ABFM + KSA CARE OF CHILDREN
EXAM QUESTIONS AND CORRECT
DETAILED VERIFIED SOLUTIONS
LATEST EXAM UPDATE WITH
RATIONALE
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 - 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
Page 1 of 35
,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
1224 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
Page 2 of 35
,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 - 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.
Page 3 of 35
, 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" - 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
Page 4 of 35
EXAM QUESTIONS AND CORRECT
DETAILED VERIFIED SOLUTIONS
LATEST EXAM UPDATE WITH
RATIONALE
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 - 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
Page 1 of 35
,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
1224 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
Page 2 of 35
,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 - 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.
Page 3 of 35
, 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" - 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
Page 4 of 35
