Final Review Flashcards
Routine Immunizations
At Birth
2 B’s
Birth
hep B
Routine Immunizations
Age 2 months
2B DR HIP
hep B DTap Rotavirus HiB Inactivated Polio Pneumococcal
Routine Immunizations
Age 4 months
4 DR HIP
DTap Rotavirus HiB Inactivated Polio Pneumococcal
Routine Immunizations
Age 6 months
B DR HIP in 6 months
hep B DTaP Rotavirus HiB Inactivated Polio Pneumococcal
Flu shot
Routine Immunizations
Age 12-18 months
1 MAD HPV
MMR hep A DTaP HiB Pneumococcal Varicella
Routine Immunizations
Age 4-6 years
Very DIM at 4-6
Varicella
DTaP
Inactivated Polio
MMR
Active Immunity
- Usually Permanent
- Naturally acquired through exposure or through immunizations
- Onset is 2-4 weeks
- Duration is years to lifetime
Passive Immunity
- Short-term immunity
- Passage of antibodies from mother to fetus during pregnancy
- Onset within 24 hours and duration is 4-6 months
Community Immunity
AKA Herd Immunity
- Obtained through indirect protection of those around them
- 90-95% of population needs to be vaccinated in order to have Herd immunity
Universal Screenings
Newborn
- Hearing
- Bilirubin
- Blood: PKU, congenital hypothyroidism, sickle cell
- Congenital Heart Disease
Universal Screenings
Age 3-5 days
- Hearing (if not done already)
- Blood (verify results of previous tests)
Universal Screenings
Age 1 month
- Hearing (if not done yet)
- Blood (verify results and make referrals if necessary)
- Maternal depression
Universal Screenings
Age 2 months
- Hearing
- Blood (follow-up if needed from birth blood tests)
- Maternal Depression
Universal Screenings
Age 4 months
- Maternal Depression
Universal Screenings
Age 6 months
- Oral Health (apply fluoride varnish on first tooth eruption)
- Maternal Depression
Universal Screenings
Age 9 months
- Developmental Screen
- Oral Health (apply fluoride varnish on first tooth eruption)
Universal Screenings
Age 1 year
- Anemia (Hct & HgB)
- Lead Blood Test (high prevalence area or medicaid)
- Oral Health (should have dental home by this time)
Universal Screenings
Age 15 months
- Oral health (encourage to have dental home, apply fluoride varnish on first tooth eruption and every 6 months)
Universal Screenings
Age 18 months
- ASD screening
- Developmental screen
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
Universal Screenings
Age 2 years
- ASD screening
- Lead Blood Test (high prevalence area or medicaid)
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
Universal Screenings
Age 2 1/2 years
- Developmental Screen
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
Universal Screenings
Age 3 years
- Vision (using HOTV or LEA symbols)
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
Universal Screenings
Age 4 years
- Hearing (audiometry)
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
- Vision (using HOTV or LEA symbols)
Contraindications to give vaccines
Allergies
Allergic to eggs, yeast, gelatin
Contraindication to giving rotavirus vaccine
If child has intussusception or gastroenteritis
What vaccine should not be given if child has allergy to yeast?
- Hep B (think B for bread)
Vaccines contraindicated during pregnancy?
- MMR
- IPV
- Varicella
- Hep A
Immunizations routinely offered to patients over 65 years old?
- Tdap
- Influenza
- Pneumococcal
If a patient has an allergy to neomycin, which vaccine should they not receive?
- Measles (MMR)
At what age should a healthy individual receive the Tdap booster?
65
Which of all childhood vaccines has most adverse effects?
Pertussis
Labs monitored for neonatal hypothyroid screen
TSH and T4
What test can confirm sickle cell disease?
Hemoglobin electrophoresis
What immunizations should be given for children who are positive for sickle cell?
- PCV
- Polysaccharide
Most common initial symptom of sickle cell occurring in up to 50% of children before age 3
- Hand-foot syndrome (dactylitis)
What two vaccines, when given together, increase chance for febrile seizures?
- MMR
- Varicella
Most common route of Hep A transmission
- Contaminated food/water
What is ankyloglossia?
- Tongue tie, when attachment is closer to tip of tongue that restricts movement
What lead blood level is abnormal?
Above 5
What lead blood level indicates chelation needed?
Greater than 45
What lead blood level is urgent?
Above 70 is URGENT
If a child is taking more than __mg per day of corticosteroids, they should not be given a live vaccine.
20mg/day for 14 days
When is it okay for a child with cancer to have a live vaccine?
