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Patient Care II > Midterm > Flashcards

Midterm Flashcards

1
Q

examples of primary prevention

A

immunizations or behavioral counseling to remove risk factors

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2
Q

examples of secondary prevention

A

screening, early detection, and treatment

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3
Q

examples of tertiary prevention

A

treatment focused on long-term outcomes and prevention of disease progression and complications

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4
Q

secondary prevention in cardiology

A

patients have known disease and are being treated or are at very high risk of disease

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5
Q

secondary prevention in neurology

A

patients who have had a stroke or TIA or who are at very high risk of ischemic stroke

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6
Q

primum non nocere

A

first, do no harm - nonmaleficence

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7
Q

3 major aspects to consider when screening

A

the burden of disease, the sensitivity/specificity of the screening test, and the efficacy of treatment

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8
Q

sensitivity

A

the probability that a patient with the disease will have a positive test (SNOUT) - high sensitivity rules out disease

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9
Q

specificity

A

the probability that a patient without the disease will test negative (SPIN) - high specificity rules in disease

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10
Q

positive predictive value

A

likelihood that a person with a positive test has the disease - dependent on prevalence

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11
Q

negative predictive value

A

likelihood that a person with a negative test does not have the disease - dependent on prevalence

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12
Q

which predictive value is more useful with a low prevalence of disease?

A

negative predictive value (rules out disease)

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13
Q

predictive value of most screening tests

A

high negative predictive value

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14
Q

lead time bias

A

people who are diagnosed with screening survive longer after diagnosis than patients who present with symptoms even if treatment does not make a difference

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15
Q

length time bias

A

slower-growing cancers are more likely to be found by screening whereas faster-growing cancers usually present between screenings or before it starts

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16
Q

compliance bias

A

compliant patients have a better prognosis than non-compliant patients regardless of screening

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17
Q

external validity

A

generalizability - how well the study applies to patients who were not in the study

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18
Q

USPSTF

A

created in 1984 and make evidence-based recommendations about clinical preventative services excluding vaccines (does not consider cost of services)

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19
Q

CDC

A

advisory committee on immunization practices

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20
Q

CDC recommends Td/Tdap

A

a single dose of Tdap in place of Td for all adults age 19+ who have not received Tdap previously followed by Td booster every 10 years

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21
Q

CDC recommends Zoster (Shingles) vaccine

A

in adults age 50+

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22
Q

CDC recommends MMR vaccine

A

1-2 doses if born in 1957 or later

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23
Q

CDC recommends Varicella vaccine

A

age 13+ without evidence of immunity (history chickenpox)

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24
Q

CDC recommends HPV vaccine

A

in females up to age 26 (or up to age 45 with shared decision making), in males up to age 21, and in men who have sex with men (MSM) up to age 26

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25
Q

CDC recommends Meningococcal vaccine

A

in adults up to age 21 who are living in college dorms

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26
Q

CDC recommends Hep B vaccine

A

in adults age 19-59 with diabetes and other adults at high risk

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27
Q

CDC recommends Pneumococcus vaccine

A

1 dose of PCV-15 or PCV-20 in adults age 65+ (if PCV-15, then followed by 1 dose of PPSV-23), 1 dose of PCV-15 or PCV-20 in adults age 19-64 with certain chronic conditions and in adults 19+ with immunocompromise

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28
Q

live, attenuated vaccines

A

contain a little version of the organism that has been weakened (attenuated) so that it doesn’t cause disease in patients with a healthy immune system (can cause disease in immunocompromised patients), confer long-lasting immunity with usually only 1-2 doses - MMR and Varicella/Zoster

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29
Q

inactivated vaccines

A

contain a killed version of the organism, may require several boosters to get long-lasting immunity or to maintain it - IPV, hepatitis A

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30
Q

subunit vaccines

A

contain part of the organism (often essential antigen) and have less side effects - pertussis

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31
Q

Toxoid vaccines

A

contain a weakened form of a bacterial toxin to prevent diseases due to bacterial toxins - tetanus and diphtheria

