1
Q
Routine Immunizations
At Birth
A
2 B’s
Birth
hep B
2
Q
Routine Immunizations
Age 2 months
A
2B DR HIP
hep B DTap Rotavirus HiB Inactivated Polio Pneumococcal
3
Q
Routine Immunizations
Age 4 months
A
4 DR HIP
DTap Rotavirus HiB Inactivated Polio Pneumococcal
4
Q
Routine Immunizations
Age 6 months
A
B DR HIP in 6 months
hep B DTaP Rotavirus HiB Inactivated Polio Pneumococcal
Flu shot
5
Q
Routine Immunizations
Age 12-18 months
A
1 MAD HPV
MMR hep A DTaP HiB Pneumococcal Varicella
6
Q
Routine Immunizations
Age 4-6 years
A
Very DIM at 4-6
Varicella
DTaP
Inactivated Polio
MMR
7
Q
Active Immunity
A
- Usually Permanent
- Naturally acquired through exposure or through immunizations
- Onset is 2-4 weeks
- Duration is years to lifetime
8
Q
Passive Immunity
A
- Short-term immunity
- Passage of antibodies from mother to fetus during pregnancy
- Onset within 24 hours and duration is 4-6 months
9
Q
Community Immunity
AKA Herd Immunity
A
- Obtained through indirect protection of those around them
- 90-95% of population needs to be vaccinated in order to have Herd immunity
10
Q
Universal Screenings
Newborn
A
- Hearing
- Bilirubin
- Blood: PKU, congenital hypothyroidism, sickle cell
- Congenital Heart Disease
11
Q
Universal Screenings
Age 3-5 days
A
- Hearing (if not done already)
- Blood (verify results of previous tests)
12
Q
Universal Screenings
Age 1 month
A
- Hearing (if not done yet)
- Blood (verify results and make referrals if necessary)
- Maternal depression
13
Q
Universal Screenings
Age 2 months
A
- Hearing
- Blood (follow-up if needed from birth blood tests)
- Maternal Depression
14
Q
Universal Screenings
Age 4 months
A
- Maternal Depression
15
Q
Universal Screenings
Age 6 months
A
- Oral Health (apply fluoride varnish on first tooth eruption)
- Maternal Depression
16
Q
Universal Screenings
Age 9 months
A
- Developmental Screen
- Oral Health (apply fluoride varnish on first tooth eruption)
17
Q
Universal Screenings
Age 1 year
A
- Anemia (Hct & HgB)
- Lead Blood Test (high prevalence area or medicaid)
- Oral Health (should have dental home by this time)
18
Q
Universal Screenings
Age 15 months
A
- Oral health (encourage to have dental home, apply fluoride varnish on first tooth eruption and every 6 months)
19
Q
Universal Screenings
Age 18 months
A
- ASD screening
- Developmental screen
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
20
Q
Universal Screenings
Age 2 years
A
- ASD screening
- Lead Blood Test (high prevalence area or medicaid)
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
21
Q
Universal Screenings
Age 2 1/2 years
A
- Developmental Screen
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
22
Q
Universal Screenings
Age 3 years
A
- Vision (using HOTV or LEA symbols)
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
23
Q
Universal Screenings
Age 4 years
A
- Hearing (audiometry)
- Oral Health (apply fluoride varnish on first tooth eruption and every 6 months)
- Vision (using HOTV or LEA symbols)
24
Q
Contraindications to give vaccines
Allergies
A
Allergic to eggs, yeast, gelatin
25
Contraindication to giving rotavirus vaccine
If child has intussusception or gastroenteritis
26
What vaccine should not be given if child has allergy to yeast?
- Hep B (think B for bread)
27
Vaccines contraindicated during pregnancy?
- MMR
- IPV
- Varicella
- Hep A
28
Immunizations routinely offered to patients over 65 years old?
- Tdap
- Influenza
- Pneumococcal
29
If a patient has an allergy to neomycin, which vaccine should they not receive?
- Measles (MMR)
30
At what age should a healthy individual receive the Tdap booster?
65
31
Which of all childhood vaccines has most adverse effects?
Pertussis
32
Labs monitored for neonatal hypothyroid screen
TSH and T4
33
What test can confirm sickle cell disease?
Hemoglobin electrophoresis
34
What immunizations should be given for children who are positive for sickle cell?
- PCV
| - Polysaccharide
35
Most common initial symptom of sickle cell occurring in up to 50% of children before age 3
- Hand-foot syndrome (dactylitis)
36
What two vaccines, when given together, increase chance for febrile seizures?
- MMR
| - Varicella
37
Most common route of Hep A transmission
- Contaminated food/water
38
What is ankyloglossia?
- Tongue tie, when attachment is closer to tip of tongue that restricts movement
39
What lead blood level is abnormal?
Above 5
40
What lead blood level indicates chelation needed?
Greater than 45
41
What lead blood level is urgent?