- Remission
- 90 days past chemo
Which immunizations are live viruses?
- MMR
- MMRV
- Varicella
- Rotavirus
- Yellow Fever
Can live virus immunizations be given together?
Yes, but if you have to give them at different times it must be 4 weeks apart
Middle childhood
7-10 years old
Early childhood
5-7 years old
What universal screenings for 5-6 year old?
- Hearing
- Vision
- Ocular motility
- Malocclusion
- Fine/Gross motor skills
- Gait
What causes acanthosis nigricans?
- Obesity
- Type 2 DM
What screening should begin at age 12?
Depression
What age do you begin screening for tobacco, alcohol, and drug use?
15 years old
HIV screening age
Performed once between 15-18 years old
Hearing/Vision Screening done at which visits?
- 5 yr, 6 yr, 8 yr, 10 yr visits
- Once between 11-14, 15-17, and 18-21
Screening for self injury begins at what age?
9-10 years old
Breast/Testicle exams begin at what age?
11 years old
Lipid screening at what age?
- 9-11 years old
- 17-21 years old
Initial pap smear done at what age?
21
At age 5, the brain is at __% of it’s adult weight.
90%
Age 6 milestones
- Recognizes numbers, letters, words
- Learns to write
- Beginning of concrete operations
- Magical thinking diminishes
Age 6 1/2 milestone
Mastered length (6 1/2 is a number you see on a ruler)
Age 7-10 is most concerned with…
Peers and school
Age 7 milestones
- Academia intensifies
- Becomes more abstract
- Language at adult proficiency
Age 8 milestone
Mastered volume
What age does rapid physical, emotional, cognitive, and social development begin?
11-12 years old
What age does rapid physical, emotional, cognitive, and social development end?
18-21 years old
What age is puberty complete by?
16-18 years old
What is included to pass from childhood to adulthood?
- Completed puberty
- Prepare for a career
- Developed socially and emotionally
3 leading causes of mortality in adolescence
- Unintentional injury
- Suicide
- Homicide
What age do you begin addressing the patient first, rather than the parent?
11-12 years old
FNP 1st priority during initial interview with adolescent?
- Ask about interests and school
What does a HEADSS tool help with?
Obtaining a psychosocial history from an adolescent
What does HEADSS stand for?
- Home
- Education/Employment
- Activities
- Drugs
- Sexuality
- Suicide/Depression
T/F: Teenager weight triples during adolescence?
False - doubles
Growth spurts happen earlier for girls or boys?
Girls
Peak age for puberty in girls?
11 1/2 - 12 years old
Peak age for puberty in boys?
13 1/2 - 14 years old
Tool used to categorize genital development?
SMR (sexual maturity rating)
SMR1 vs SMR5
- SMR1 is pre-puberty
- SMR5 is adult maturity
T/F: Axillary hair will begin before pubic hair.
False - pubic hair begins about 1 year before axillary
Psychosocial development characteristics present in 10-13 year olds?
- Feels more comfortable with same sex
- Rapid growth and secondary sex characteristics
Psychosocial development characteristics present in 14-16 year olds?
- Formal operations and abstract thinking
- Yearn for independence and autonomy
Psychosocial development characteristics present in >17 year olds?
- Less self-centered
- Dating becomes more intimate
- Period of idealism
Order for puberty in girls
- Height spurt
- Menarche
- Breasts
- Pubic hair
Order for puberty in boys
- Testicular growth
- Height spurt
- Penis growth
- Pubic hair
Most widely used illicit drug during HS?
Marijuana
Complications associated with marijuana
- Elevated B/P
- ADHD
- Coordination/memory issues
What drug has recently increased?
Ecstasy
Complications of ecstasy
- Delayed memory
- Insomnia
- Pulmonary HTN
- Increased appetite
Most widely used prescription drug by 12th graders?
Vicodin
Some clues that you may see in adolescents that abuse drugs/ETOH
- Delinquincy (truancy, failing grades)
- Chronic fatigue
- Generalized physical complaints
What disorders are commonly linked with substance abuse?
Psychiatric disorders
What tool used for screening for substance abuse?
CAGE questionnaire - 4 questions
What CAGE score indicates the patient abuses substances?
2 or above
Co-morbidities associated with substance abuse in adolescents?