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32
Q

conjugate vaccines

A

link antigens or toxoids that the immune system does not recognize to polysaccharides preventing the immune system in children and infants from recognizing them - Hib

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33
Q

live attenuated vaccine (MMR, varicella, live zoster, live influenza) contraindications

A

pregnancy, severe immunodeficiency

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34
Q

potential major vaccine contraindications

A

allergies to eggs (influenza), gelatin (varicella), baker’s yeast (hep B), neomycin/streptomycin (MMR, IPV), severe immunodeficiency (MMR, varicella, zoster), encephalopathy within 7 days of getting DTP, Tdap, or DTaP, if history of severe side effects such as Guillain-Barre, high fevers, seizures, or prolonged inconsolable crying

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35
Q

precautions to giving vaccines

A

delay if the patient is moderately to severely ill or if received IVIG

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36
Q

USPSTF recommends cervical cancer screening

A

in females age 21-65 by Pap every 3 years or Pap-HPV co-testing every 5 years

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37
Q

USPSTF recommends colorectal cancer screening

A

in adults age 50-75 (grade A) and in adults age 45-49) grade B

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38
Q

USPSTF recommends breast cancer screening

A

in adults aged 50-74 by mammography every 2 years (grade B)

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39
Q

USPSTF recommends prostate cancer screening

A

in adults age 55-69 by PSA based on individual decision making (grade C)

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40
Q

USPSTF recommends lung cancer screening

A

in adults who are smokers/former smokers aged 50-80

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41
Q

USPSTF recommends behavioral counseling for

A

smoking cessation, healthy diet and physical activity, obesity screening and counseling, STI counseling, fall prevention, and skin cancer prevention

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42
Q

USPSTF recommends screening for

A

blood pressure, depression, HIV, unhealthy alcohol use, diabetes, intimate partner violence, osteoporosis, AAA, STIs, hepatitis

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42
Q

USPSTF chemoprevention includes

A

use of statins, tobacco cessation, and aspirin use to prevent ASCVD and colorectal cancer

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42
Q

neonate/newborn

A

from birth to 28 days of life

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43
Q

infant

A

29 days to 1 year

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44
Q

early childhood

A

1-4 years old (preschool or toddler)

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45
Q

middle childhood

A

5-10 years old

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46
Q

adolescence

A

10-20 years old

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47
Q

early adolescence

A

10-14 years old

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48
Q

middle adolescence

A

15-16 years old

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49
Q

late adolescence

A

17-20 years old

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50
Q

goals of pediatric visits

A

disease prevention and detection, health promotion, and anticipatory guidance

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51
Q

components of pediatric visit

A

interval history, surveillance of development, review of systems, observation of parent/child interaction, physical exam including growth measurements, screening, immunizations, and anticipatory guidance

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52
Q

developmental surveillance

A

ongoing process done at every pediatric visit

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53
Q

developmental screening

A

formal process that uses a standardized tool done at specified ages or on a set schedule to identify children at risk for a developmental disorder

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54
Q

main differences in pediatric HPI

A

history is obtained from the parent and requires asking about both the child’s and parents’ perspectives as child gets older, must note parent-child interaction

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55
Q

components of well child visit

A

obtain any parental or child concerns as they get older, any changes since last visit, general status, and other priorities

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56
Q

pediatric past medical history

A

includes all normal components with the addition of prenatal history, birth history, and newborn history (newborn history included for all children age 3 and under and older if pertinent)

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57
Q

prenatal history includes

A

mother’s age at delivery, previous pregnancy history, maternal illnesses during pregnancy, complications of pregnancy

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58
Q

birth history includes

A

duration of pregnancy, kind and duration of labor, type of delivery, medications during delivery, condition of child at birth, need for resuscitation at birth, APGAR scores, complications of delivery

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59
Q

APGAR score includes

A

activity (muscle tone), pulse, grimace (reflex, irritability), appearance (skin color), and respirations - rated from 0-2

60
Q

When is APGAR scoring used?

