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Unit 2 Flashcards

1
Q

Middle childhood is considered what age group?

A

7-10

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2
Q

Early childhood is considered what age group?

A

5-7

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3
Q

What ages have BP and height, weight and BMI collected at annual visits?

A

Ages 5-21yr (BP 1st begins @ 3 yr. old annually)

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4
Q

During the physical exam of a 5-6-year-old patient, the FNP will assess/observe and perform what universal
screening(s)?

A

US (hearing, vision); assess/observe for ocular motility, malocclusion, fine/gross motor skills, gait

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5
Q

During the physical exam of a 7-year-old, the FNP will perform what universal screening?

A

None (“lucky number 7”)

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6
Q

During the physical exam of a 7-8-year-old patient, the FNP will assess/observe?

A

malocclusion, SMR (1st time this happens), hip/knee/ankle function, gait

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7
Q

During the physical exam of an 8-year-old patient, the FNP will conduct what universal screening?

A

hearing, vision

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8
Q

During the physical exam of a 9-10-year old, the FNP will assess/observe?

A

signs of self-injury, SMR, examine back (anticipatory guidance requires you to inquire about concerns with
weight, often the period of time when eating disorders can begin)

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9
Q

What ages will have a lipid screening performed?

A

once, 9-11 yr. visit and once, 17-21yr visit (lipid profile)

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10
Q

What universal screenings will be conducted during the 10yr old visit?

A

hearing, vision

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11
Q

What screening should begin at 12 years old?

A

depression

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12
Q

ing the physical exam of a 11-21yrs old patient, the FNP will assess/observe?

A

acne, acanthosis nigricans (skin condition that causes areas of dark in the armpits, neck, groin – sign of obesity or
type 2 DM), atypical nevi (noncancerous moles; people who have them are @ increased risk of developing melanoma),
piercings, signs of abuse and self-injury

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13
Q

11-14yr is classified as what stage of adolescence?

A

early

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14
Q

15-17yr is classified as what stage of adolescence?

A

middle

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15
Q

18-21yr is classified as what stage of adolescence?

A

late

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16
Q

During the physical exam of a 11-17yrs old patient, the FNP will examine/perform?

A

examine back/spine; assess breasts / SMR (females); assess gynecomastia, SMR, testicular hydrocele, hernias,
varicocele, masses (males)

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17
Q

During the physical exam of an 18-21yrs old patient, the FNP will examine/perform specific to females/males?

A

perform pelvic exam / pap smear @ 21yr (females); assess gynecomastia, SMR, testicular hydrocele, hernias,
varicocele, masses (males)

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18
Q

Beginning at the 15-yr. visit, what should the FNP begin screening for?

A

tobacco, alcohol, drug use

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19
Q

What screening should be performed once between 15-18 yr. visits?

A

hiv

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20
Q

hearing vision: when

A

5yr; 6yr; 8yr; 10 yr. visits; once @ 11-14 visit, 15-17 visit, and 18-21 yr. visit)

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21
Q

srm begins when

A

7-8

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22
Q

Signs of self-injury:

A

9-10

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23
Q

Breast inspect/testes inspect:

A

11

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24
Q

lipid inspect:

A

9-11 and 17-21

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25
Q

depression inspect

A

12

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26
Q

tobacco/drugs inspect

A

15

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27
Q

HIV inspect

A

15-18

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28
Q

PAP inspect

A

21

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29
Q

When conducting anticipatory guidance, what age do you begin addressing both the adolescents and parental
concerns simultaneously?

A

11

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30
Q

When conducting anticipatory guidance, what age do you begin addressing bullying?

A

5 years old, until 14 years old

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31
Q

When conducting anticipatory guidance, what age do you begin addressing safeguarding info from online, talk
about worries, inquire about activities most liked in school?

A

7

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32
Q

When conducting anticipatory guidance, what age do you instruct to consume milk 2-3x/day?

A

5-6

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33
Q

When conducting anticipatory guidance, what age do you instruct to consume milk 3x/day?

A

7-8

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34
Q

When conducting anticipatory guidance, what age do you discuss making and keeping friends?

A

9-10

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35
Q

When conducting anticipatory guidance, what age do you discuss making and keeping friends, inquire about what
friends like to do together, and reinforce values?

A

9-10 years old

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36
Q

When conducting anticipatory guidance, what age do you discuss weight?

A

9-10 years old

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37
Q

When conducting anticipatory guidance, what age do you discuss switching from booster seat to seat belt in back
seat of car?

A

9-10 years old

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38
Q

When conducting anticipatory guidance, what age do you discuss managing conflict non-violently?

A

11 years old, until 21 years old

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39
Q

When conducting anticipatory guidance, what age do you 1st discuss dating / sexual situations, NO means NO?

A

11 years old, until 21 years old

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40
Q

When conducting anticipatory guidance, what age do you 1st discuss spending time with family and taking
responsibility for your schoolwork?

A

11 years old, until 21 years old

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41
Q

When conducting anticipatory guidance, what age do you 1st discuss being physically active at least 60min per day?

A

11 years old, until 21 years old

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42
Q

When conducting anticipatory guidance, what age do you 1st discuss pregnancy and STI protection?

A

11

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43
Q

When conducting anticipatory guidance, what age do you 1st discuss ETOH/drugs/vaping?

A

11

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44
Q

When conducting anticipatory guidance, what age do you 1st discuss refraining from riding in car with someone
under the influence?

A

11

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45
Q

When conducting anticipatory guidance, what age do you 1st discuss refraining from texting and driving?

A

15

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46
Q

When conducting anticipatory guidance, what age do you begin addressing the adolescents concerns only?

A

18

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47
Q

When conducting anticipatory guidance, what age do you 1st discuss eating foods rich in folate and avoid
ETOH/drugs if considering pregnancy?

A

18

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48
Q

Age 5: we have the kindergartner. this boy is ready to relate to peers, brain is ___% of its adult weight, Able to
complete pencil/paper tasks better; cognitive: _________ stage (focuses on 1 variable in problem at a time);
Activities: catch a ball, skips, copies a ___, tells age, understands concept of _, knows __ from __ hand, draws
recognizable person with _ details; per the parent: can complete simple ____, little awareness of ______

A

right from left; 90%; preoperational stage; copies a cross; 8 details; complete simple chores; little awareness of
danger

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49
Q

Age 6-7: copies a __; defines words by __; knows if it’s _______ or _______ (time of day); draws a person with how many
details? __; reads several ____-syllable words; knows approx. how many words?

A

triangle; what is; morning/afternoon; 12; 1; 2560 words

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50
Q 
7-10 age range is MOST concerned with?
A: magical thinking / imaginative play
B: peers and school
C: sports & extracurricular
D: academia and school
A

B

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51
Q

Age 7: academia intensifies; becomes more _________; language: what proficiency?

