Primary Healthcare Exam 2 PDF

**Exam 2 -- Primary Healthcare I** **Pediatrics** 1. **Be able to provide examples of primary, secondary and tertiary prevention.** - Primary care: Prevention. Immunizations, education, nutrition, exercise, weight control. - Secondary Care: Referral to specialist. Screening CA, DM2,...

**Exam 2 -- Primary Healthcare I** **Pediatrics** 1. **Be able to provide examples of primary, secondary and tertiary prevention.** - Primary care: Prevention. Immunizations, education, nutrition, exercise, weight control. - Secondary Care: Referral to specialist. Screening CA, DM2, HTN, - Tertiary Care: Treatment to prevent further sequelae of mult diseases. 2. Recognize when common pediatric immunizations are given such as hep B, Tdap -CDC schedule 3. Know the Tanner stages of development -- puberty typically occurs during Tanner Stg III 4. **Common pediatric milestones** Bright Futures -Pocket Guide 5. **Lead poisoning in children** High Prevalence area or Medicaid. **Women's Health** 6. **Common sexually transmitted diseases and treatment do you treat the partner** **Disease** **Treatment**- Do you treat the partner? --------------- ------------------------------------------ Gonorrhea Chlamydia Herpes Syphilis Genital warts Trichomonas 7. Understand the **menstrual cycle** when -luteinizing hormone and follicle-stimulating hormone peaks, and when ovulation occurs, when would a patient experience premenstrual syndrome 8. **Define primary and secondary amenorrhea** [Primary] type begins with adolescents that attain ambulatory cycles, no pelvic pathology [Secondary] type is due to pelvic pathology or a recognized medical condition such as endometriosis. 9. **Be knowledgeable about iron deficiency anemia, common iron supplement doses** Anemia caused by low iron intake, inefficient iron absorption in the gastrointestinal tract, or\ chronic blood loss. Iron deficiency anemia (IDA) is characterized by decreased or absent iron\ stores, low serum iron concentration, low transferrin saturation, and low hemoglobin\ concentration or hematocrit value. The erythrocytes are hypochromic and microcytic and the iron\ binding capacity is increased. This type of anemia is most commonly associated with chronic\ blood loss. Adults need about 180 mg of elemental iron daily during anemic states.\ Children need about 3 mg/kg/day during anemic states. **Patient Education About Iron Replacement**\ For greatest absorption, take 1-2 hours before meals on empty\ stomach\ Take with meals if GI upset occurs; this decreases iron absorption Do not take concomitantly with antacids, tetracycline, dairy products\ Bowel movements will be dark in color\ Iron is highly toxic; keep out of children's reach\ Place iron drops in back of mouth to reduce staining of teeth in infants\ and young children\ Administration of iron with vitamin C enhances absorption\ Food may reduce absorption of iron by 50% 10. **Contraception-what can be given during breastfeeding, during smoking and postpartum** Minipill -- **progesterone only** 11. **What is a common side effect of progestin-based** **Depo-Provera injection** - Irregular or no periods - Bone thinning - Weight gain - Delayed ovulation - Injection site reactions(tenderness) - Depression 12. **Understand how to read a pap report-ASCUS, LSIL, etc, what are high risk strains for HPV** ASCUS LSIL High-risk HPV 16, 18, 31, 33, & 42 13. **Polycystic Ovarian Syndrome -- what is the pathology of this?** Too much androgen causing hirsutism - [Hirsutism]: - Excess terminal body hair. - Male distribution: [Upper lip, Chin,] Periareolar Linea alba - [Acne vulgaris] - Male-pattern [alopecia] - Early adrenarche (development of pubic hair, apocrine glands, and sebaceous glands) - [Menstrual cycle irregularities] - [Oligomenorrhea](cycle length \> 35 days) - [Amenorrhea](cycles absent)In addition to infrequent [menses], individuals often have other types of [abnormal uterine bleeding]([AUB]) when they do bleed, which may include: - [Heavy menstrual bleeding] ([HMB]) - Prolonged menstrual bleeding (\> 8 days) - Intermenstrual bleeding - Symptoms present for 3--6 months or 3 cycle lengths due to chronic [anovulation] 14. **How would you counsel your lactating mother with regarding nutrition** Increase vegetables, fruits, whole grains, and dairy Decrease added sugars, saturated fat, and sodium Achieve adequate dietary levels of the nutrients- calcium, vitamin D, potassium, and dietary fiber. Folate, iodine, and choline: dark green vegetables and beans, peas, and lentils, dairy products, eggs, seafood, eggs, meats Supplements: Continue pre-natal vitamins 15. **Osteoporosis -- when to order a DEXA scan; what is recommended for calcium and vitamin D supplementation** Osteopenia is precursor for osteoporosis. Women over 65 or under with one or more risk factors should be screened with DEXA scan. 16. **How to diagnosis a rectocele and cystocele** Rectocele: A condition where weakened tissues in the pelvis cause the rectum to sag onto the vaginal wall. Pelvic exam Cystocele: Anterior vaginal exam. Pelvic exam. May cause UTIs. Pessary if surgery is not recommended. 17. **What symptoms are prevalent for primary, secondary, and tertiary syphilis?