Young Adult

Question 1

Developmental

• A young adult’s mental health is dependent on the ability to enter a ______. This relationship may be defined as a commitment to another person, c____, or c_____ effort.
• Erickson’s: ______ vs. _______
• Problem: _____, Self-_______

Answer 1

• relationship, person, cause, creative effort
• Intimacy vs. Isolation
• Isolation, Self-absorption

Question 2

History

• Past _____ History
• D _
• As____
• An____
• M _ _
• Hypo/hyper_____

Answer 2

• medical
• DM
• Asthma
• Anemia
• MVP
• thyroidism

Question 3

PMH

• De_______
• Past M_____ Syndrome
• U _ _
• Her____
• S_ _/ P _ _
• H _ _
• Acc_______

Answer 3

• Depression
• Menstrual
• UTI
• Hernia
• STI/PID (pelvic inflammatory disease)
• HIV
• Accidents
• Recurrent UTIs in men is a RED FLAG!*
• Hernias in young adults are dt pressure from obesity, weightligters (should be concerned if they are NON-reducable)*
• Recurrent accidents: always falling? lots of bruises-potential for violence?*

Question 4

PMH continued

• If female ask about: G_____ P____ SAB, TAB
• Ps______ History
• ______ Abuse - ETOH, IVDU, Nasal
• _________ Coverage?

Answer 4

• Gravida, Para, Spontaneous, Elective abortion
• Psychiatric
• Substance
• Insurance
• Be aware of commonly used drugs and slang in the community you work in - Xanax (stix), fentanyl lollipops, IVDU skin popping*
• REmember most young adults are covered up until 26*

Question 5

Medication History*

• Vitamins
  
  • AAFP, USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.43-0.8mg (400-800 ug) of ____ _____*
• H______ Supplements
• _ _ _ Meds
• I_______ history
• ____ control/___ sex practices

Answer 5

• Folic Acid
• Herbal
• OTC
• Immunization
• Birth/safe sex practices

Question 6

Family History

• Elevated ______
• D_____
• H_____
• P______ Disease
• G_____ Abnormalities
• Ps_____ Disorders

Answer 6

• Cholesterol
• Diabetes
• HTN
• Pulmonary
• Genetic
• Psychiatrc (depression, schiz)

FAP: Familial adeno-polyposis - if they have ths genetic anomaly - have to screen early with colonoscopies

Question 7

Social History

• S______
• D____ use
• A____ use
• S_____ Activity - How do you obtain sexual history
• S_____ system
• Ed_____
• W____ History
• H______

Answer 7

• Smoking
• Drug
• Alcohol
• Sexual
• Support
• Education
• Work
• Housing

Question 8

STI Screening Gender

What website to find

Answer 8

UTD-2020 uptodate.com

Question 9

Women STI

Answer 9

• gets updated every year
• who and when should we be screening for STDs
• <25 yo = increased risk means multiple partners, previous STI

Question 10

Men STI

Answer 10

• If your in practice taking care of an HIV positive pt, look at updated guidelines bc they have diff recommendations
  
  • Screening is expensive so just keep in mind that not everyone in this age group can afford it
  • Advocate for them to get screening

Question 11

Chlamydia and Gonorrhea USPSTF

• Sexually Active Women
  
  • The UPPSTF recommends screening for chlamydia and gonorrhea in sexually active women ___ years and younger and in older women who are at increased ____ for infection
• Sexually Active Men
  
  • The USPSTF concludes that the current evidence is ______ to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men
  • Screen for (5) if at increased risk
  • Targeted screening venues for chlamydia include ______ clinics, ___ clinics, and _______ facilities

Answer 11

• Women
  
  • 24, risk
• Men
  
  • insufficient
  • Chlamydia, Gonorrhea, Syphilis, HBV, HCV
  • adolescent, STI, correctional

For men- we only really screen when they have increased risk

Question 12

Health Maintenance-GYN/GU

• The AAFP recommends screening for chlamydia and gonorrhea in sexually active women ___ years and younger and in older whomen who are at _____ ____ for infection
• The AAFP concludes that the current evidence is ______ to assess the balance and harms of screening for chlamydia and gonorrhea in ___