A

abstract; adult

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52
Q

Age 7-8yrs: counts by ___ and ___; ties shoes; copies a _____; knows what about a calendar? draws a man with ____
details? what type of arithmetic can they complete?

A

2s and 5s; diamond; day of the week (not date/year); 16 details; adds/subtracts 1-digit #s

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53
Q

Age 8: mastered what?

A

volume

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54
Q

Age 8-9: defines words better than by use; what type of arithmetic can they perform?

A

use; borrowing/carrying in add/subtraction

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55
Q

Age 9-10: knows ___, ___, ___ (related to calendar); names what in order? makes sentences with what three words
in it? what arithmetic can they perform?

A

month, day, year; months in order; work/money/men; boy/river/ball; simple multiplication

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56
Q 
What age does rapid physical, emotional, cognitive, and social development begin?
A: 9-10
B: 12-13
C: 11-12
D: 13-14
A

C

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57
Q 
What age does rapid physical, emotional, cognitive, and social development end?
A: 17-18
B: 18-19
C: 19-20
D: 18-21
A

D

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58
Q 
What age is puberty complete by?
A: 15-16
B: 16-17
C: 16-18
D: 17-18
A

C

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59
Q

The developmental passage from childhood to adulthood includes which of the following - SELECT ALL THAT
APPLY!
A: completes puberty
B: establishes an identity while maintaining closeness with family
C: prepare career
D: develops socially and emotionally
E: moves from abstract to concrete thinking

A

A, C, D (establishes own identity and separates from family; moves from concrete to abstract thinking)

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60
Q

T or F: adolescence is typically a time in life where sickness occurs often

A

False

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61
Q

What are the 3 leading causes of MORTALITY in adolescence?

A

unintentional injury, suicide, homicide

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62
Q

What is the primary cause of unintentional injury?

A

MVA

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63
Q

T or F: mortality rates are highest in males vs. women

A

True

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64
Q

Major causes of morbidity are related to what two factors?

A

psychosocial and poverty

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65
Q

Higher risk in one area is frequently associated with?

A

problems with another

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66
Q 
An adolescent comes to your clinic for an initial visit and appears closed-off and sullen. As the FNP, you know a
cause of this could be?
A: developmental delay
B: drug use
C: feeling afraid or judged
D: depressed
A

C (your initial approach is IMPORTANT to the success of the interview process. PCP must behave simply,
honestly, without an authoritarian attitude)

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67
Q

During the interview process, the FNP recognizes who as their primary patient?

A

adolescent

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68
Q

What age do you transition from addressing the concerns of the parent first to NOW including the adolescent?

A

11-12 (visit is conducted in two parts, one with adolescent and the other with parent present)

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69
Q 
What is the FNP 1st priority during the first few minutes of the interview process?
A: assess the social history
B: ask about school and interests
C: developmental screening
D: explain the process of the interview
A

Answer: B (1st few minutes determines entire visit: ask neutral, nonpersonal questions – allows adolescent to become
comfortable)

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70
Q

What is the BEST way to successfully obtain social history info from adolescent?

A

questionnaire (most often adolescents feel more comfortable divulging this info on paper)

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71
Q

What does confidentiality NOT extend to?

A

life-threatening situations

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72
Q

At what age is it appropriate to ask adolescents whether or not they want their parents involved in their medical
visits?

A

18

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73
Q

What tool employed in a questionnaire is good to obtain a psychosocial history on the adolescent patient?

A

HEADSS assessment

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74
Q

What does HEADSS stand for?

A

home, education, employment, activities, drugs, sexuality, suicide/depression

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75
Q

T or F: 11-21yr have annual visits

A

True

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76
Q

Motivational Interviewing: What is this?

A

style that guides patients towards behavior change by helping resolve ambivalence

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77
Q

What is the hallmark of motivational learning?

A

change talk” – patient is given the opportunity to tell PCP why it’s important to change vs. telling PCP
convincing reasons why it is NOT important to make changes

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78
Q

T or F: motivational learning is an appropriate tool to employ in all situations with the adolescent

A

False (not appropriate in medical / psychiatric instability)

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79
Q

Components of motivational learning include:

A

asking permission, open-ended questions, eliciting/evoking change talk,
reflective listening, affirmations, decisional balancing, normalizing, advice/feedback, readiness to change ruler, exploring
important and confidence, summaries, statements supporting self-efficacy

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80
Q

What is NOT a good predictor of physiologic or psychosocial development?

A

chronological age

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81
Q

T or F: Teenagers weight triples in adolescence

A

False; doubles [height increases by 15-20%; major organs double in size]

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82
Q

Growth spurts happen first in what gender?

A

girls (2 years before boys)

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83
Q

What age does peak of puberty occur for girls?

A

11.5-12

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84
Q

What age does peak of puberty occur for boys?

A

13.5-14

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85
Q

Pubertal growth lasts about how many years?

A

2-4 years, continues longer in boys

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86
Q

What tool is used to categorize genital development?

A

SMR

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87
Q

SMR1 vs. SMR5?

A

SMR1 = pre-puberty; SMR5 = adult maturity

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88
Q

First measurable sign of puberty for girls?

A

height spurt

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89
Q

First conspicuous sign of puberty for girls?

A

breast buds (occurs between 8-11yr)

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90
Q

T or F: pubic hair correlates more closely with breast development than height spurt

A

False (height spurt correlates more closely with breast development than pubic hair)

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91
Q

T or F: axillary hair will show before pubic hair (occurs 1 year early)

A

False (pubic hair precedes axillary hair by 1 year)

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92
Q

First sign of puberty in boys?

A

scrotal / testicle growth

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93
Q

What age is pubertal growth competed for boys?

A

not until age 18 yr.

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94
Q

What usually appears 2 years after growth of pubic hair for boys?

A

axillary hair, deepened voice, chest hair (occurs mid-puberty)

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95
Q

In early adolescence (ages 10-13 years), what psychosocial development characteristics are present? SELECT ALL
THAT APPLY!
A: feels more comfortable with same sex
B: thinks abstractly and doesn’t think about future
C: realistic goals about future
D: rapid growth and secondary sex characteristics

A

A, D [rapid growth and secondary sex characteristics, feels more comfortable with same sex, thinks concretely
and doesn’t think about future, vague and unrealistic professional goals]

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96
Q

In middle adolescence (ages 14-16 years), what psychosocial development characteristics are present? SELECT ALL
THAT APPLY!
A: uncomfortable with their bodies
B: atypical to have mood swings
C: formal operations and abstract thinking
D: sexually active but uses contraception
E: grounded in their self-image
F: yearn for independence and autonomy

A

C, F (Becomes more comfortable with their bodies; Mood swings are typical; Formal operations and abstract
thinking. Sexually active and don’t think they need to use contraception; Self-centered at times; Different self-images. They
want to be independent and autonomous)

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97
Q

In late adolescence (ages >17years), what psychosocial development characteristics are present? SELECT ALL
THAT APPLY!
A: Less self-centered
B: Dating becomes intimate
C: Concrete thinking and plans for future
D: Period of idealism

A

A,B,D (Becomes less self-centered and cares for others. Dating becomes more intimate. By 10th grade, 40% have
had sex and by 12th grade, 62% have had sex. Abstract thinking and plan for the future. Period of idealism)

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98
Q

Regarding puberty in girls, what is the order in which each physical change begins?
A: menarche, height spurt, pubic hair, breasts
B: height spurt, pubic hair, menarche, breasts
C: pubic hair, height spurts, breasts, menarche
D: height spurt, menarche, breasts, pubic hair

A

D

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99
Q

Regarding puberty in boys and girls, what is the sexual maturity rating (SMR) based on?

