Midterm Flashcards
1
Q
examples of primary prevention
A
immunizations or behavioral counseling to remove risk factors
2
Q
examples of secondary prevention
A
screening, early detection, and treatment
3
Q
examples of tertiary prevention
A
treatment focused on long-term outcomes and prevention of disease progression and complications
4
Q
secondary prevention in cardiology
A
patients have known disease and are being treated or are at very high risk of disease
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
6
Q
primum non nocere
A
first, do no harm - nonmaleficence
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
8
Q
sensitivity
A
the probability that a patient with the disease will have a positive test (SNOUT) - high sensitivity rules out disease
9
Q
specificity
A
the probability that a patient without the disease will test negative (SPIN) - high specificity rules in disease
10
Q
positive predictive value
A
likelihood that a person with a positive test has the disease - dependent on prevalence
11
Q
negative predictive value
A
likelihood that a person with a negative test does not have the disease - dependent on prevalence
12
Q
which predictive value is more useful with a low prevalence of disease?
A
negative predictive value (rules out disease)
13
Q
predictive value of most screening tests
A
high negative predictive value
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
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
16
Q
compliance bias
A
compliant patients have a better prognosis than non-compliant patients regardless of screening
17
Q
external validity
A
generalizability - how well the study applies to patients who were not in the study
18
Q
USPSTF
A
created in 1984 and make evidence-based recommendations about clinical preventative services excluding vaccines (does not consider cost of services)
19
Q
CDC
A
advisory committee on immunization practices
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
21
Q
CDC recommends Zoster (Shingles) vaccine
A
in adults age 50+
22
Q
CDC recommends MMR vaccine
A
1-2 doses if born in 1957 or later
23
Q
CDC recommends Varicella vaccine
A
age 13+ without evidence of immunity (history chickenpox)
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
25
CDC recommends Meningococcal vaccine
in adults up to age 21 who are living in college dorms
26
CDC recommends Hep B vaccine
in adults age 19-59 with diabetes and other adults at high risk
27
CDC recommends Pneumococcus vaccine
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
28
live, attenuated vaccines
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
29
inactivated vaccines
contain a killed version of the organism, may require several boosters to get long-lasting immunity or to maintain it - IPV, hepatitis A
30
subunit vaccines
contain part of the organism (often essential antigen) and have less side effects - pertussis
31
Toxoid vaccines
contain a weakened form of a bacterial toxin to prevent diseases due to bacterial toxins - tetanus and diphtheria
32
conjugate vaccines
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
33
live attenuated vaccine (MMR, varicella, live zoster, live influenza) contraindications
pregnancy, severe immunodeficiency
34
potential major vaccine contraindications
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
35
precautions to giving vaccines
delay if the patient is moderately to severely ill or if received IVIG
36
USPSTF recommends cervical cancer screening
in females age 21-65 by Pap every 3 years or Pap-HPV co-testing every 5 years
37
USPSTF recommends colorectal cancer screening
in adults age 50-75 (grade A) and in adults age 45-49) grade B
38
USPSTF recommends breast cancer screening
in adults aged 50-74 by mammography every 2 years (grade B)
39
USPSTF recommends prostate cancer screening
in adults age 55-69 by PSA based on individual decision making (grade C)
40
USPSTF recommends lung cancer screening
in adults who are smokers/former smokers aged 50-80
41
USPSTF recommends behavioral counseling for
smoking cessation, healthy diet and physical activity, obesity screening and counseling, STI counseling, fall prevention, and skin cancer prevention
42
USPSTF recommends screening for
blood pressure, depression, HIV, unhealthy alcohol use, diabetes, intimate partner violence, osteoporosis, AAA, STIs, hepatitis
42
USPSTF chemoprevention includes
use of statins, tobacco cessation, and aspirin use to prevent ASCVD and colorectal cancer
42
neonate/newborn
from birth to 28 days of life
43
infant
29 days to 1 year
44
early childhood
1-4 years old (preschool or toddler)
45
middle childhood
5-10 years old
46
adolescence
10-20 years old
47
early adolescence
10-14 years old
48
middle adolescence
15-16 years old
49
late adolescence
17-20 years old
50
goals of pediatric visits
disease prevention and detection, health promotion, and anticipatory guidance
51
components of pediatric visit
interval history, surveillance of development, review of systems, observation of parent/child interaction, physical exam including growth measurements, screening, immunizations, and anticipatory guidance
52
developmental surveillance
ongoing process done at every pediatric visit
53
developmental screening
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
54
main differences in pediatric HPI
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
55
components of well child visit
obtain any parental or child concerns as they get older, any changes since last visit, general status, and other priorities
56
pediatric past medical history
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)
57
prenatal history includes
mother's age at delivery, previous pregnancy history, maternal illnesses during pregnancy, complications of pregnancy
58
birth history includes
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
59
APGAR score includes
activity (muscle tone), pulse, grimace (reflex, irritability), appearance (skin color), and respirations - rated from 0-2
60
When is APGAR scoring used?