Above 70 is URGENT
42
If a child is taking more than __mg per day of corticosteroids, they should not be given a live vaccine.
20mg/day for 14 days
43
When is it okay for a child with cancer to have a live vaccine?
- Remission
| - 90 days past chemo
44
Which immunizations are live viruses?
- MMR
- MMRV
- Varicella
- Rotavirus
- Yellow Fever
45
Can live virus immunizations be given together?
Yes, but if you have to give them at different times it must be 4 weeks apart
46
Middle childhood
7-10 years old
47
Early childhood
5-7 years old
48
What universal screenings for 5-6 year old?
- Hearing
- Vision
- Ocular motility
- Malocclusion
- Fine/Gross motor skills
- Gait
49
What causes acanthosis nigricans?
- Obesity
| - Type 2 DM
50
What screening should begin at age 12?
Depression
51
What age do you begin screening for tobacco, alcohol, and drug use?
15 years old
52
HIV screening age
Performed once between 15-18 years old
53
Hearing/Vision Screening done at which visits?
- 5 yr, 6 yr, 8 yr, 10 yr visits
| - Once between 11-14, 15-17, and 18-21
54
Screening for self injury begins at what age?
9-10 years old
55
Breast/Testicle exams begin at what age?
11 years old
56
Lipid screening at what age?
- 9-11 years old
| - 17-21 years old
57
Initial pap smear done at what age?
21
58
At age 5, the brain is at __% of it's adult weight.
90%
59
Age 6 milestones
- Recognizes numbers, letters, words
- Learns to write
- Beginning of concrete operations
- Magical thinking diminishes
60
Age 6 1/2 milestone
Mastered length (6 1/2 is a number you see on a ruler)
61
Age 7-10 is most concerned with...
Peers and school
62
Age 7 milestones
- Academia intensifies
- Becomes more abstract
- Language at adult proficiency
63
Age 8 milestone
Mastered volume
64
What age does rapid physical, emotional, cognitive, and social development begin?
11-12 years old
65
What age does rapid physical, emotional, cognitive, and social development end?
18-21 years old
66
What age is puberty complete by?
16-18 years old
67
What is included to pass from childhood to adulthood?
- Completed puberty
- Prepare for a career
- Developed socially and emotionally
68
3 leading causes of mortality in adolescence
- Unintentional injury
- Suicide
- Homicide
69
What age do you begin addressing the patient first, rather than the parent?
11-12 years old
70
FNP 1st priority during initial interview with adolescent?
- Ask about interests and school
71
What does a HEADSS tool help with?
Obtaining a psychosocial history from an adolescent
72
What does HEADSS stand for?
- Home
- Education/Employment
- Activities
- Drugs
- Sexuality
- Suicide/Depression
73
T/F: Teenager weight triples during adolescence?
False - doubles
74
Growth spurts happen earlier for girls or boys?
Girls
75
Peak age for puberty in girls?
11 1/2 - 12 years old
76
Peak age for puberty in boys?
13 1/2 - 14 years old
77
Tool used to categorize genital development?
SMR (sexual maturity rating)
78
SMR1 vs SMR5
- SMR1 is pre-puberty
| - SMR5 is adult maturity
79
T/F: Axillary hair will begin before pubic hair.
False - pubic hair begins about 1 year before axillary
80
Psychosocial development characteristics present in 10-13 year olds?
- Feels more comfortable with same sex
| - Rapid growth and secondary sex characteristics
81
Psychosocial development characteristics present in 14-16 year olds?
- Formal operations and abstract thinking
| - Yearn for independence and autonomy
82
Psychosocial development characteristics present in >17 year olds?
- Less self-centered
- Dating becomes more intimate
- Period of idealism
83
Order for puberty in girls
- Height spurt
- Menarche
- Breasts
- Pubic hair
84
Order for puberty in boys
- Testicular growth
- Height spurt
- Penis growth
- Pubic hair
85
Most widely used illicit drug during HS?
Marijuana
86
Complications associated with marijuana
- Elevated B/P
- ADHD
- Coordination/memory issues
87
What drug has recently increased?
Ecstasy
88
Complications of ecstasy
- Delayed memory
- Insomnia
- Pulmonary HTN
- Increased appetite
89
Most widely used prescription drug by 12th graders?
Vicodin
90
Some clues that you may see in adolescents that abuse drugs/ETOH
- Delinquincy (truancy, failing grades)
- Chronic fatigue
- Generalized physical complaints
91
What disorders are commonly linked with substance abuse?
Psychiatric disorders
92
What tool used for screening for substance abuse?
CAGE questionnaire - 4 questions
93
What CAGE score indicates the patient abuses substances?
2 or above
94
Co-morbidities associated with substance abuse in adolescents?