A

pubic hair growth

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100
Q

Regarding puberty in boys, what is the order in which each physical change begins?
A: height spurt, testes growth, penis growth, pubic hair
B: testes growth, height spurt, penis growth, pubic hair
C: height spurt, testes growth, pubic hair, penis growth
D: penis growth, testes growth, height spurt, pubic hair

A

B

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101
Q

When performing a breast examination on a female patient, the FNP knows the correct positioning is?
A: supine with arms by her side
B: supine with the opposite arm from breast examined raised above the head
C: supine with the same arm from breast examined raised above the head
D: supine with both arms raised above the head

A

C [use finger pads to palpate breast tissue in concentric circles starting at outer borders of breast tissue along
sternum, clavicle, axilla à moving towards areola; compress areola to check for discharge; palpate supraclavicular /
infraclavicular and axillary regions for lymph nodes]

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102
Q

T or F: teaching a self-breast exam to healthy girls remains controversial

A

True (self-breast exam should be performed by those at increased risk of breast cancer [hx of malignancy,
adolescents who are at least 10yrs post-radiation therapy to chest, adolescents 18-21 yr. old whose mother carry the
BRCA1 or BRCA2 gene] and done after each menstrual period)

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103
Q

T or F: most breast masses are benign and common

A

True

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104
Q

What is the MOST COMMON breast mass found in adolescence?

A

Fibroadenoma (67%); (fibrocystic change 15%, abscess/mastitis 3%)

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105
Q

Fibroadenoma

A

Non-tender, glandular, fibrous tissue; rubbery, smooth, wellcircumscribed,
mobile mass noted to the upper/outer quadrant of
breast; slow growing; US to evaluate

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106
Q

Fibrocystic change

A

More common in adults; mild swelling and palpable nodularity in
the upper outer breast quadrants

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107
Q

abscess/mastitis

A

Caused by normal skin flora related to manipulation of periareolar
hair and nipple piercings; presents with breast pain,
erythema, and warm to touch

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108
Q

galactorrhea

A

Milky nipple discharge; typically benign; can be caused by

chronic nipple stimulation, certain psych drugs or illicit drug use

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109
Q

gynecomastia

A

Palpable fibroglandular mass located concentrically beneath the
nipple-areolar complex; can be unilateral or bilateral)

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110
Q

mastalgia

A

Breast pain that is typically cyclic; occurs just prior to

menstruation

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111
Q

papilloma tumor

A

Unilateral bloody nipple discharge; REFER

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112
Q

A patient presents to your clinic to discuss the results of the ultrasound evaluating a fibroadenoma. Results indicate
the mass measures <5cm. The FNP knows the indicated treatment for this is to?

A

monitor for growth or regression over 3-4 mo (>5cm, undiagnosed breast masses that are enlarging or have
overlying skin changes, or any suspicious mass with hx of previous malignancy à REFER!)

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113
Q 
What are some common medications associated with galactorrhea? SELECT ALL THAT APPLY!
A: valproic acid
B: amphetamines
C: depakote
D: atenolol
E: hormonal contraceptives
A

a,b,d,e

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114
Q 
What are some common medications associated with gynecomastia? SELECT ALL THAT APPLY!
A: cimetidine
B: cocaine
C: haldol
D: lorazepam
E: amiodarone
A

a,c,e

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115
Q

During adolescence, substance abuse is limited to what?

A

experimentation with tobacco and ETOH

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116
Q

Why do adolescents’ experiment with tobacco and ETOH?

A

part of establishing independence and attempt to identify with peer groups

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117
Q

The perception of danger decreases as old drugs reappear is considered what?

A

“Generational Forgetting”

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118
Q

According to Hays, what age do you begin screening for substance abuse? What tool is used?

A

> 11 years and older; CRAFFT screening tool DISCREPENCY between HAYS table 4.3 and BRIGHT
SCREENINGS INFO link- states start @ age 15 years old tobacco/alcohol/drug use

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119
Q

What is the MOST frequently abused substance beginning in middle school?

A

ETOH (more common in boys; 2/3 of adolescents consume ETOH before graduation)

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120
Q

What is the MOST commonly used illicit drug used during middle or early HS?

A

marijuana

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121
Q 
What complications can occur when adolescents use marijuana? SELECT ALL THAT APPLY!
A: bradycardia
B: elevated BP
C: bronchoconstriction
D: increases fertility
E: ADHD
F: issues with coordination / memory
A

B,E,F

(tachycardia, hypertension, bronchodilation, decrease fertility, learning problems, coordination, and
memory)

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122
Q

What three drugs have decreased in their use over the last decade?

A

LSD, meth, coke

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123
Q

What drug has increased in use RECENTLY in adolescence?

A

ectasy

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124
Q 
What complications can occur when adolescents use ecstasy? SELECT ALL THAT APPLY!
A: decline of immediate/delayed memory
B: insomnia
C: pulmonary HTN
D: increased appetite
A

A, B, C, D (decline of immediate and delayed memory, mood sleep and appetite alterations, cardiomyopathy,
pulmonary edema, and pulmonary hypertension)

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125
Q

What recreational drugs have increased in their use by adolescents?

A

OTC cough/cold meds

126
Q

What is the MOST WIDELY used prescription drug by 12th graders?

A

vicodin

127
Q

T or F: predicting progression from use to abuse in adolescence is challenging

A

true

128
Q

T or F: substance abuse is more of a personal symptom and maladjustment more than a cause of issues

A

False (substance abuse is a symptom of personal and social maladjustment as often as it is a cause)

129
Q

What is the BEST WAY to screen for substance abuse among adolescents?

A

general psychosocial assessment

130
Q

What is the GREATEST BARRIER to screening adolescents in the primary care setting for substance abuse?