evaluated at 1 and 5 minutes postpartum in all newborns to assess the need for resuscitation
61
newborn history includes
birth weight, length, and head circumference, complications after birth, and whether or not the baby went home with mother
62
HEADSS includes
social history for teens that includes home, education, activities, drug use, sexual activity, suicide
63
key questions in initial evaluation of newborn
full-term? good muscle tone? infant breathing or crying?
64
normal 1-minute APGAR score
8-10
65
1-minute APGAR score requiring immediate resuscitation
0-4
66
newborn assessment
should happen during the first day of life 1-2 hours after feeding with parents present
67
normal temperature for newborn
36.5-37.5 degrees Celsius or 97.7-99.5 degrees Fahrenheit
68
normal respirations for newborn
35-60 breaths/minute
69
normal heart rate for newborn
120-160 bpm
70
pediatric blood pressure
not measure until age 3
71
head circumference is measured
at every pediatric visit until age 2
72
central or mucous membrane cyanosis in newborns is concerning for
congenital heart disease
73
acrocyanosis
cyanosis of hands and feet which can be a normal finding in newborns
74
Port Wine stain
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
closure of anterior fontanelle
happens between 4 and 26 months of age
76
closure of posterior fontanelle
happens by 2 months of age
77
low set or posteriorly rotated ears are concerning for
a genetic syndrome such as Down, Turner, or Trisomy 18 syndrome
78
Infants are commonly what kind of breathers?
obligate nasal breathers
79
a short frenulum in an infant is concerning for
ankyloglossia (tongue-tied)
80
webbed neck and widely spaced nipples in an infant is concerning for
Turner syndrome
81
normal heart sound heard on auscultation of newborn
S3
82
blood vessels contained in umbilical cord
2 arteries and 1 vein
83
pigmented spots, hairy patches, and deep pits on spine are associated with
neural tube defects
84
tests to assess for developmental dysplasia of hip in newborns
Barlow and Ortolani maneuvers (should be done at newborn assessment up to 3 months)
85
Barlow maneuver
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
Ortolani maneuver
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
primitive reflexes
Moro reflex, grasp reflex, stepping reflex, rooting reflex, Babinski, and asymmetrical tonic neck reflex
88
Moro reflex
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
Stepping reflex
disappears by age 1-2 months
90
Rooting reflex
disappears by age 2-3 months
91
Babinski reflex
disappears by age 9-24 months
92
preventative care for newborns includes
eye care - erythromycin ophthalmic ointment or silver nitrate, vitamin K to prevent bleeding, hepatitis B vaccination
93
test used to assess for congenital heart disease
pulse oximetry on the RIGHT hand (pre-ductal) and on EITHER foot (post-ductal) between 24-48 hours
94
pulse oximetry requiring immediate evaluation of infant's heart by pediatric cardiology and echocardiogram
O2 saturation < 90% in either extremity, abnormal heart rate or respiration rate, or ill appearance
95
universal newborn screening tests includes
hearing test, testing for metabolic and genetic disorders (Cystic fibrosis), endocrine disorders (hypothyroidism), and hemoglobinopathies (Sickle cell)
96
4 main areas of surveillance of development done at every pediatric visit
social and emotional, language and communication, gross motor skills, and fine motor skills
97
1-week old milestones
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
1 month-old milestones
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
2-month-old milestones
smiles responsively, vocalizes with simple cooing, lifts head and chest in prone, opens and shuts hands
100
4-month-old milestones
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
6-month-old milestones
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
9-month-old milestones
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
12-month-old milestones
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
15-month-old milestones
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
18-month-old milestones
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