** +-----------------------------------+-----------------------------------+ | Primary | Chancre\* = primary lesions | | | | | | Painless local infection | +===================================+===================================+ | Secondary | 2-12 weeks after initial | | | infection | | | | | | Fever headaches swelling, rash | | | | | | Full body involvement = | | | hepatitis, nephrosis, etc.. | +-----------------------------------+-----------------------------------+ | Latent | Period between secondary and | | | tertiary | | | | | | Can be less than or more than a | | | year | +-----------------------------------+-----------------------------------+ | Tertiary | Occurs 1-30 years after | | | | | | Can lead to Neurosyphilis \> | | | meningitis | | | | | | Cardiosyphillis, etc\... | +-----------------------------------+-----------------------------------+ **Unit 3 (Wk 3 & 4) Pediatric** **Developmental management and milestones of infants, children, and adolescents** -Bright Futures-Pocket Guide- [Bright Futures Milestones and Anticipatory Guidance.pdf (aap.org)](https://publications.aap.org/DocumentLibrary/Solutions/Toolkits/BFTK-IR/Bright%20Futures%20Milestones%20and%20Anticipatory%20Guidance.pdf)   **Developmental Stages for Children**  **Developmental Stages for Children and Adolescents**  **Tanner staging** **Females:** Prepubertal -- Tanner 1 Pubic hair -- villus hair only Breasts -- Elevation of papilla only Adrenarche and ovarian growth 8-11.5 years -- Tanner 2 Pubic hair -- sparse along the labia Breasts -- Buds are palpable -- first sign of puberty in females, areole are enlarged. Clitoral enlargement, labial pigmentation, growth of uterus 11.5-13 years -- Tanner 3 ([Puberty]) Pubic Hair -- coarse and curly Breast tissue -- grows with no contour or separation Axillary hair, acne 12-15 -- Tanner 4 Pubic Hair -- adult hair that doesn't spread to thigh Breasts -- enlargement and areole form secondary mound on breast Menarche and development of menses Over 15 years old -- Tanner 5 Pubic hair -- adult hair reaching the thigh Breasts -- adult breast contours present, only papilla is raised Adult genitalia **Males:** Prepubertal -- Tanner 1 Pubic Hair -- villus only Genitalia -- testes \ Over 15 -- Tanner 5 Pubic hair -- adult including thigh Genitalia -- testes over 4.5cm, adult sized genitals Facial hair, increase in muscle mass **Screening guidelines** Universal: Hearing. Newborn: Bilirubin, blood, critical congenital disease. Selective: BO, Vision **Screening tools and diagnostics** Hearing Blood USG **Sports physical -- (**Dunphy, 2023. pg 1406**;** Hollier, pg 1045**)** Marfan Syndrome: genetic disorder that changes the proteins that help make healthy connective tissue. Prevention-focused healthcare encounter to screen for conditions that may predispose a person to injury risk. [Components]: Health history, ROS, Physical Assessment, Health Promotion Education. Z02.5 - Encounter for examination for participation in sport **Autism** (Hollier, 703) Neurodevelopmental disorder characterized by persistent social communication deficits and restricted or repetitive patterns of behaviors, interest or activities. Autism Spectrum Disorder (ASD) is present is early developmental period and causes varying degrees of functional impairment. People with ASD express a broad range of intelligence, from intellectually disable to gifted. Etiology most likely multi-factorial: Neurodiversity, brain development, genetic and epigenetic. \- 4x more common in boys than girls. Girls frequently underdiagnosed. Clinician must specify severity based on degree of social communication impairment/severity. Level 1- Requiring support Level 2 -- Requiring substantial support Level 3 -- Requiring very substantial support Screening 18-24mo; if concerns referral to pediatric neurodevelopmental specialist. The goal of ASD treatment is maximize independence, functioning and quality of life. **Family Theory** Definition? **Mental health** Depression Screening **Genetic Screening in Pregnancy** Trisomy 21 -Down Syndrome Autosomal **trisomy of chromosome 21** - - - **Dysmorphic features** - - **Most common issues for those affected with Down\'s Syndrome** - - - - - **Annual childhood wellness exams** Social Behavioral Developmental Milestones **Newborn screenings** Screening: Bilirubin, blood, critical congenital disease  **Newborn Assessment:** **Immunizations --**CDC; Hollier pg 121-123 **Anticipatory guidance** The first priority is to attend to the concerns of the parent. Injury prevention, Violence prevention, nutritional counseling and Fostering Optimal development. **Overweight & obesity** With approximately 17% of children being obese, many strategies for obesity prevention have been proposed [Drinking juice should be avoided] before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities. **Eating disorders** **Anorexia nervosa** is defined by the [restriction of nutrient intake relative to requirements,] which leads to significantly low body weight. Patients with this eating disorder will have a [fear of gaining weigh]t along and a [distorted body image] with the i[nability to comprehend the seriousness of their condition]. **Bulimia nervosa** is a condition that occurs most commonly in adolescent females, characterized by indulgence in [binge-eating], and inappropriate compensatory behaviors(Self-induced vomiting, Extreme physical activity, Fasting, Laxatives/Diuretic abuse) to prevent weight gain. **Sexuality** Substance use ↓ ability to experience pleasure. ↑ Risk of risky sexual behavior. **Addiction- Substance Use Disorder (**Dunphy, 2023. pg 1209) Risk Factors: Fam Hx of SUD, Fam rejection of sexual orientation, Hx Childhood sexual abuse, low school connectedness, peers with Hx delinquent behavior. CDC. By 12^th^ Grade 1/3 Adolescents have tried ETHO ½ Marijuana 20% Rx- opioids **Infant, children, and adolescent injuries** Injuries remain the leading cause of death among children, - Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). - Infants should not be left alone on any high surface, and stairs should be secured by gates. Infant walkers should be discouraged because they provide no benefit and increase falls downstairs, even if stair gates are installed. - Children should never be unsupervised around cars, driveways, and streets. - Young children should wear bicycle helmets while riding tricycles or bicycles. - Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. - Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. - Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. - Window locks, screens, or limited-opening windows decrease injury and death from falling. - Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. - Young children should be closely always supervised. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. Long strings and cords can strangle children. - Firearms should be kept unloaded and locked.