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Additional resources for Kaplan USMLE - Step 2 CK Lecture Notes 2017 Pediatrics
Total of 5 doses is recommended before school entry, with the final given at preschool age, 4–6 years. • Pertussis booster (Tdap) vaccine is now recommended during adolescence, regardless of immunization status; is also recommended even if one has already had pertussis disease. • Tdap (childhood tetanus) is given at age 11–12, and then Td (adult tetanus) every 10 years. Tetanus Table 6-3. Tetanus Prophylaxis in Wound Management History of Doses of Tetanus Toxoid <3 or unknown >3 Clean, Minor Wounds All Others* Td TIG Td TIG Yes No Yes Yes No, unless >10 years No No, unless >5 years No from last dose from last dose Definition of abbreviations: TIG, tetanus immune globulin; Td, tetanus and diptheria vaccine.
Boys’ highest growth stops at age 18. 5 years (2–3 years later than girls, and continues 2–3 years after girls have stopped). 5 years and it stops at age 16. Assessment of Growth • Child is genetically programmed to stay on 1–2 growth curves after age 2 years. • Height percentile at age 2 years correlates with final adult height percentile. • Low-birth-weight and very-low-birth-weight infants may continue to show catch-up growth through early school age. • Weight/height <5th percentile is the single best growth curve indicator for acute malnutrition.
37 USMLE Step 2 CK l Pediatrics • Management – All cases caused by underfeeding from maternal neglect must be reported to CPS – Infants discharged to natural home require intensive and long-term intervention – Feed, as above; usually require greater calories for catch-up growth. May need NG feedings or even gastrostomy tube in severe cases Obesity • R isk factorspredisposition, parental obesity, family/patient inactivity, feeding baby as response to any crying, and rarely associated in syndromes (Prader-Willi; Down) • Presentationtall stature in some, abdominal striae, associated obesity of extremities; increased adipose tissue in mammary tissue in boys, large pubic fat pad, early puberty • Diagnostic tests – BMI >95% for age and sex is diagnostic of obesity – 85 to 95% = overweight • ComplicationsObese infants and children are at increased risk of becoming obese adults (the risk is greater with advanced age of onset); cardiovascular (hypertension, increased cholesterol), hyperinsulinism, slipped capital femoral epithesis, sleep apnea, type 2 diabetes, acanthosis nigrans.