Answer 12

• 24 years, increased risk
• insufficient for men
• Gonorrhea and chlamydia screen is by cervical swab*
• For men theres urine tests but there is a swab through the urethra which is painful/complications*

Question 13

Cervical Cancer

• Women aged ___ - ___years
• The USPSTF recommends screening for cervical cancer every ___ years with cervical _____ alone in women aged __-__ years
• For women ___-___, the USPSTF recommends screening every ___ years with cervical ______ alone, every __ years with high-risk human _______ (hrHPV) testing alone, or every ___ years testing with ____

Answer 13

• 21-65
• 3y, cytology, 21-29
• 30-65, 3y cytology, 5y high risk human papillomavirus, or 5y both (cotesting)
• ​Cervical cytology means liquid pap smear - cells from endo and ecto cervix ar obtained and submerged in formula and sent to lab*
• Every 3 years for NORMAL WOMEN/previous normal pap smears*

Question 14

Syphilis

• What adults do you screen, what adolescents do you screen?
• THe USPSTF recommends screening for syphilis in persons who are?

Answer 14

• Asymptomatic, nonpregnant adults, Adolescents at increased risk
• Increased risk persons (multiple partners)
• Syphilis screening is a blood test based on a number: 1 = negative, higher the number-higher the risk*
• untreated syphilis can cause neurosyphilis, damages nervou system*
• We screen all pregnant women*

Question 15

HIV AAFP 2019

• Population: Adolescents and adults aged __ - __ yrs and ______ persons
• Risk Assessment: What are some risk factors? - in which case all ppl should be screened regardless of age when at increased risk
• Screening Tests (2)
• Screening intervals =
• Tx and Interventions =

Answer 15

• 15-65, pregnant
• male-male, IV drug, no condom use, transactional sex, STIs, those who requests tests
• Antigen/antibody immunoasay that detects both HIV-1 and HIV2 antibodies and the HIV1 p24 antigen/ supplemental testing with reactive asssay to differentiate btwn HIV1 and 2
• insufficient evidence to determine time interval
• No cure or vaccine

Question 16

USPSTF-PrEP

What is PrEP?

Who do we give it to?

Answer 16

Pre-exposure prophylaxis with antiretroviral therapy to persons at high risk for HIV

Question 17

Breast

• Mammogram Screening when?
• SBE =

Answer 17

• Risk Factors -We don’t really do mammograms for those under 40
• Self Breast Exam –Awareness of breast health and familiarity with one’s own body is typically promoted intead of self-exam

But we educate about being aware of body and self checking (even tho not officially recognized anymore)

Question 18

CKD

• The AAFP concludes =
• Common tests considered for CKD screening include _____-derived estimates of _ _ _ and urine testing for ______

Answer 18

• Insufficient evidence for routine screening
• creatinine, GFR, albumin
• We are seeing an increase in CKD bc of increased DM/HTN -> in this case we routinely screen more often (is not technically recommended but may be appropriate now)*
• Increased risk with taking lots of meds ie motrin*

Question 19

BMI

AAFP Recommendation =

• Intensive, multicomponent behavioral interventions include behavioral _____ activities (__ - __ sessions in the first year) such as setting ____ loss goals, improving ___/nutrition and increasing physical ____, addressing barriers to ____, self-______, and strategizing how to maintain ______ changes.