A

insufficient time and lack of training

131
Q 
What are some clues to substance abuse seen in adolescents? SELECT ALL THAT APPLY?
A: delinquency
B: elevated mood
C: chronic fatigue
D: generalized physical complaints
A

A, C, D (truancy, failing grades, problems with interpersonal relationships, delinquency, depressive affect,
chronic fatigue, and unexplained physical complaints)

132
Q

T or F: family history of substance abuse does not pose an increased risk the adolescent will also abuse drugs

A

False

133
Q

T or F: psychiatric disorders are common among drug abuse in the pediatric patient

A

true

134
Q

After the FNP elicits information indicating substance abuse seems to be present, what information is pertinent to
collect next?

A

extent and circumstances of the problem (how much do you drink a day? What do you drink? How long has this
occurred?)

135
Q

T or F: The use of pharmacologic screening (urine drug tests or drug blood panel) should be reserved for situations
in which patients’ behavior and/or medical condition is of sufficient concern

A

True (AAP recommends doing so in the ED only, not routine screening; outweigh practical and ethical drawbacks
of testing)

136
Q

A screening instrument used in primary care settings to question a patient regarding their substance use is called?

A 
CAGE questionnaire (4 questions; employed after you’ve established patient is using – and want to inquire more
about how they feel about using)
137
Q

Using CAGE questionnaire, what score would indicate highly suggestive of abuse?

A

2 or more

138
Q

What co-morbidities are associated with substance abuse in adolescents?

A

ADD/ADHD, bipolar disorder, depression, anxiety disorders “B-A-A-D”

139
Q

What is a CRITICAL first step in office-based interventions when working towards treatment of substance abuse in
an adolescent?

A

assessment of the patient’s readiness for change

140
Q

What are the key elements to an effective adolescent drug treatment program?

A

family involvement, developmentally appropriate, and comprehensive approach to treatment

141
Q

What are the 5 A’s of smoking cessation?

A

ask (abut tobacco use from all pt.), advise (about quitting), assess (willingness/motivation to quit), assist (in quit
attempt), arrange (for follow-up)

142
Q

What smoking cessation treatment recommendations are specific for teens?

A

nicotine gum and patches

143
Q

What is the aim of primary prevention technique employed to prevent substance abuse – give an example?

A

prevents initiation of substance use; ex: DARE program

144
Q

What is the aim of secondary prevention technique employed to prevent substance abuse – give an example?

A

aims to prevent progression from initiation to continuance/maintenance; ex: Alateen (supports children of
alcoholic parents)

145
Q

What is the aim of tertiary prevention technique employed to prevent substance abuse – give an example?

A

targets those who are substance users; ex: identify someone who drinks at parties, and provides them with
resources for safe rides home at night

146
Q

Patient presents to the ED with nystagmus, decreased core body temp, hyporeflexia, ataxia, and nausea/vomiting.
What substance do you suspect they’ve used?

A

ETOH

147
Q

Patient presents to the ED with conjunctival injection, hypotension, sedation, hallucinations. What substance do you
suspect they’ve used?

A

marijuana

148
Q

Patient presents to the ED with respiratory depression, pulmonary edema, hypotension, and decreased body
temperature. What substance do you suspect they’ve used?

A

opioids

149
Q

Patient presents to the ED with tachycardia, HTN, elevated core body temp, hyperreflexia, tremors, seizures,
nausea/vomiting. What substance do you suspect they are withdrawing from?

A

alcohol, barbiturates, benzos

150
Q

Patient presents to the ED with sleepiness, memory loss, and begins to have a seizure. What substance do you believe
is the cause?

A

GHB

151
Q

Patient presents to the ED and appears euphoric, giddy, rhinorrhea, and hallucinating that quickly progresses to
respiratory depression. What substance do you suspect they’ve used?

A

inhalants

152
Q

Patient presents to the ED with hyper alertness, increased energy, confident, dilated pupils, and an arrythmia on the
monitor. What substance do you suspect they’ve used?

A

cocaine

153
Q

Patient presents to the ED with hallucinations, anxiety, paranoia, dilated pupils, dry mouth. What substance do you
suspect they’ve used?

A

LSD/mushrooms/nutmeg/jimson weed (hallucinogens)

154
Q

Patient presents to the ED with euphoria, hyperalert, hyperactive, fever, flushed appearance to skin, and dry mouth.
What substance do you suspect they’ve used?

A

amphetamines

155
Q

What are the two principles that must be present for anticipatory guidance?

A

age-appropriate and timely

156
Q

What two components are essential to obtaining a thorough pediatric history?

A

parents objective reporting of face and subjective interpretation of their information (in older children, obtain
their own history of events as well)

157
Q 
EMR includes which of the following? SELECT ALL THAT APPLY!
A: problem list
B: VIS sheet
C: allergies
D: immunizations
E: demographic data
A

A, C, D, E (demographic data, problem list, info about chronic medications, allergies, previous hospitalizations,
names of other physicians providing care for patient. Documentation of immunizations (inc. data required by National
Vaccine Injury Act) should be kept on second page)

158
Q

What are the 15 components encompassed in the comprehensive pediatric history?

  • MISS
  • BIRD
  • OLD
  • FAM
A

Meds (chronic)
Immunizations
Screening
Sexual/Social hx

Birth hx
Illness (Present)
Reasons for visit
Development

ROS
Problem List
Demographic data/Diet

Family hx
Allergies
Medical hx

159
Q

T or F: chaperones must be present during an adolescent pelvic exam or a stressful/painful procedure

A

true

160
Q

Vision screenings are conducted at which aged visits?

A

5, 6, 8, 10, 12, and 15 yr. visits

161
Q

Hearing screenings are conducted at which aged visits?

A

5, 6, 8, 10, 11-14yr and 18-21 yr

162
Q

What elements are included in vision screening for ages 5-21yr?

A

inspection of eye/eyelids, assessment of fixation/following, fundoscopic exam, eye chart testing (ALL ages); 5
years old also need corneal light reflex and cover testing performed – tests for strabismus

163
Q

What is the age appropriate visual acuity for a 3-5-year-old?

A

20/40

164
Q

What is the age appropriate visual acuity for a >6year-old?

A

20/30

165
Q

Any ____ line discrepancy between two eyes (even within passing range ages >6yr) should be ________!

A

2, refer

166
Q

In ages >4yr, what could be mistaken for hearing loss?

A

inattention; hearing screening should be a part of attention problems work-up

167
Q

Health supervision visits: What tools can be used to elicit information regarding development?

A

formal parent-directed screening tools ASQ or PEDS is recommended (ASQ: (ages and stages questionnaire) –
family-friendly and creates the snapshot needed to catch delays and celebrate milestones; PEDS: a surveillance and
screening tool, for children 0 to 8 years; elicits and addresses parents’ concerns about development, behavior and mental
health)

168
Q

According to Hays, for children 2-18yrs – what is the MOST appropriate way to determine obesity?

