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89 Cards in this Set
- Front
- Back
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what is recommended for preventative health visits for adolescence?
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every year 5-21 years
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when do kids need check ups according to public schools
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entrance to preschool and kindergarden up to age 6
entrence in 6th grade entrance into 9th grade new transfer to IL school sports physicals |
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what should you focus on during the subjective part of the visit?
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history
child behavior checklist, filled out by parent GAPS, filled out by adolescent, use bright futures screen for anemia, lead |
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what pneumonic should you use for psychological history for adolescents?
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HEEADSSS
home education employment eating activities drugs sexuality suicide/derpession safety |
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what should you focus on during object assessment of the adolescent?
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vs
plot ht/wt bmi head to toe, have parent out of room tanner staging |
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which immunizations are of focus for adolescence?
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TDAP
meningococcal HPV |
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when is Tdap due? what age?
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11-12
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how often should people get Td once they have a Tdap?
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q10 years through adulthood
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when do you get your first dose of MCV
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11-12
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when do you get the booster dose of MCV?
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16
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if a patient wants the MCV vaccine and is more than 16, how should the schedule go?
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1 vaccine, no booster
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which HPV vaccines are for males? which for females?
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HPV4 for males and females
HPV2 for females only |
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how much weight do children gain per year until puberty? height?
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7lb/yr
2.5 in/year |
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what happens to body fat in girls in early adolescence? boys?
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girls, increase (for menarche)
boys, decreases, muscle mass increases |
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describe the physical development of the adolescent girl
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enlarged ovaries
thelarche, breasts 6 months later, adrenarche, pubic hair growth spurt in height menarche |
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what is the average age for menarche
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between 10.5-14.5
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how long does it take for girls to have regular periods?
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18-24 months
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describe the physical development of the adolescent male
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testicular enlargement
6 months later, adrenarche, pubic hair spermarche, age 13.5-14.5 penile growth growth spurt in height, voice changes axillary, facial, body hair |
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if your male patient has secondary sex characteristics but not enlarged testicles, what substance would you consider is the cause?
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anabolic steroid use
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when is too early for puberty? boys? girls?
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9 in boys
8 in girls |
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what is precocious puberty?
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puberty too early
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when is puberty considered delayed?
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no signs of sexual maturity in boys of 14 years and girls of 13 years
also no period by age 16 |
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which ethnic group of girls develop fast?
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african american girls
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what are the two types of precocious puberty? which is more common
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central and peripheral
central is more common |
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what is central percoscious puberty?
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physiologically normal puberty development before 8 years old
follows normal pubertal pattern, other than onset |
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what hormone is central precocious puberty dependent on?
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GnRH
^GnRh=^gonadotropin=^ovarian estrogen production and eventual ovulation |
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how can I remember which type of precocious puberty is which?
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central=central nervous system=brain=hypothalamus
periphreal=outside CNS=gonads |
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central precocious puberty is more common in _______?
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girls
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what is th emost common cause for central precocious puberty?
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CNS tumor
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what is peripheral precocious puberty
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too early puberty
can have some/all physical changes of puberty GnRH independent due to inappropriate sex hormone secretion or exposure to exogenous sex hormones |
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describe periphreal precocious puberty and the levels of FSH, LH, and estrogen
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LH/FSH levels are low while estrogen is high
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what are some causes of peripheral precocious puberty?
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cysts/ovarian tumors
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what are some history findings of kids with precocious puberty?
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breast
pubic hair genital enlargement acne body odor oily scalp all before they should <8 years |
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what are some PE findings of a child with precocious puberty?
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tall, change in height velocity
cafe au lair spots hirtuism hypothyroidism hyperadrenalism masses in abdomen do neuro exam |
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who do you refer precocious puberty patient to?
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pediatric endo
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what tests could you expect a peds endo to run on kid with precocious puberty?
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bone age X-ray
FSH/LH CT/MRI, tumor? pelvic ultrasound, mass? testicular ultrasound, mass? |
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children with _______ precocious puberty appear shooter and younger compared to their peers.
what are some social risks of this? |
central
adults may expect less out of them |
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children with _________ precocious puberty are taller and look older than their peers.
what are some social consequences of this? |
periphreal
parents and teachers may expect TOO MUCH from them |
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talk about the risk of sexual abuse and precocious puberty?
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kids are at higher risk since they are physically more mature
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when is a kid dx with delayed pubertry
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fail to begin puberty >2.5 SD above the mean of puberty onset
girls 13 boys 14 absence of menarche 16 or w/in 5 years of first s/s puberty |
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what are the first normal pubertal events in kids?
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testicular enlargement
breast budding |
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what test to run when delayed puberty?
