1
Q

Types of Macrocytic Anemia

A
Vitamin B 12 Deficiency 
Folic acid Deficiency 
Hypothyroidism
dug-induced anemia
Reticulocytosis
Liver Disease
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2
Q

Types of Microcytic Anemia

A

Iron Deficiency
Lead poisoning
Sideroblastic
Genetic anomaly - sickle cell or Thalassemia

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3
Q

Types of Normocytic Anemia

A
Reticulocyte Count - 
Chronic Disease
Blood loss
Infection
Aplastic Anemia
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4
Q

Iron Deficiency Anemia

A
Microcytic
Decreased MCV
Low MCH
High TIBC
Low Ferritin
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5
Q

B12 Deficiency Pernicious Anemia

A
Macrocytic
Increased MCV
Normal or High MCH
High Ferritin
Low B12
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6
Q

Anemia of Chronic Disease

A

Normocytic

everything normal except H&H

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7
Q

Validity

A

a test that is able to classify a large portion of diseased and non-diseased individuals correctly.

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8
Q

Sensitivity

A

The number of diseased divided by the total number of individuals
Proportion of correctly classified diseased individuals.

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9
Q

Specificity

A

The number of correctly classified non-diseased divided by the total number of non-diseased individuals.

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10
Q

Adaptive immunity

A
Natural
•	Passive (maternal)
•	Active (infection)
Artificial
•	Passive (antibody transfer)
•	Active (immunization)
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11
Q

Live vaccines

A
LAIV (Live attenuated influenza vaccine), 
MMR, 
Var, 
Zos 
and/or yellow fever
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12
Q

IPV, MMR, Varicella

A

History of Anaphylactic reaction:

Neomycin

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13
Q

IPV, Smallpox

A

History of Anaphylactic reaction

Streptomycin, polymyxinB, Neomycin

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14
Q

Hepatitis B

A

History of Anaphylactic reaction

Baker’s yeast

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15
Q

Varicella

A

History of Anaphylactic reaction:

Gelatin, neomycin

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16
Q

MMR

A

History of Anaphylactic reaction:

Gelatin

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17
Q

Autonomy

A

rights of individuals and their right to determine their lives

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18
Q

Beneficence

A

doing good
• Screening
• Based on economic considerations

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19
Q

Non-maleficence

A

– do no harm

• Screening may foster anxiety or be painful

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20
Q

Justice

A

being fair and equitable

• What is the fair distribution of scarce resources

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21
Q

Veracity

A

tell the truth
• Unbiased information based on evidence
• Some cultures do not bale truth in cases of terminal illness

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22
Q

Vulnerable Populations at risk for health promotion

A
o	Depressed
o	Job changes
o	Unemployed
o	Chronic illness
o	Martial crisis
o	LGBTIQ
o	Incarcerated
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23
Q

Primary Prevention

A

promoting optimum health before the onset of problems. Precedes disuse or dysfunction.

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24
Q

Secondary Prevention

A

early identification and treatment.