A

BMI chart

169
Q

What ages are height plotted on charts?

A

2-21

170
Q

A BMI of >95th percentile for age (must be same age / gender) indicates what?

A

obese

171
Q

A BMI between 85th-95th percentile for age (must be same age / gender) indicates what?

A

overweight

172
Q

A BMI <5th percentile for age (must be same age / gender) indicates what?

A

underweight

173
Q

A BMI >99th percentile for age (must be same age / gender) indicates what?

A

sever obesity

174
Q

According to the USPSTF, what age is recommended that clinicians screen for obesity?

A

6yr and older (refer as appropriate for comprehensive, intensive behavioral intervention to promote improvement
in weight status)

175
Q

What standard measure correlates with more accurate measures of body fatness?

A

bmi

176
Q

What is the formula for BMI?

A

weight and height (kg/m2)

177
Q

What should prompt further evaluation and possible treatment from the FNP in a pediatric patient evaluated for
obesity?

A

an upward change (crossing of them) in BMI % in any range

178
Q

What is the MOST commonly used indicator to measure size and growth patterns on children and teens in the US?

A

cdc growth charts

179
Q

What is the MOST successful way to combat obesity?

A

anticipatory guidance or early intervention in childhood (vs. delayed intervention when weight gain becomes
severe)

180
Q

A 4yr old patient presents to your clinic with a BMI-for-age of 96th percentile. What weight status category is this?
What would be included in your physical exam? What labs would you order?

A

obese; physical exam: BP, distribution of adiposity (central vs. generalized), markers of comorbidities and genetic
syndromes (Prader Willi syndrome); CONSIDER labs in patient with family hx or heart disease risk factors: fasting lipid
profile, fasting glucose and/or hgb A1C, ALT)

181
Q

An 8yr old patient presents to your clinic with a BMI-for-age of 89th percentile. When you check the chart from
previous visit, you note her BMI-for-age was 95th percentile 6 months ago. What weight status category is this
patient currently? What weight status category were they at their last visit? As the FNP, how would you proceed?

A

overweight currently, obese at previous visit; this change in weight especially given the timeframe it occurred
prompts the FNP to discuss with the patient whether they have any concerns regarding weight, and if they are trying to lose
weight. Explore the patients eating habits and discuss with the parent if you’ve noticed any changes in behavior around
mealtime or sudden increase in activity. Inspect patients back (possible bruising associated with increased sit-ups)

182
Q

A 13yr old patient presents to your clinic with a BMI-for-age of 95th percentile. You discuss the weight management
goals with this patient to determine the appropriate weight loss needed to maintain a healthy lifestyle. What would
you recommend? What does the AAP recommend regarding sedentary lifestyle modifications?

A

Lose 2lb/wk (age 12-18yr); a max of 2hr/day of TV; at least 60min per day of physical activity

183
Q

Prior to this discussion, you complete your physical exam and note this patients BP is 91%. What does this value
indicate regarding the patient? What would you do first? What things should be considered?

A

suggests pre-HTN; you must reassess BP in that visit and evaluate if patient has any risk factors

184
Q

You’ve determined the BP should be re-checked in this current visit – and decide to do so yourself. What are the
appropriate steps to take? When determining the proper cuff size for this patient you choose?

A

sit in quiet room for at least 3-5min, feet uncrossed on floor; measure in right arm for consistency (avoids false
low readings from left arm in the case of coarctation of aorta); arm at heart level supported; length should be 80-100% of
circumference of arm and width 40% à adult cuff)

185
Q

The repeat BP is 120/80. What category is this considered? Likely, the cause of the previous falsely elevated BP
reading was?

A

normal BP; white coat syndrome, improper cuff size/measurement techniques, or use of stimulants

186
Q

You’ve completed your exam and move onto discussing patients BMI. After discussing this information with the
adolescent and their parent, you determine increased resistance and unwillingness to change from both parties. How
would you proceed?

A

early intervention is IMPORTANT to decrease future co-morbidities. Due to increased resistance to make lifestyle
modifications, the FNP should consider the use of Orlistat, a lipase inhibitor approved in children >12 yr. old. You
would still provide counseling regarding weight management in addition (age 12-18yr @ 95-98% should lose 2lb/wk).
Counsel on sedentary lifestyle and electronic use recommendations. Schedule follow-up with patient in 4 weeks.

187
Q

Patient returns to your clinic for his 4-wk follow-up appointment. His BMI is re-checked and is 93%. What weight
status category is this?

A

overweight

188
Q

You inquire from the patient whether he is taking steps to actively lose weight in which he states he has increased
physical exercise and monitoring weight loss per week. From the previous BMI of 95th percentile to his current 93%
- would you instruct the patient to continue losing weight OR maintain weight?

A 
maintain weight (age 12-18yr: once you’ve reached 85 to <95% range, you can maintain weight); however, being
this patient is still considered OVERWEIGHT you would reiterate the need for continued physical activity daily (60min per
day) and healthy eating choices.
189
Q

Following the appointment, you conduct a “self-assessment” on yourself and how you handled that patient
encounter. You are comfortable with your recommendations because you are aware that this 13-yr. old male is
expected to enter what stage of growth and development?

A

puberty (growth spurt – 13.5-14yr old; with maintaining a healthy lifestyle, this issue could in fact correct itself)

190
Q 
Consequences of obesity NOW – SELECT ALL THAT APPLY!
A: elevated BP and normal lipids
B: increased insulin resistance
C: OSA
D: heartburn
E: depression
A

B, C, D, E (high BP, HLD, impaired glucose tolerance, insulin resistance, type 2 DM, breathing issues – OSA and
asthma – joint/muscle discomfort, fatty liver dx, gallstones, GERD, self-esteem issues à depression as an adulthood)

191
Q

T or F: consequences of obesity LATER include obese adults that have CVD, HTN, DM, and some cancers.

A

true

192
Q

What is the PREFERRED METHOD to obtain a patients BP?

A

auscultation

193
Q

What must you obtain in order to diagnose a patient with hypertension?

A

2 or more elevated BPs (in ADDITION to the 1st elevated BP) separated in time & >95th percentile for 2 visits) –
SO TOTAL OF 3 BPs!

194
Q

The cause of primary (essential) HTN is?

A

idiopathic (most often genetics) ** high blood pressure that doesn’t have a known secondary cause**

195
Q

Following a work-up of an adolescent patient, you’ve diagnosed this patient with stage 1 essential (primary)
hypertension. What would be the appropriate treatment regimen?

A

If no cause is identified and HTN is deemed essential antihypertensive therapy should be initiated as well as
counseling given regarding nutrition/exercise (60min/day). The 1st line medication: beta blockers or ACE inhibitors.

196
Q

The cause of secondary HTN is?