2-year-old milestones
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
2.5-year-old milestones
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
3-year-old milestones
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
4-year-old milestones
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
screening tool used for Autism
M-CHAT-R/F
111
vitals obtained at every pediatric visit
weight, length, and head circumference (until age 2)
112
expected weight in 4-6-month-olds
double birth weight
113
expected weight in 1-year-olds
triple birth weight
114
expected length change by 1 year
increased by 50% of birth length
115
growth chart preferred for breastfed infants
WHO growth charts
116
recommended growth chart usage
use WHO growth chart until age 2 then CDC growth chart from ages 2-19
117
esotropia
eye deviates nasally
118
exotropia
eye deviates temporally
119
strabismus
eyes are not aligned
120
age by which testes should be descended
age 1 year
121
recommended screening for hearing
in all newborns within 36 hours of birth and audiology screening for all children ages 4,5,6,8 and 10 years old
122
required childhood vaccinations by age 6 years
5th dose of DTaP, 3rd or 4th dose of Hib, 4th dose of IPV, and 2nd dose of MMR
123
anticipatory guidance includes
social determinants of health, behavior and development, discipline (boundaries), nutrition and feeding, and safety
124
mean age of puberty in girls
10.5 years old (ranges from 8-12), occurs earlier in African Americans
125
mean age of puberty in boys
11.5 years old (ranges from 9-13)
126
time of growth spurt in girls
6 months before onset of menses, lasts 2 years
127
time of growth spurt in boys
2 years later compared to girls, lasts 2 years
128
Tanner staging
used to assess the level of sexual maturity and consists of 5 stages
129
Tanner Stage 2 of breast development
breast bud formation with elevation of breast and nipple, enlargement of areola
130
Tanner Stage 3 of breast development
further enlargement of breast and areola, no separation of their contour
131
Tanner Stage 4 of breast development
areola and nipple form a secondary mound above the level of breast
132
Tanner Stage 5 breast development
mature stage - projection of nipple only related to recession of areola
133
Tanner Stage 2 of pubic hair growth
sparse growth, slightly pigmented, at base of penis or along labia
134
Tanner Stage 3 pubic hair growth
darker, courser and more curled hair beginning to spread over pubis symphysis
135
Tanner Stage 4 pubic hair growth
hair is adult type but covers less area than in adult with no spread to medial surface of thighs
136
Tanner Stage 5 pubic hair growth
hair is adult type and quantity with horizontal and upper border spread over medial thighs
137
Tanner Stage 2 penis, testes, and scrotum development
slight or no enlargement of the penis, testes and scrotum larger and somewhat reddened with altered texture
138
Tanner Stage 3 penis, testes, and scrotum development
penis larger in length, testes and scrotum further enlarged
139
Tanner Stage 4 penis, testes, and scrotum development
further enlargement of penis in length and breadth with development of glans, further testes and scrotum enlargement with darkened scrotal skin
140
adult testes size
12-25 ml
141
pubertal testes size
4-12 ml
142
contraception consent age
anyone above age 12 or 14 in 27 states and DC
143
abortion consent for minors
37 states require some type of parental involvement whether its one or both parents' consent and one or both parents to be notified
144
best time to assess for scoliosis in adolescents
before the adolescent growth spurt usually starting at age 9-10
145
Adams forward bend test
used to assess for scoliosis, can use scoliometer
146
routine immunizations for adolescents
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
universal screenings recommended for adolescents
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
PHQ-2
adolescent screening tool for depression
149
CRAFTT
adolescent screening tool for alcohol/drug use
150
Preparticipation Physical Exam components
medical history, injury history, cardiovascular history, family history, ROS, and possibly depression screening