A

evaluated at 1 and 5 minutes postpartum in all newborns to assess the need for resuscitation

61
Q

newborn history includes

A

birth weight, length, and head circumference, complications after birth, and whether or not the baby went home with mother

62
Q

HEADSS includes

A

social history for teens that includes home, education, activities, drug use, sexual activity, suicide

63
Q

key questions in initial evaluation of newborn

A

full-term? good muscle tone? infant breathing or crying?

64
Q

normal 1-minute APGAR score

A

8-10

65
Q

1-minute APGAR score requiring immediate resuscitation

A

0-4

66
Q

newborn assessment

A

should happen during the first day of life 1-2 hours after feeding with parents present

67
Q

normal temperature for newborn

A

36.5-37.5 degrees Celsius or 97.7-99.5 degrees Fahrenheit

68
Q

normal respirations for newborn

A

35-60 breaths/minute

69
Q

normal heart rate for newborn

A

120-160 bpm

70
Q

pediatric blood pressure

A

not measure until age 3

71
Q

head circumference is measured

A

at every pediatric visit until age 2

72
Q

central or mucous membrane cyanosis in newborns is concerning for

A

congenital heart disease

73
Q

acrocyanosis

A

cyanosis of hands and feet which can be a normal finding in newborns

74
Q

Port Wine stain

A

capillary malformations in the skin that grow in proportion to the child’s growth - can indicate underlying disease especially if in V1 or V2 of cranial nerve 5 (Sturge-Weber syndrome which causes capillary-venous malformations in the brain and eye)

75
Q

closure of anterior fontanelle

A

happens between 4 and 26 months of age

76
Q

closure of posterior fontanelle

A

happens by 2 months of age

77
Q

low set or posteriorly rotated ears are concerning for

A

a genetic syndrome such as Down, Turner, or Trisomy 18 syndrome

78
Q

Infants are commonly what kind of breathers?

A

obligate nasal breathers

79
Q

a short frenulum in an infant is concerning for

A

ankyloglossia (tongue-tied)

80
Q

webbed neck and widely spaced nipples in an infant is concerning for

A

Turner syndrome

81
Q

normal heart sound heard on auscultation of newborn

A

S3

82
Q

blood vessels contained in umbilical cord

A

2 arteries and 1 vein

83
Q

pigmented spots, hairy patches, and deep pits on spine are associated with

A

neural tube defects

84
Q

tests to assess for developmental dysplasia of hip in newborns

A

Barlow and Ortolani maneuvers (should be done at newborn assessment up to 3 months)

85
Q

Barlow maneuver

A

trying to sublux or dislocate the hip by adducting and pushing posteriorly with knees and hips flexed - positive test will feel a clunk as hip subluxes

86
Q

Ortolani maneuver

A

trying to relocate the hips by abducting both hips at the same time with baby supine and knees and hips flexed and pulling anteriorly - positive test will feel a clunk as hip relocates

87
Q

primitive reflexes

A

Moro reflex, grasp reflex, stepping reflex, rooting reflex, Babinski, and asymmetrical tonic neck reflex

88
Q

Moro reflex

A

startle reflex characterized by sudden, slight dropping of the head from a slightly raised supine position, opening of the hands, extension and abduction of the arms, then flexion of arms and crying - disappears by age 5-6 months

89
Q

Stepping reflex

A

disappears by age 1-2 months

90
Q

Rooting reflex

A

disappears by age 2-3 months

91
Q

Babinski reflex

A

disappears by age 9-24 months

92
Q

preventative care for newborns includes

A

eye care - erythromycin ophthalmic ointment or silver nitrate, vitamin K to prevent bleeding, hepatitis B vaccination

93
Q

test used to assess for congenital heart disease

A

pulse oximetry on the RIGHT hand (pre-ductal) and on EITHER foot (post-ductal) between 24-48 hours

94
Q

pulse oximetry requiring immediate evaluation of infant’s heart by pediatric cardiology and echocardiogram

A

O2 saturation < 90% in either extremity, abnormal heart rate or respiration rate, or ill appearance

95
Q

universal newborn screening tests includes

A

hearing test, testing for metabolic and genetic disorders (Cystic fibrosis), endocrine disorders (hypothyroidism), and hemoglobinopathies (Sickle cell)