A

an underlying health condition (premature birth, LBW, congenital heart disease, renal dysfunction)

197
Q

What is the appropriate age to begin checking BP during annual visits?

A

3

198
Q

What would prompt the clinician to check a patients BP in children <3 yr. old?

A

hx of prematurity (<32 wks), congenital heart disease, recurrent UTIs, renal disease, family hx of renal disease,
organ transplant, bone marrow transplant, on meds that increase BP

199
Q

In a 4-yr. old patient with sickle cell, would you check their BP? How often?

A

children >3 yr. with underlying risk factors / obesity – BP should be checked at EVERY VISIT

200
Q

What is the leading cause of death in the US in which research has documented that the atherosclerotic process
begins in childhood?

A

CVD

201
Q

What are the risk factors for CVD?

A

genetics, diet, and physical activity

202
Q

In regard to the universal screening recommendations per Hays, what ages should lipid panel be checked?

A

9-11 yr. = universal lipid screen with non-fasting non-HDL cholesterol or fasting lipid profile; (17?)18-21 yr =
measure a non-fasting non-HDL cholesterol or fasting lipid profile in all once

203
Q

What ages (with RISK FACTORS PRESENT) would you want to conduct a fasting lipid screening?

A

2-8, and 12-16

204
Q

What is the primary intervention for a pediatric patient with HLD?

A

diet, and weight management strategies

205
Q

What constitutes severe dyslipidemia?

A

LDL > 190mg/dl (In this case, the FNP should consider pharmacological therapy)

206
Q

What LDL level warrants pharmacologic therapy when family hx of heart disease is present?

A

> 160mg/dl

207
Q

What LDL level in regard to pharmacologic therapy is DEPENDENT ON amount of risk factors present?

A

all patients @ > 130mg/dl

208
Q

T or F: all children, regardless of general health or presence of CVD risks, between 9-11 yrs. should be screened for
lipids and have repeat screening every 5 years thereafter if normal

A

true

209
Q

What is the BEST way to obtain a lipid panel?

A

venipuncture or finger stick (point of care lipid testing)

210
Q

When calculating non-HDL-C, a level >145mg/dl equates to what?

A

95th percentile and warrants follow-up

211
Q

How many fasting lipid profiles should be obtained?

A

2 with the results averaged for evaluation of the CVD risk

212
Q

What is the #1 cause of death in adolescents, ages 16-19yrs)?

A

unintentional injury with higher risk in males

213
Q

What is the primary cause of death in children, ages 12 and younger due to not wearing a seatbelt?

A

MVAs; instruct to ride in backseat; height requirements to transition from belt positioning booster to lap belt is
generally 4ft 9in between the ages of 8-12 years

214
Q

What is the primary cause of death in children < 15 years old?

A

guns

215
Q

What is the 2nd leading cause of death in ages 1-3yr?

A

drownings

216
Q

School-aged children – teens are most likely to drown in what conditions?

A

large bodies of water (swimming pools/open water)

217
Q

What is the chief cause of death from a fire?

A

smoke inhalation

218
Q

What is the most common thermal injury in kids?

A

sunburn (requires minimum of 30SPF, reapply every 2 hours when in water)

219
Q

T or F: A medical home is not a place. It is a way for children and families to receive health care from a primary
care provider they know and trust.

A

true

220
Q

hep B.

A

minimum age = birth; Unvaccinated persons should complete a 3-dose series at 0, 1-2, and 6 months

221
Q

RV

A

minimum age = 6 weeks; 5 doses 2,4,6,15-18mo and 4-6yr; 5th dose NOT NECESSARY IF 4th DOSE WAS
ADMINISTERED @ 4 years old

222
Q

TDaP

A

minimum age = 11 years old (routine vaccine); 7 years old (catch-up vaccine)
§ 11-12 yrs.: 1 dose Tdap MAY BE ADMINISTERED REGARDLESS OF THE INTERVAL SINCE LAST
TETANUS and DTAP
§ Pregnant adolescents: 1 dose during EACH pregnancy 27-36wks
§ Catch-up vaccine:
o 13-18 yr not received Tdap: 1 dose followed by Td booster every 10 years
o 7-18 years not fully immunized with DTaP: 1 dose Tdap; if additional doses are needed à Td

223
Q

HiB

A

minimum age = 6 weeks; doses must be given at least 4 weeks apart; final/booster dose = 12-15mo of age
Children over 5 years old and adults usually do not need Hib vaccine. But it may be recommended for older children
or adults with asplenia or sickle cell disease, before surgery to remove the spleen, or following a bone marrow transplant. It
may also be recommended for people 5 to 18 years old with HIV

224
Q

Pneumococcal:

A

minimum age = 6 weeks [PCV13]; 2 years [PPSV23]; if you receive 1st dose at 24 months or older – YOU
DO NOT NEED ANYMORE DOSES! Catch-up vaccine: 1 dose for healthy children aged 24-59 months with any
incomplete* PCV13 schedule (4 doses: 2, 4, 6, 12-15mo) ** The total number and timing of doses for complete PCV13
series are dictated by the age at first vaccination**; AFTER

225
Q

IPV

A

minimum age = 6 weeks; routine series à 4-dose series at ages 2, 4, 6-18 months, and 4-6 years. IPV is not routinely
recommended for U.S. residents 18 years of age and older; unimmunized patients that are traveling to country at risk of
contracting polio, working in lab handling possible polio specimens, health care worker treating polio – can receive
vaccine (1st dose anytime, 1-2 mo, 6-12 mo) Administer the final dose on or after the 4th birthday and at least 6 months
after the previous dose; All children who have received three doses of IPV before age 4 years should receive a fourth
dose at 4 to 6 years of age (before or at school entry).

226
Q

MMR

A

minimum age = 12 mo (for routine vaccine); Unvaccinated children and adolescents: 2 doses at least 4 weeks apart
[max age for use of MMRV = 12 years old)

227
Q

Hep A

A

minimum age = 12mo; age 2yr and older à minimum interval between dose is 6 months (2 dose series)

228
Q

Meningococcal vaccine (MenACWY):

A

minimum age = 2 mo [menveo] 9 mo [menactra]; 2 dose series given at 11-12yr,
booster @ 16 yr; Catch-up vaccine: Age 13-15 years: 1 dose now, booster at age 16-18 years (minimum interval 8 weeks);
Age 16-18 years: 1 dose.
§

229
Q

Meningococcal B

A 
minimum age 10 years ONLY FOR THOSE ADOLSCENTS AT RISK for
SEROGROUP B (spleen damage, sickle cell, using eculizumab, and during an outbreak); more than 1 is needed
(must be same type of vaccine for all doses); preferred vaccine ages are 16-18yr; can be given up to 23 years old
230
Q

Influenza

A

minimum age = 6 mo; Children 6 months-8 years who did not receive at least 2 doses of influenza vaccine
before July 1, 2017, should receive 2 doses separated by at least 4 weeks; Persons 9 years and older: 1 dose.
§ LAIV: not for younger than 2 yr, older than 49 yr; recommended for the 2019-2020 flu season

231
Q

HPV

A

2 doses admin at 11-12 = on time; 2 dose schedule is for 9-14yr old’s (received their 1st dose before 15th bday; with
6-12 mo between dose 1 & 2) 3 dose schedule is for 15-26yr old’s (received their 1st dose after their 15th bday or
immunocompromised; given on a 0, 1-2, 6 month schedule) * If the vaccination schedule is interrupted, vaccine doses
DO NOT NEED to be repeated (no maximum interval)*

232
Q

Drinking is assessed in which three assessments?