Answer 19

Reccomends screening all adults for obesity, BMI > 30 should be refered to intensive, multicomponent behaviorhal interventions

• 12-26, weight loss, diet, physical activity, barriers to change, monitoring, lifestyle

Question 20

Obesity

• BMI calculators (2)
  
  • http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/index.htm
• Adults
  
  • Underweight =
  • Normal =
  • Overweight =
  • Obese =

Answer 20

• Adults, Childs and Teens
• Adults
  
  • <18.5
  • 18.5-24.9
  • 25-29.9
  • > 30

Question 21

Thyroid Screening

AAFP Recommendations:

Answer 21

Insufficient evidence for screening in nonpregnant, asymptomatic adults

• But usually is a part of blood work or prenatal panel (T4)*
• Not recommended and not every plan covers it, often need to inke with a reason like obesity or past hx of palpitations*

Question 22

Thyroid USPSTF

Recommendations =

Answer 22

Insufficient evidence to balance benefits and harms of screening in nonpregnant, asymptomatic adults

Question 23

Calcium Recommendations 2020

1. 0-6m* M/F =
2. 7-12m* M/F =
3. 1-3y M/F =
4. 4-8y M/F =
5. 9-13y M/F =
6. 14-18y M/F, Pregnant/Lactating =
7. 19-50y M/F, Pregnant/Lactating =
8. 51-70y M/F =
9. 71+y M/F =

Answer 23

1. 200mg
2. 260mg
3. 700mg
4. 1,000mg
5. 1300mg
6. 1300mg
7. 1,000mg
8. 1,000mg, 1,200mg
9. 1200mg

Encourage through nutritional intake rather than supplementation as much as possible

Question 24

Vitamin D Screening

AAFP Recommendations

Answer 24

Current evident is insufficient to assess balance of benefits and harms of screening for Vitamin D Deficiency.

Not officially recommended but we do it alot anyways, especially with COVID, low D seems to be at higher risk or more sick

Question 25

Vitamin D and Calcium Recommendation for Supplementation ## Footnote * The AAFP concludes that the current evidence is ______ to assess the balance of the benefits and harm of _____ Vit D and calcium supplementation for the primary ______ of _____ in ______ women or in men. * AAFP concludes that the current evidence is _____ to assess balance of the benefits andharms of daily supplementation of \> ____ IU of Vitamin D3 and _____ mg of Ca for the primary prevention of _____ in noninstitutionalized _______ women.

Answer 25

* insufficient, combined, prevention, fractures, **premenopausal** * insufficient, 400, 1,000, fractures, **postmenopausal** * Not recommended above 2,000/day* * A lot of Americans are VD deficient bc we work indoors*

Question 26

Vitamin D and Calcium Screening ## Footnote Consider screening patients who report a current or past medical history of the following * Chronic musculoskeletal ____ including f\_\_\_\_\_\_ * Osteo\_\_\_\_\_ * Rh\_\_\_\_\_ \_\_\_\_\_\_ * Mal\_\_\_\_\_\_ syndromes * Ob\_\_\_\_\_, M\_\_\_\_\_ syndromes, and Type II \_\_\_\_\_\_ * Cardio\_\_\_\_\_\_\_ disease * Chronic K\_\_\_\_\_ disease and \_\_\_\_\_\_\_\_\_thyroidism * Dep\_\_\_\_\_\_ * High risk population such as elderly (over ____ yrs of age) and \_\_\_\_-skinned individuals * Chronic use of cortico\_\_\_\_\_ * P\_\_\_\_\_/S\_\_\_\_\_ hx of inadequate sun exposure (working indoors, homebound, living in higher latitude, wearing excessive clothing, dark skin and use of sun block) insufficient dietary intake of vit D fortified foods

Answer 26

* pain, fibromyalgia * porosis * Rheumatoid arthritis * Malabsorption * Obesity, Metabolic, Diabetes * Cardiovascular * CKD, Hyperparathyroidism * Depression * \>71, dark * steroids * Personal/Social

Question 27

Recommendations for the diagnosis and management of Vitamin D deficiency in adults ## Footnote * _____ exam including general \_\_\_\_\_, ____ signs, h\_\_\_ and w\_\_\_\_, general s\_\_\_\_ assessment, skin \_\_\_\_\_, and assessment for ___ pain\*\* may provide the examiner with clues to possible vit D deficiency * Diagnostic tests indicated (1) * In adults, vit D _deficiency_ is defined as a serum 25-hydroxyvitamin D lvl of \< ____ ng/mL (50 nmol per L), and _insufficiency_ is defined as lvl of \_\_-\_\_ ng/mL (50-75 nmol/L)

