Stony Brook Medicine
Stony Brook Children’s Pediatric Primary Care Clinic CurriculumHealth Supervision IISeptember 2015Some quiz questions developed by Joseph Lopreiato MD, MPH and Jennifer Hepps MD of the National Capital Consortium Pediatric Residency Program Bethesda, MD, adapted for use by Susan Walker, MDAll other materials developed by Susan Walker, MDGoal:? Become familiar with the AAP's recommendations for preventive pediatric health careObjectives:1. Understand and apply the AAP guidelines for screening for and evaluation of iron deficiency anemia2. Understand and apply the AAP recommendations and NYS DOH requirements for lead screening and for evaluation and treatment of a child with elevated blood lead level3. Understand and apply the AAP recommendations for hypertension and dyslipidemia screening?ABP Content Specifications covered in this session:Iron deficiency1. Identify non-hematologic effects of iron deficiency2. Understand the etiology of iron deficiency3. Recognize the clinical findings associated with iron deficiency in patients ofvarious ages4. Plan the appropriate diagnostic evaluation of iron deficiency5. Plan the appropriate management of iron deficiencyLeadUnderstand the importance of a screening examination for lead during early periodic screening evaluationsRecognize the multiple sources of exposure to leadUnderstand the outcomes associated with lead poisoningPlan appropriate management of an increased blood lead concentrationCholesterol, lipidsUnderstand the importance of cholesterol/lipid screening examinationsRecognize the clinical features associated with hypercholesterolemia/hyperlipidemia, and evaluate appropriatelyKnow the risk factors associated with hypercholesterolemia/hyperlipidemiaKnow the risk factors associated with coronary artery diseaseUnderstand the recommendations of the National Cholesterol Education Program for ChildrenBlood pressureUnderstand when to screen for an increased blood pressure and how to interpret the resultsUnderstand the appropriate technique, including appropriate cuff size, for measuring blood pressurePre-session required reading:1. Clinical Report- Diagnosis and Prevention of Iron Deficiency and Iron Deficiency Anemia in Infants and Young Children (0-3 Years of Age). (attached to this email)2. New York State DOH recommendations for lead screening: . Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics 2011;128;S213. (attached to this email) Focus on Table 3, the highlighted sections, and the algorithms for BP and lipid evaluation4. "Recommendations for Pediatric Preventative Health Care” Bright Futures/American Academy of Pediatrics. (attached to this email)Quiz:1. For each blood test, list the AAP recommendations for risk assessment and actual testing:a. H/H:b. Pb:c. Lipids:d. Blood Pressure:2. What are the causes of iron deficiency in infants ages 0-3?3. You screen a 12mo and obtain the CBC below. He was recently weaned from breast milk to whole milk, and mother reports that he takes 32-40oz per day. Lead screening was normal. What is your working diagnosis? What additional testing do you want, if any? What interventions, if any, will you make today?WBC 10.3RBC 4.85Hemoglobin 9.6 (L)Hematocrit 29.0 (L)MCV 69.0 (L)MCH 19.9 (L)MCHC 33.1RDW 25.0 (H)Platelets 730 (H)MPV 7.34. A 12 month old child has a blood lead level of 12 μg/dL. What do you do next?5. A mother asks about cholesterol screening for her 18 month old and 5 year old boys after their 38 year old father undergoes a coronary catheterization for angina. What do you tell her and what screening and follow-up will you order?What are the risk factors for which testing a lipid profile younger than the age of 10 is recommended? (see table 9-5)6. You perform lipid testing on a 13 year old patient with BMI >98th percentile. He has no other CV risk factors or family history. You obtain the following results (average of two tests):LDL 157TG 120HDL 47What do you recommend?7. You are seeing a 15 year old athlete in your office for his annual well visit. You note his BP: 130/80. His height and weight are at the 75th percentile for age. How do you proceed? ................
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