- BAAD
- Bipolar disorder
- ADD/ADHD
- Anxiety disorders
- Depression
95
Components of a comprehensive pediatric history
| MISS
- Meds (chronic)
- Immunizations
- Screening
- Sexual/social hx
96
Components of a comprehensive pediatric history
| BIRD
- Birth hx
- Illness (present)
- Reason for visit
- Development
97
Components of a comprehensive pediatric history
| OLD
- rOs (review of systems)
- problem List
- Demographic data/Diet
98
Components of a comprehensive pediatric history
| FAM
- Family hx
- Allergies
- Medical hx
99
Appropriate visual acuity for a 3-5 year old
20/40
100
Appropriate visual acuity for a >6 year old
20/30
101
Most appropriate way to assess for obesity in ages 2-18 years?
BMI chart
102
BMI >__% for age/gender is considered obese
95%
103
BMI >__% for age/gender is considered overweight
85-95%
104
BMI
5%
105
BMI >__% for age/gender is considered severe obesity
99%
106
According to USPSTF, what age should FNP screen for obesity?
6 years old or older
107
Requirement to diagnose HTN
- 2 or more elevated B/Ps separated in time
| - >95th percentile for 2 visits
108
1st line medications for essential (primary) HTN
- Beta blockers or ACE inhibitors
109
Appropriate age to begin checking B/P during annual visits
3 years old
110
Leading cause of death in US (process begins often in childhood)
Cardiovascular disease
111
Risk factors for CVD
- Genetics
- Diet
- Physical activity
112
First lipid panel screening (without risk factors)
9-11 years old
113
What age would you check fasting lipid panel in a patient with CVD risk factors
2-8 years old and 12-16 years old
114
What constitutes severe dyslipidemia
LDL >190mg/dl
115
What LDL level, with family hx of CVD, warrants pharmacologic intervention?
>160mg/dl
116
What LDL level is dependent on risk factors present to determine pharmacologic intervention?
>130mg/dl
117
What measurement is necessary to diagnose scoliosis?
COBB Angle Measurement
118
Most common cancer for males age 15-34
Testicular cancer
119
Most common type of cancer in the world
Skin cancer
120
Assessing for skin cancer
| ABCDE
- Asymmetry
- Border
- Color
- Diameter
- Evolving
121
Prevention of skin cancer
- Stay out of sun 10am-4pm
- Minimum SPF 30 sunscreen, reapply every 2 hours
- Hats, sunglasses, long-sleeves
122
Who should be screened for IPV?
Women of childbearing age
123
Screening tool for IPV
```
HITS tool (hurt, insult, threaten, scream)
- each graded on scale 1-5, anything >10 is suggestive of IPV
```
124
How to obtain a sexual history from adolescent
| 5 Ps
- Partners (number, men/women)
- Prevention of pregnancy (what are they doing)
- Protection from STIs
- Practices (type of sex)
- Past hx of STIs
125
When to begin and how often screen for STIs with a pap smear?
- 21 years old
| - Screen every 3 years until age 65
126
STI associated with almost all cervical cancers?
HPV
127
Most common bacterial STIs in adolescent and young women?
Chlamydia/Gonorrhea
128
Mild depression symptoms, short duration, specific stressor causing depressed mood
Adjustment disorder
129
MDD characteristics
- Several depressive symptoms clustered over time
- Persistent for 2 weeks or more
- Cause impairment
130
Rate of depression highest in females at what age?
15 years old
131
Screening tool used in primary care to eval for depression
PHQ-9
132
Dental screening in adults, how often
Every 6 months
133
ETOH Misuse Screening tool
AUDIT tool
134
AUDIT Tool
- Quantify ETOH consumption
- Dependency
- Related problems
135
Vision Screenings
| in 20s and 30s
Only once each
136
Vision Screenings
| age 40
Baseline Exam
| NOTE: Pre-DM or DM require YEARLY exam
137
Vision Screenings
| Over 65 years old
Comprehensive exam yearly
138
ASCVD Screening
| What age to begin screening?
Age 20
139
ASCVD Screening
| Ages 20-39
- Measure risk factors every 4-5 years (tobacco, dyslipidemia, fam hx of ASCVD, HTN, T2DM)
- Estimates 10 year risk
140
Blood Glucose testing
- Begin age 45
| - Normal test, recheck every 3 years
141
Colorectal Cancer screening
- Begin age 45-75
- FOBT yearly
- Flexible sigmoidoscopy q5 years
- OR Colonoscopy q10 years
- Screen until age 85
142
Breast Cancer Screening
- Begin at age 40
| - Screen annually until age 54, then q2 years >55 years old
143
Prostate Cancer Screening
- Begin at age 50
| - Test using DRE or PSA blood test
144
Testicular exam
- Begin at age 15
145
Osteoporosis Screening
- Begin at age 65
- BMD = osteoporosis risk score (T-score)
- FRAX tool = 10 year risk of fracture
146
Cervical Cancer Screening
- Begin at age 25-65 and test q3 years
| - If over 65 years and all normal screening, no more screening needed
CMN 571 Final
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