Answer 27

* Physical, appearance, VS, height and weight, skin, color, BONE PAIN\*\* * Serum 25-hydroxyvitamin D (25OHD) concentrations * \<20 ng/mL, 20-30ng/mL * Don't need to memorize this- just know that this may be indicated even tho not recommended (the test is a serum 25)* * Supplementation depends on lvl, can have high dose for 3 wks and taper, chronic low dose, etc*

Question 28

7 Warning Signs of Cancer ## Footnote * Change in b\_\_\_\_ or bl\_\_\_\_\_ * A sore that doesn't \_\_\_\_ * Unusual bl\_\_\_\_\_ or dis\_\_\_\_ * Thickening or ___ in breast or elsewhere * In\_\_\_\_\_ or difficulty in sw\_\_\_\_\_ * Obvious change in a w\_\_\_ or m\_\_\_\_\_ * Nagging c\_\_\_\_ or \_\_\_\_ness

Answer 28

* bowel, bladder * heal * bleeding, discharge * lump * Indigestion, swallowing * wart, mole * cough, hoarseness

Question 29

Cervical Cancer RIsk Factors ## Footnote * Sexual _____ before age \_\_ * More than __ sexual ____ in a lifetime * Intercourse with a _____ who has had multiple partners * Sm\_\_\_\_\_ or hx of * _ \_ _ ....6, 11, 16, 18 viruses with increase risk * Intercourse with ___ who has _ \_ \_ * REVIEW HPV V\_\_\_\_\_\_\_ * Age \_\_-\_\_, ____ vaccines\* * Age \_\_-\_\_, do you give the vaccines?

Answer 29

* intercourse, \<20 * 2, partners * male * Smoking * HPV * male with HPV * Vaccine * 9-26, three * 27-45, SHARED DECISION MAKING ## Footnote * Still v prevalent, and usually metastatic by the time its diagnosed* * HPV vaccine\*\*! encourage to stop smoking* * KNOW not just 9-26, 27-45 w shared decision making*

Question 30

HPV Vaccine ## Footnote * ____ Vaccines are very effective against HPV types (2), which cause most cervical cancers. So both vaccines prevent cervical cancer and precancer in women. * Only ___ of the vaccines (\_\_\_\_\_\_) also protects against HPV types (2). These HPV types cause most genital ___ in females and males.

Answer 30

* Both, 16 and 18 * one (Gardasil), 6 and 11, warts ## Footnote *2 vaccines - diff names and diff vaccines all the time, don't get fixated on name, what you should know - give the vaccine with the most coverage!*

Question 31

Skin Cancer ## Footnote AAFP Recommendations for 1. Age 10-24 2. Age \> 24

Answer 31

1. RECOMMENDS 10-24yo with fair skin about minimizing exposure to ultraviolet radiation 2. Current evidence insuficient to assess balance of benefits and harms of counseling adults older than 24 about minizing risks to prevent skin cancer ## Footnote *Again, insufficient evidence, but regardless we still COUNSEL OFTEN esp with increased riks (sun tanning often, tanning beds, etc)*

Question 32

Sunscreen ## Footnote * The American Academy of Dermatology recommends that, regardless of skin type, a \_\_\_\_-spectrum (protects againts ___ and ___ rays) - ____ resistant sunscreen with SPF at least ___ should be used year round. * In addition, ppl need to limit UV exposure by seeking \_\_\_\_, wearing protective \_\_\_\_\_\_, h\_\_\_ and sun\_\_\_\_, and avoiding _____ beds.