- BAAD
- Bipolar disorder
- ADD/ADHD
- Anxiety disorders
- Depression
Components of a comprehensive pediatric history
MISS
- Meds (chronic)
- Immunizations
- Screening
- Sexual/social hx
Components of a comprehensive pediatric history
BIRD
- Birth hx
- Illness (present)
- Reason for visit
- Development
Components of a comprehensive pediatric history
OLD
- rOs (review of systems)
- problem List
- Demographic data/Diet
Components of a comprehensive pediatric history
FAM
- Family hx
- Allergies
- Medical hx
Appropriate visual acuity for a 3-5 year old
20/40
Appropriate visual acuity for a >6 year old
20/30
Most appropriate way to assess for obesity in ages 2-18 years?
BMI chart
BMI >__% for age/gender is considered obese
95%
BMI >__% for age/gender is considered overweight
85-95%
BMI
5%
BMI >__% for age/gender is considered severe obesity
99%
According to USPSTF, what age should FNP screen for obesity?
6 years old or older
Requirement to diagnose HTN
- 2 or more elevated B/Ps separated in time
- >95th percentile for 2 visits
1st line medications for essential (primary) HTN
- Beta blockers or ACE inhibitors
Appropriate age to begin checking B/P during annual visits
3 years old
Leading cause of death in US (process begins often in childhood)
Cardiovascular disease
Risk factors for CVD
- Genetics
- Diet
- Physical activity
First lipid panel screening (without risk factors)
9-11 years old
What age would you check fasting lipid panel in a patient with CVD risk factors
2-8 years old and 12-16 years old
What constitutes severe dyslipidemia
LDL >190mg/dl
What LDL level, with family hx of CVD, warrants pharmacologic intervention?
> 160mg/dl
What LDL level is dependent on risk factors present to determine pharmacologic intervention?
> 130mg/dl
What measurement is necessary to diagnose scoliosis?
COBB Angle Measurement
Most common cancer for males age 15-34
Testicular cancer
Most common type of cancer in the world
Skin cancer
Assessing for skin cancer
ABCDE
- Asymmetry
- Border
- Color
- Diameter
- Evolving
Prevention of skin cancer
- Stay out of sun 10am-4pm
- Minimum SPF 30 sunscreen, reapply every 2 hours
- Hats, sunglasses, long-sleeves
Who should be screened for IPV?
Women of childbearing age
Screening tool for IPV
HITS tool (hurt, insult, threaten, scream) - each graded on scale 1-5, anything >10 is suggestive of IPV
How to obtain a sexual history from adolescent
5 Ps
- Partners (number, men/women)
- Prevention of pregnancy (what are they doing)
- Protection from STIs
- Practices (type of sex)
- Past hx of STIs
When to begin and how often screen for STIs with a pap smear?
- 21 years old
- Screen every 3 years until age 65
STI associated with almost all cervical cancers?
HPV
Most common bacterial STIs in adolescent and young women?
Chlamydia/Gonorrhea
Mild depression symptoms, short duration, specific stressor causing depressed mood
Adjustment disorder
MDD characteristics
- Several depressive symptoms clustered over time
- Persistent for 2 weeks or more
- Cause impairment
Rate of depression highest in females at what age?
15 years old
Screening tool used in primary care to eval for depression
PHQ-9
Dental screening in adults, how often
Every 6 months
ETOH Misuse Screening tool
AUDIT tool
AUDIT Tool
- Quantify ETOH consumption
- Dependency
- Related problems
Vision Screenings
in 20s and 30s
Only once each
Vision Screenings
age 40
Baseline Exam
NOTE: Pre-DM or DM require YEARLY exam
Vision Screenings
Over 65 years old
Comprehensive exam yearly
ASCVD Screening
What age to begin screening?
Age 20
ASCVD Screening
Ages 20-39
- Measure risk factors every 4-5 years (tobacco, dyslipidemia, fam hx of ASCVD, HTN, T2DM)
- Estimates 10 year risk
Blood Glucose testing
- Begin age 45
- Normal test, recheck every 3 years
Colorectal Cancer screening
- Begin age 45-75
- FOBT yearly
- Flexible sigmoidoscopy q5 years
- OR Colonoscopy q10 years
- Screen until age 85
Breast Cancer Screening
- Begin at age 40
- Screen annually until age 54, then q2 years >55 years old
Prostate Cancer Screening
- Begin at age 50
- Test using DRE or PSA blood test
Testicular exam
- Begin at age 15
Osteoporosis Screening
- Begin at age 65
- BMD = osteoporosis risk score (T-score)
- FRAX tool = 10 year risk of fracture
Cervical Cancer Screening
- Begin at age 25-65 and test q3 years
- If over 65 years and all normal screening, no more screening needed