96
Q

4 main areas of surveillance of development done at every pediatric visit

A

social and emotional, language and communication, gross motor skills, and fine motor skills

97
Q

1-week old milestones

A

makes brief eye contact, cries with discomfort and calms to adult voice, reflexively moves arms and legs, turns head to the side when on stomach, holds fingers closed and grasps reflexively

98
Q

1 month-old milestones

A

calms when picked up or spoken to, looks briefly at objects, alerts to unexpected sounds, makes short vowel sounds, holds chin up in prone, holds fingers more open at rest

99
Q

2-month-old milestones

A

smiles responsively, vocalizes with simple cooing, lifts head and chest in prone, opens and shuts hands

100
Q

4-month-old milestones

A

laughs aloud, turns to voice, vocalizes with extended cooing, rolls over from prone to supine, supports on elbows and wrists in prone, keeps hands unfisted, grasps objects

101
Q

6-month-old milestones

A

pats or smiles at reflection, begins to turn when name called, babbles, rolls over from supine to prone, sits briefly without support, reaches for objects and transfers, rakes small objects with 4 fingers, bangs small object on surface

102
Q

9-month-old milestones

A

uses basic gestures, looks for dropped objects, picks up food with fingers and eats it, turns when name called, says “Dada” or “Mama” nonspecifically, sits well without support, pulls to stand, balances on hands and knees, crawls, picks up small objects with 3 fingers and thumb, bangs objects together

103
Q

12-month-old milestones

A

looks for hidden objects, imitates new gestures, says “Dada” or “Mama” specifically, uses 1 word other than Mama, Dada, or personal names, takes first independent steps, stands without support, drops object in a cup, picks up small objects with 2-finger pincer grasp

104
Q

15-month-old milestones

A

imitates scribbling, drinks from a cup with little spilling, points to ask for something, uses 3 words other than names, speaks in jargon, follows a verbal command without a gesture, squats to pick up objects, begins to run, makes mark with crayon, drops object in and takes it out of a container

105
Q

18-month-old milestones

A

engages with others for play, helps dress and undress, points to pictures in books, points to objects of interest to draw attention to them, uses 6-10 words other than names, identifies at least 2 body parts, walks up with 2 feet per step with hand-held, carries things while walking, scribbles spontaneously and throws small ball a few feet while standing

106
Q

2-year-old milestones

A

plays alongside other children, undresses independently, scoops well with small spoon, uses 50 words, combines 2 words into short phrase or sentence, uses words that are 50% intelligible to strangers, kicks ball and jumps off ground with 2 feet, runs with coordination, stacks objects, turns book pages, and uses hands to turn objects (doorknobs, toys)

107
Q

2.5-year-old milestones

A

urinates in a potty or toilet, engages in pretend play, spears food with a fork, uses pronouns correctly, begins to walk up steps alternating feet, runs without falling, grasps crayon with thumb and fingers instead of fist

108
Q

3-year-old milestones

A

enters the bathroom and urinates by self (girls), plays in cooperation and shares, gets dressed by self, eats independently, uses 3-word sentences, uses words that are 75% intelligible to strangers, pedals tricycle, climbs on and off couch or chair, jumps forward, draws a single circle, a person with head and 1 other body part, cuts with scissors

109
Q

4-year-old milestones

A

enters bathroom and has bowel movement by self, brushes teeth, dresses and undresses without much help, engages in well-developed imaginative play, uses 4-word sentences and words that are 100% intelligible to strangers, climbs stairs alternating feet without support, draws a person with at least 3 body parts, grasps pencil with thumb and fingers instead of fist

110
Q

screening tool used for Autism

A

M-CHAT-R/F

111
Q

vitals obtained at every pediatric visit

A

weight, length, and head circumference (until age 2)