A

HEADDS
SBIRT
CAGE

233
Q

“Talk. They Hear You”: campaign

A

aims to reduce underage drinking and substance abuse use among youths
underage of 21 – info to help parents address ETOH / drug use with their kids early.

234
Q

Testicular CA screening at what age

A

15-34

Dont have routinely screen d/t low incidence and favorable outcomes

235
Q

Scoliosis

A

Develops at 8-10

NOT painful

236
Q

Adams forward bend test

A

is more specific to curvatures that are
<30degrees (TEST DOES NOT QUANTIFY THE ACTUAL
DEGREES)
§ Stand facing away from PCP
§ Bend at waist (90degrees), feet 10cm apart and parallel,
knees straight, head down
§ Palms facing each other, arms hanging down & relaxed

237
Q

SCOLIOMETER:

A

greater than 10 degrees à COBB ANGLE

MEASUREMENT: required for official diagnosis of scoliosis

238
Q

According to the USPSTF clinical guidelines, who does it recommend we screen for intimate partner violence?

A

women of childbearing age (GRADE B)

239
Q

The warning signs for intimate partner violence include which of the following – SELECT ALL THAT APPLY!
A: argue with partner when instructed to do something
B: report what they are doing to partner
C: wear long sleeves during winter
D: discuss the partners angry outbursts with friends

A

B, D

240
Q

According to the ACOG clinical guidelines, who does it recommend we screen for intimate partner violence?

A

non-pregnant women @ routine OBGYN visits, family planning and preconception visits; pregnant women @
various times over course of pregnancy (1st prenatal visit, at least once per trimester, postpartum check-up)

241
Q

At the beginning of the intimate violence assessment, what should be offered to the female to waylay fears of being
targeted?

A 
framing statement (shows that screening is done universally and not because IPV is suspected, ensures patient is
aware of confidentiality of discussion, and exactly what state law mandates that a PCP must disclose)
242
Q

What are the two most important components to ensure IPV screening is done correctly?

A

ensure staff receives training about IPV and training should be offered regularly

243
Q

What are the screening tools for IPV?

A

RADAR tool and HITS tool (AAS Tool)

244
Q

What is the purpose of utilizing the RADAR tool in practice?

A

summarizes key action steps the physicians should take in recognizing and treating patients
affected by IPV (steps include the following: (1) Routinely screen adult patients, (2) Ask direct questions,
(3) Document your findings, (4) Assess patient safety, and (5) Review options and referrals.

245
Q

What is the purpose of utilizing the HITS tool in practice?

A

HURT INSULT THREATEN SCREAM
Answer: screens for IPV (During the HITS assessment: a provider asks a patient the following: How often does your
partner physically Hurt you, Insult or talk down to you, Threaten you with harm, and Scream or curse at you? Each
category is graded on a scale of 1 (never) to 5 (frequently) and a sum of all the categories is generated. A total score of >
10 is suggestive of IPV)

246
Q

What is the purpose of utilizing the AAS tool in practice?

A

IPV screening tool in the pregnant population (five-question screen that involves the following open-ended
questions)

247
Q

According to the CDC, how should the provider obtain a sexual history from an adolescent?

A

utilize the 5 P’s framework (Sexual Health Assessment (It is helpful to ask the adolescent directly what behaviors
are practiced “What types of sexual experiences have you had?” rather than, “Are you sexually active?” because this can
be interpreted in different ways. For example, the CDC suggests the 5 P’s framework for a provider to obtain a sexual
history)

248
Q

Ask about partners

A

a. Do you have sex with men, women, or both?”
b. In the past 2 months, how many partners have you had sex with?”
c. In the past 12 months, how many partners have you had sex with?”
d. Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were
still in a sexual relationship with you?”

249
Q

Ask about prevention of pregnancy and STD

A

What are you doing to prevent pregnancy?”

What do you do to protect yourself from STDs and HIV?”

250
Q

What age do you begin screening for STDs with a pap smear?

A 
begin @ 21 years for both sexually experienced/inexperienced women à screen for cervical cx w/cytology every
3 years (ages 21-65yr)
251
Q

What is the STD associated with almost all cervical cancers?

A

HPV

252
Q

What can the FNP do to decrease an adolescent’s apprehension to their 1st pelvic exam

A

provide sensitive counseling and age-appropriate education (purpose of the examination, pelvic anatomy, and the
components of the examination); conduct exam in an unhurried manner; use diagrams and models to facilitate discussion;
time should be allotted for the adolescent to ask questions

253
Q

T or F: the FNP should have another female staff chaperone should be present with male examiner

A

True

254
Q

Regarding the positioning of the patient during a pelvic exam, the appropriate placement is?

A

dorsal lithotomy position AFTER equipment / supplies are ready

255
Q

What should the FNP inspect 1st during the exam?

A

external genitalia [note: SMR, estrogenization of the vaginal mucosa (moist, pink, and more elastic mucosa), shape
of the hymen, size of the clitoris (2–5 mm wide is normal), unusual rashes or lesions on the vulva (folliculitis from shaving,
warts or other skin lesions, and genital piercing or body art)

256
Q

In cases of alleged sexual abuse or assault, what should the FNP note during the exam?

A

presence of any lesions, lacerations, bruises, scarring, or synechiae about the hymen, vulva, or anus

257
Q

What should the FNP inspect 2nd during the exam?

A

prepare patient for insertion of the speculum

258
Q

How should the speculum be inserted into the patient’s vagina?

A

posteriorly with a downward direction to avoid the urethra

259
Q

Prior to the speculum exam of a virginal female, what should the FNP do?

A

one-finger exam of vagina – helps FNP identify the position of cervix/prepare patient for what’s to come

260
Q

What can the FNP do to make the insertion of the speculum more comfortable for the patient?

A

warm the speculum with tap water prior to insertion

261
Q

When going to insert the speculum, what can the FNP do simultaneously to help distract attention from the
placement of the speculum?

A

touch the inner aspect of the patient’s thigh or apply gentle pressure to the perineum (away from the introitus)
while inserting the speculum

262
Q

When performing the speculum exam, what should the FNP inspect?