25
Tertiary Prevention
restoration and maximizing potential | • Restoration and rehabilitation
26
Healthy People 2020 4 Goals
- Attain longer lives free from preventable disease. - Achieve health equity; improve the health of all groups. - Create social and physical environments that promote good health for all. - Promote quality of life across all life stages.
27
Screenings | NEWBORN
* PKU * Sickle Cell * Hypothyroidism * Hearing * Developmental milestones * Wellness visits 1, 2, 4, 6, 9
28
Screenings | Kids <5
* Well Child Visits: 12, 15, 18, 24, 30 months, 3, 4 and 5 years * Developmental and Behavioral Screening at 9, 18, 24 or 30 months and each routine visits/wellness * Anemia Screening at 9-12 months routinely; and 1-5 years if at risk. Highest risk between 1 and 2 years(AAP) * Autism Screening 18 and 24 months * Lead Testing if indicated age 1 and 2 years old * Height/Weight/BMI: Every visit * Blood Pressure, Vision, Hearing: Around 3 years old
29
Sceenings Kids 5 – 12
* Yearly Wellness Visits * Height/Weight/BMI yearly * Blood Pressure yearly * Lipid Screening age 9 to 11 years * Dental Visits * Hearing and Vision Screening yearly * TB testing if At Risk * Hgb/Crit if At Risk * Diabetes Screening if At Risk * Drug/Alcohol Screening for At Risk * STI’s if at High Risk
30
Screenings Adolescents
* Yearly Wellness Visits * Height/Weight/BMI/Blood Pressure * Lipid Screening age 17-21 years * Hearing Screening 11 to 14 years, 15-17 years and 18 to 21 years * Vision Annually * Depression Screening at 12 yrs. * Alcohol, Tobacco and Drug Use Screening * HIV, Hep B, Hep C and STI Screening for At Risk * Diabetes Screening if At Risk
31
Screenings Adults
``` age for mammograms o 21 to begin self exams o >50, yearly age for Paps o 21 ```
32
Influences that effect how we process information
- genetics - environment - Societal Influences - Developmental level
33
Teaching Kids
- get them interested - simplify the task - maintain the pursuit of the goal -control frustration and risk through achievable goals demonstrate an idealized version on the act to be performed
34
Teaching teens
• simple, concrete, today & tomorrow focus - use physical advantages when listing Pros & Cons - use peer situations identify confidentiality boundaries
35
Teaching Adults
- active discussion and role play - present smaller amount of new material - help w/ synthesis, analysis and application - validate that they can learn - provide an environment that allows for sensory changes - provide visual information as well
36
Families
``` • assessment • function • involvement with children • teaching o more effective - resource for the individuals - strong interrelationship between family & health of it's member ```
37
Physical activity
o children 60 minutes per week o adults 150 minutes per week • formula o 220 – age X 0.6 = target HR
38
Dash Diet
o Eat more fruits, vegetables, and low-fat dairy foods. o Cut back on foods that are high in saturated fat, cholesterol, and trans fats. o Eat more whole-grain foods, fish, poultry, and nuts. o Limit sodium, sweets, sugary drinks, and red meats.
39
Modifiable Risk Factors
``` • High cholesterol • Smoking • DM • Thyroid • 30% unaware of thyroid issues o Contributing behaviors • Diet • Physical activity • 37% of adults are obese ```
40
Non-Modifiable Risk Factors
* Age * Family hx * Genetic determinants
41
CVD
* Stage I HTN – 130 – 139/80 – 89 * Implement lifestyle changes alone * Use BP meds w/ CVD, DM, CKD. * Stage II HTN >140/90 * Reinforce lifestyle changes and initiate meds
42
Benefits of Lowering B/P
* Decreased CVA by 35 – 40% * Decreased MI by 20 – 25% * Decreased HF by 50%
43
JNC - 8 Recommendations | >60
Goal: <150/90
44
JNC - 8 Recommendations | <60
Goal: <140/90
45
JNC - 8 Recommendations | Tx non-black
Thiazide type diuretic, CCB, ACE – 1 or ARB. | No beta-blockers for initial Tx, larger stroke outcome.
46
JNC - 8 Recommendations | Black
Thiazide type diuretic or CCB
47
JNC - 8 Recommendations | 18 w/ CKD & HTN
monitor labs: place on ARB & ACEI
48
Reduction of LDL w/ diet changes
8 - 14 mmHg
49
Reduction of LDL w/ lower sodium, <2.4 GM/day
2 - 8 mmHg
50
Reduction of LDL w/ physical activity, aerobic activity
4 - 9 mmHg
51
Reduction of LDL w/ ETOH limited to 1 - 2 drinks
2 - 4 mmHg
52
Pt. to receive Statins
o Dx atherosclerotic CV (ASCVD) o Primary LDL >190 (high intensity statin) o DM 40 -75 yr. w/ LDL 70 – 189. (moderate intensity statin) o 10 yr. ASCVD > 7.5% (high intensity statin) o < 75 yr. ASCVD → high intensity statin o >75 yr. → moderate intensity statin, as tolerated
53
High Intensity Statin
* LDL lowered at least 50% * Atorvastatin 40/80mg * Rosuvastatin 20/40mg
54
Moderate Intensity Statin
* LDL lowered 30 – 50% * Atorvastatin 10/20mg * Rosuvastatin 5/10mg * Simvastatin 20/40mg * Pravastatin 40/80mg * Lovastatin 40mg * Pitavastatin 2-4mg
55
Low Intensity Statin
* LDL lowered <30% * Simvastatin 10mg * Pravastatin 10-20mg * Lovastatin 20mg * Fluvastatin 20-40mg * Pitavastatin 1mg
56
Labs to check prior to Tx initiation Statin
o Fasting lipid o A1C, if DM unknown o ALT o CK, if indicated
57
Monitor response of Statin initiation
in 6 wks. and then routine q 6 – 12 months.
58
Family Genogram
Family diagram that views the family from identification data that depicts each member of the family with connections between the Generations