112
Q

expected weight in 4-6-month-olds

A

double birth weight

113
Q

expected weight in 1-year-olds

A

triple birth weight

114
Q

expected length change by 1 year

A

increased by 50% of birth length

115
Q

growth chart preferred for breastfed infants

A

WHO growth charts

116
Q

recommended growth chart usage

A

use WHO growth chart until age 2 then CDC growth chart from ages 2-19

117
Q

esotropia

A

eye deviates nasally

118
Q

exotropia

A

eye deviates temporally

119
Q

strabismus

A

eyes are not aligned

120
Q

age by which testes should be descended

A

age 1 year

121
Q

recommended screening for hearing

A

in all newborns within 36 hours of birth and audiology screening for all children ages 4,5,6,8 and 10 years old

122
Q

required childhood vaccinations by age 6 years

A

5th dose of DTaP, 3rd or 4th dose of Hib, 4th dose of IPV, and 2nd dose of MMR

123
Q

anticipatory guidance includes

A

social determinants of health, behavior and development, discipline (boundaries), nutrition and feeding, and safety

124
Q

mean age of puberty in girls

A

10.5 years old (ranges from 8-12), occurs earlier in African Americans

125
Q

mean age of puberty in boys

A

11.5 years old (ranges from 9-13)

126
Q

time of growth spurt in girls

A

6 months before onset of menses, lasts 2 years

127
Q

time of growth spurt in boys

A

2 years later compared to girls, lasts 2 years

128
Q

Tanner staging

A

used to assess the level of sexual maturity and consists of 5 stages

129
Q

Tanner Stage 2 of breast development

A

breast bud formation with elevation of breast and nipple, enlargement of areola

130
Q

Tanner Stage 3 of breast development

A

further enlargement of breast and areola, no separation of their contour

131
Q

Tanner Stage 4 of breast development

A

areola and nipple form a secondary mound above the level of breast

132
Q

Tanner Stage 5 breast development

A

mature stage - projection of nipple only related to recession of areola

133
Q

Tanner Stage 2 of pubic hair growth

A

sparse growth, slightly pigmented, at base of penis or along labia

134
Q

Tanner Stage 3 pubic hair growth

A

darker, courser and more curled hair beginning to spread over pubis symphysis

135
Q

Tanner Stage 4 pubic hair growth

A

hair is adult type but covers less area than in adult with no spread to medial surface of thighs

136
Q

Tanner Stage 5 pubic hair growth

A

hair is adult type and quantity with horizontal and upper border spread over medial thighs

137
Q

Tanner Stage 2 penis, testes, and scrotum development

A

slight or no enlargement of the penis, testes and scrotum larger and somewhat reddened with altered texture

138
Q

Tanner Stage 3 penis, testes, and scrotum development

A

penis larger in length, testes and scrotum further enlarged

139
Q

Tanner Stage 4 penis, testes, and scrotum development

A

further enlargement of penis in length and breadth with development of glans, further testes and scrotum enlargement with darkened scrotal skin

140
Q

adult testes size

A

12-25 ml

141
Q

pubertal testes size

A

4-12 ml

142
Q

contraception consent age

A

anyone above age 12 or 14 in 27 states and DC

143
Q

abortion consent for minors

A

37 states require some type of parental involvement whether its one or both parents’ consent and one or both parents to be notified

144
Q

best time to assess for scoliosis in adolescents

A

before the adolescent growth spurt usually starting at age 9-10

145
Q

Adams forward bend test

A

used to assess for scoliosis, can use scoliometer

146
Q

routine immunizations for adolescents

A

annual flu shot, 2 doses of meningococcal vaccine at age 11-12 and at age 16, Tdap booster at age 11-12, and HPV series (2-3 doses depending on age started)

147
Q

universal screenings recommended for adolescents

A

depression starting at age 12, drug use beginning at age 12, hearing once between age 9-11 and again between age 15-17, vision at age 12, HIV screening once between age 15-18 if risk factors present, lipids once between age 17-21 (especially if done at age 11-12)

148
Q

PHQ-2

A

adolescent screening tool for depression

149
Q

CRAFTT

A

adolescent screening tool for alcohol/drug use

150
Q

Preparticipation Physical Exam components

A

medical history, injury history, cardiovascular history, family history, ROS, and possibly depression screening

Patient Care II (2 decks)

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