A

vaginal walls and cervix (anatomical abnormalities, inflammation, and lesions; quantity and quality of discharge
adherent to the vaginal walls and pooled in the vagina)

263
Q

What is commonly observed in adolescents as erythema surrounding the cervical os?

A

presence of a cervical ectropion

264
Q

What are the correct order specimens should be obtained?

A
  1. vaginal pH, 2. saline and 3. KOH wet preparations, 4. cervical cytology (Pap) screening if indicated, and 5.
    endocervical swabs for gonorrhea and Chlamydia
265
Q

What should be conducted following the removal of the speculum?

A

conduct a bimanual examination

266
Q

To conduct a bimanual examination on a patient, how should this be performed?

A

using one or two fingers in the vagina with the other hand placed on the abdomen

267
Q

The bimanual examination of the patient allows the FNP to palate what?

A

uterus and adnexa for size, position, and tenderness

268
Q

How can the FNP aid in STD prevention?

A

Risk assessment & education, pre-exposure vaccines, ID asymptomatic pts & pts with symptoms, effective
diagnosis treatment counseling & follow-up, eval treatment and follow-up with sex partners

269
Q

What is the most common/highest BACTERIAL STD in the US among adolescent and young women?

A

Chlamydia / Gonorrhea

270
Q

What are the risk factors related to chlamydia / gonorrhea?

A

early age at sexual debut; lack of condom use; multiple partners; prior STI; hx of STI in a partner; sex with partner
who is 3 yr. or older

271
Q

What risk factors specific to adolescents increase their risk for contracting an STI?

A

smoking, ETOH use, dropping out of school, pregnancy, and depression

272
Q

Which age group/gender is ESPECIALLY PRE-DISPOSED to chlamydia, gonorrhea, and HPV infection?

A

adolescent female

273
Q

What is the GYN disorder commonly requires hospitalization and is most common in teen girls?

A

PID

274
Q

Epididymitis is most commonly seen caused by what bacteria in males?

A

C trachmomatis and N gonorrhea

275
Q

Proctitis, procolitis, enteritis is more common among which persons?

A

those who participate in anal intercourse

276
Q

Those who have multiple sex partners have this STD.

A

BV

277
Q

Bacterial vaginosis increases the risk for?

A

STD

278
Q

50% of women in the U.S. are infected with this STD.

A

Trich

279
Q

The STD with the highest incidence occurring between 16-30yr.

A

Vulvovaginal candidiasis

280
Q

What risk factors are associated with vulvovaginal candidiasis?

A

antibiotic use, DM, pregnancy, HIV

281
Q

Vulvovaginal candidiasis is caused by what bacteria?

A

C. albicans

282
Q

What is the most common STD cause of visible genital warts?

A

herpes simplex

283
Q

HSV-1 is often established in children via oral route by what age?

A

5

284
Q

T or F: HSV-1 and HSV-2 cause STIs

A

true

285
Q

The predominant cause of genital infection in teen-young adults is what STD?

A

HSV1

286
Q

Syphilis occurs predominantly in _______?

A

gay men

287
Q

New cases of primary/secondary syphilis are highest among which aged males?

A

15-19

288
Q

The overall highest rate of syphilis in men occurs during which age group?

A

20-24

289
Q

Sexually active adolescents and young adults ages 15-24 yrs. of age (females <25yr) are infected with this STD?

A

HPV

290
Q

22% of new HIV infects young and young adults ages _________ in the U.S.

A

13-24

291
Q

What is the highest-risk group to contract HIV?

A

Gay men

292
Q

An adolescent patient presents to the ED with complaints of vaginal discharge and abdominal pain. Does the FNP
need to obtain parental consent prior to evaluating/treating patient?

A

NO

293
Q

What is the FIRST THING the FNP can do to aid in reduction of STI risk behavior PRIOR TO onset of sexual
experimentation?

A

1st à help youth personalize their risk for STIs and encourage positive behaviors that minimize the risks (then
enhance communication skills with sexual partners about STI prevention, abstinence, and condom use)

294
Q

What is an example of primary prevention regarding STIs?

A

focuses on education and risk-reduction techniques (address sexuality routinely as part of well-checkups; discuss
STIs prevalence – make it real for them; make condoms available and discuss other forms)

295
Q

What is an example of secondary prevention regarding STIs?
requires identification and treatment of STIs before infected individuals transmit to others (MUST BE
CONFIDENTIAL; annual screening of all sexually active females <25 yr. for chlamydia/gonorrhea; pap smear 1st done at
21 years then every 3 years; HPV typing not recommended before age 30)

A

requires identification and treatment of STIs before infected individuals transmit to others (MUST BE
CONFIDENTIAL; annual screening of all sexually active females <25 yr. for chlamydia/gonorrhea; pap smear 1st done at
21 years then every 3 years; HPV typing not recommended before age 30)

296
Q

What is an example of tertiary prevention regarding STIs?

A

directed towards complications of specific illness

297
Q

What can you do to reduce the risk of acquiring preventable STDs?

A

administer preexposure vaccines (hep B, hep A, HPV)

298
Q

T or F: depression in children increases with age with highest in adolescents

A

true

299
Q

T or F: the rate of depression in females approaches adult levels by age 18 yr

A

False- 15

300
Q

T or F: no increases in incidence are seen when family hx of depression is present

A

False

301
Q

What are the characteristics that define MDD?

A

several depressive symptoms cluster together over time, are persistent 2 weeks or more, and cause impairment

302
Q

Depressive symptoms of lesser severity but persist over 1 year or more – this is considered?

A

dysrhythmic disorder

303
Q

Mild depression symptoms of short duration due to recent stressful life event is considered?

A

adjustment disorder with depressed mood

304
Q

What are the risk factors for depression?

A

: chronic medical illness, stress, pain; family hx; FEMALE; low income, self-esteem, support; prior depression;
single/divorced/widow; TBI; YOUNGER AGE

305
Q

According to the AAP, what is the recommendation for depression screening age?

A

12

306
Q

What screening tools are used to evaluate for depression in adolescents?

A 
CESD-R
CDI
Beck depression inventory 
RADS-2
PHQ-9
307
Q

What screening tool used to evaluate for depression in adolescents is used in the primary care setting?

A

PHQ-9

308
Q

What screening tool used to evaluate for depression in adolescents is specific to depression or dysthymic disorder?

A

CDI

309
Q

What screening tool used to evaluate for depression in adolescents is used for individual practice or schools?

A

RADS-2

310
Q

The PHQ-2 differs from the PHQ-9 in what way?

PHQ-2 result

A

PHQ-2 may rule out but not definitively diagnose depression whereas PHQ-9 is the most common instrument
used for depression screening; the PHQ-9 is administered to confirm a positive

571 (3 decks)

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