2000 g, three additional
doses are required and should be given at 1, 2-3, and 6 months of age, or at 2, 4, and 6
months of age.
Since this is prophylactic, treatment of the infant for an active infection with an antiviral
medication such as adefovir dipivoxil is unnecessary. A hepatitis profile to check for
HBsAg
Exclusively breastfed infants have higher rates of which one of the following?
A. Leukemia
B. Obesity
C. Otitis media
D. Rickets
E. Sudden infant death syndrome - Answers-ANSWER: D
The benefits of breastfeeding are numerous, including reductions in a number of
infectious diseases, such as otitis media, respiratory infections, bacterial meningitis,
bacteremia, diarrhea, necrotizing enterocolitis, and urinary tract infections. The rates of
other adverse health outcomes are also reduced, including sudden infant death
syndrome in the first year of life, type 1 diabetes, lymphoma, leukemia, overweight,
obesity, hypercholesterolemia, and asthma.
Studies have shown that up to 96% of children who have rickets were breastfed, as the
small amount of vitamin D in breast milk is inadequate for preventing this condition in
infants or children. While development of rickets requires the severe vitamin D
deficiency seen in less wealthy countries, cases are still diagnosed in the United States.
Subclinical vitamin D deficiency is more prevalent in breastfed infants, and it can be
associated with complications of insufficient bone density in later life. The American
Academy of Pediatrics recommends that all breastfed infants receive 400 IU of oral
vitamin D drops daily, beginning the first few days of life and continuing until the infant's
daily intake of vitamin D-fortified formula or milk is at least 500 mL.
On a routine examination an otherwise healthy 4-month-old male is found to have a
flattened right occiput, with the right ear slightly anterior to the left ear. The child's
posterior fontanelle is closed and the anterior fontanelle is open, measuring 2.5×2.0 cm.
No other abnormal findings are noted on examination.
The most likely cause of this deformity is
A. craniosynostosis
B. esotropia
C. sleeping on his back
D. torticollis, or "wry neck" - Answers-ANSWER: C
, The prevalence of deformational plagiocephaly, or positional head flattening, has been
increasing steadily since the early 1990s when the "Back to Sleep" campaign began
recommending that infants be placed on their backs for sleep to prevent sudden infant
death syndrome. Positional skull deformities are generally benign and reversible,
decreasing in frequency in proportion to increasing age. These do not require surgical
intervention, as opposed to craniosynostosis, which can result in neurologic damage
and progressive craniofacial distortion.
Routine evaluation of the skull in newborns and infants includes palpation of the
sutures, evaluation of the posterior and anterior fontanelles, and palpation of the
sternocleidomastoid muscles to detect torticollis. An abnormal fontanelle or a raised firm
edge along the sutures can indicate the possibility of craniosynostosis, a relatively rare
condition in which the sutures close too early. The posterior fontanelle may be closed at
birth and is usually closed by 2-4 months of age. The anterior fontanelle usually is open
until at least the fourth month, and commonly until 2-2½ years of age.
Children may hold their head in an abnormal position if they have severe esotropia,
creating either real or perceived changes in skull growth.
A lump in the sternocleidomastoid muscle may indicate that the child has had either
hemorrhage or scarring into that muscle, which can result in torticollis and deformity of
the skull as the sternocleidomastoid muscle pulls on that side of the head.
In most cases, positional plagiocephaly can be treated with a combined approach of
physical therapy and repositioning, which is more effective than repositioning alone. A
custom-fitted cranial molding orthosis (helmet) designed to relieve pressure on the
flattened side should only be used in th
You are seeing a 12-month-old healthy female for a routine well care visit. Her mother
had an uncomplicated pregnancy, and the birth history and newborn nursery period
were also without complications. She has been seen for all age-appropriate well child
visits and is up to date on immunizations. Her growth and development have
progressed normally since birth and she is in the 50th percentile for height and weight.
.
Testing for which one of the following should be repeated in 1-2 weeks?
A. Congenital adrenal hyperplasia
B. Congenital hypothyroidism
C. Galactosemia
D. Phenylketonuria
E. Sickle cell anemia - Answers-ANSWER: D
There are several genetic and metabolic diseases that can be detected by a simple
blood test in the newborn period. It is important for family physicians who care for
children to know about the detection of these diseases and how to interpret the
laboratory results. Many of these screening tests are mandatory, with the specific
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