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FSH/LH
elevated means primary, in ovary or testical low or normal, suspect hypothal/pit |
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what systems do you review when working up a delayed puberty kid`
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chronic dz s/s
neurologic s/s, vision/smell head trauma |
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what medical history do you want to focus on when working up a delayed puberty kid
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birth history, congenital anomaly
surgies chemotherapy |
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what social history do you want to focus on when working up a delayed puberty kid
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excessive exercise
anoxrexia bulemia substace abuse |
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what PE areas would you focus on for a kid with delayed puberty
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growth measurements, usually shorter, may be obese, or cachexic
sexual maturity ratings |
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genital measurements for boy with delayed puberty for dx
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greater than or equal to 2.5cm testicals
penis less than 4cm |
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what ROS to check with kids who delayed puberty
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thyroid
neuro, smell, vision, hearing, optic discs cognitive development, behavior physical characteristics of turner, klinefelter, prader-willi, dallmans |
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routine labs for delayed puberty kids
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cbc
esr tsh cortisol LH/FSH |
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in kids, BMI is age and gender non specific/specific?
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specific
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when do you start screening for BMI/obesity?
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age 2
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is BMI diagnostic for obesity/underwegight in children?
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no, need more investigation.
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what if a mom comes to the office and asks about her two kids who have the same BMI but one is obese and the other is not?
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it varies based on age and sex. so numbers will have different meanings.
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BMI cutoffss?
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>95 overweight
85-95 risk for overweight <50 underweight |
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what are some principles to assessing bp in kids
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measure bp at every visit
use correct size start at 3 years of age diagnosis is made with percentiles |
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what are diagnostics for adolescent bps
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<90th normal
>90 repeat at same visit 90-95th prehypertension >95th may have htn, repeat at 2 additional visits compare SBP and DBP by age and height with charts |
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how do you manage htn in kids?
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about the same as adults
the effects of htn on kids same as adults health body weight eat healthy no smoke work out 20 mins >3 days a week limit alcohol and drugs htn rx same as adult lifestyle adjustment first! |
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when do you screen for cholesterol in kids
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2-18 based on risk factors
2 6, 8, 10, 11 12-18 annually |
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what are risk factors for high cholesterol in kids
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parents with TC >240
family hx of premature CVD <55 smoking, htn, obesity, sedentary |
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what is acceptable cholesterol levels for kids
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TC <170
LDL <110 |
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cholesterol cutpoints
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acceptable, <75th, TC <170, LDL < 110
borderline, 75-95, 170-199, 110-129 elevated, >95th, >200, >130 |
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how young can you give statins?
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8yrs
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what are pravastatin doses for 8-13yr? 14-18?
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20mg/po/qd
40mg/po/qd |
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children with obese families, what kind of milk?
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after 1yr, low fat
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dx for metabolic syndrom?
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waist circumferences
lipid levels blood pressure BGL |
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when do you do DM screening?
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at each physical exam for those:
overweight, >85th BMI first/2nd degree relatives, american indian, AfrA, hispanics, asians signs of insulin resistance, htn, dyslipid, acanthus nigaricans, PCOS |
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what is the recommended nutritional intake for school aged kids
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5 fruit/ veg
2 hours less tv time 1 hour physical activity 0 sugary drinks 3-4 servings of fat free milk |
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what are the recommendations for school aged kids physical activity?
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60 mins each day
limit screen time to 1-2hrs |
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talk about lead poisoning screening
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required for children 6 or younger prior to admission to school
low risk area: no screen high risk area: screen ages 3-6, previous levels < 10, do risk assessment questionnaire |
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what are risk factors that would indicated lead screening after 6 years old?
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food utensils lead based
buildings before 1950 and 1978 sibling/freind w/ lead poisoning stained glass, pottery, auto repair active smelting plant, battery recycling plant ingestion of foreign body |
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talk about H/H screening
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not recommended during school aged children
recommended for -hx iron defic anemia -once for menstruating girls -annual if risk factors for adolescent females 11-21 |
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what are risk factors for females 11-21 that would indicated annual monitoring of HH
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moderate/heavy menses
chronic weight loss nutritional deficit athelte |
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what are high risk tb countries?
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Latin America
Caribbean Africa Asia Eastern Europe Russia |
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what are other risk factors for tb
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homeless
migrant farms medically underserved low income minority high prevalence immigration exposure xray/clinical findings |
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when do you screen for scoliosis
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begin at age 10
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which tanner age is scoliosis most likely found?
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2-3
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recommended calcium for 13-18?
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1,300mg/day
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who is most at risk for low calcium
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female athlete triad
eating disorder, amenorrhea, bone loss running, gymnastics, figure skating, ballet |
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name some calcium rich foods.. besides milk!
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yogurt
caclicum fortified OJ cheese pudding tofu broccoli |
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when should you do a PE for athletes?
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6 weeks before
before each sport |
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talk about privacy
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abuse, suicidal, homicidal thoughts require breaking of confidentiality.
otherwise, confidential. |
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what is HEEADSSS
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home
education eating activities drugs suicide safety sex |
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work up for obese adolescent at risk for DM
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fasting BGL
chol panel with LFT TSH stress team sports 5 fruits/veg each day 1,300mg calcium each day |
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when do paps start? how often
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21
q2yrs until 29 |
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talk about testicular exam
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stress self exam
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how to screen for literacy and learning probs?
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simple add/subtract problems as well as 2-3 line sentences
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who to screen for sickle/thalassemia
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af am
sout east asain med symptomatic menstruating girls |
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how to screen for sickle/thalamsemia?
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cbc
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what to check on muskulosckeltal exam
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scoliosis
osgood-schlatter slipped capital femoral epiphysis leg length in toeing |