Answer 32

* broad, UVA and UVB, water, 30 * shade, clothing, hats, sunglasses, avoid tanning beds

Question 33

Signs and Symptoms of Drug Abuse ## Footnote * ____ to work frequently * Increased a\_\_\_\_teeism * Increased ______ for short periods * F\_\_\_\_\_ productivity, poorer _____ of work, disorganized th\_\_\_\_\_, missed \_\_\_\_lines * F\_\_\_\_fulness, failure to follow \_\_\_\_\_ * P\_\_\_\_\_\_\_ changes, sl\_\_\_\_\_ on the job * Chronic _____ nose * _____ proneness * What is the number you can call - Community Resources

Answer 33

* Late * absenteeism * productivity * Falling, quality, thinking, deadlines * Forgetfulness, instructions * Personality, sleeping * runny nose * Accident * 1-800-LIFENET

Question 34

Alcohol Screening ## Footnote AAFP recommendations

Answer 34

Recommends that clnicians screen adults aged _\>_ 18 for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. ## Footnote *However, we do screen younger if they have risk*

Question 35

IPV Screening ## Footnote AAFP Recommendations

Answer 35

Recommends that clinicians screen women of childbearing age for intimate partner violence (IPV), such as domestic violence, and provide or refer women who screen positive to intervention services. This recommendation applies to women who do not have signs or symptoms of abuse.

Question 36

IPV ## Footnote Risk Factors * Social \_\_\_\_\_\_ * Women with increased \_\_\_lessness, g\_\_\_\_, is\_\_\_\_\_ and low \_\_\_-\_\_\_\_ * _____ abuse in the home * F\_\_\_\_\_\_ stressors * Violence against ____ partners * Violence against ____ sex partners

Answer 36

* isolation * helplessness, guild, isolation, self-esteem * Substance * Financial * male * same sex

Question 37

Intimate Partner Violence ## Footnote Definition * **Intimate partner violence is a p\_\_\_\_\_ of ass\_\_\_\_\_ and c\_\_\_\_\_ behaviors that may** include inflicted physical injury, ps\_\_\_\_\_\_ abuse, s\_\_\_\_ assault, progressive social \_\_\_\_\_, sta\_\_\_\_, dep\_\_\_\_\_, int\_\_\_\_\_ and threats. * These behaviors are perpetrated by someon who is, was, or wishes to be involved in an _____ or d\_\_\_\_\_ relationship with an adult or adolescent, and are aimed at establishing _____ by one partner over the other.

Answer 37

* **pattern, assault, coercive,** psychological, sexual, isolation, stalking, deprivation, intimidation * intimate, dating, control

Question 38

IPV Screening Tests ## Footnote * Several screening instruments can be used to screen women for IPV in the past year, such as? * USPSTF recommendation for screening tools?

Answer 38

* Humiliation, Afraid, Rape, Kick (HARK) * Hurt/Insult/Threaten/Scream (HITS) * Extended Hurt/Insutl/Threatens/Scream (E-HITS) * Partner Violence Screen (PVS) * Women Abuse Screening Tool (WAST) * No valid, reliable screening tool in the primary care setting to identify abuse of older or vulnerable adults without recognized S/S of abuse. * Don't focus on this, theres so many tools, just know we do it in every practice/ EPIC has its own tool*

Question 39

Domestic Violence-AAFP ## Footnote * Watch for ________ between injury pattern and patient's story: notice behavioral clues such as _______ to speak in front of partner. * Be prepared with non\_\_\_\_\_\_\_ responses to affirmative screening: many domestic violence prevention coalitions provide scripts for screening and responding to pt's situations * Determine whether an abused woman is in _______ danger; if so, implement urgent \_\_\_\_\_\_. If she needs info or literature, ensure she can safely hide it -- often in the sole of her ___ or in feminine hygiene _____ -- so her abuser won't find it * Become familiar with your \_\_\_\_'s family \_\_\_. Not all states have mandated reporting laws for HCPs * You may need the patient's _____ to call the \_\_\_\_.

Answer 39

* inconsistencies, reluctance * nonjudgmental * imminent, intervention, shoe, products * states, law * permission, police

Question 40

Domestic Violence ## Footnote * _____ exam * _______ consequences...more passive, less flexible, more apathetic, depressed * S\_\_\_\_\_ complaints * Hotline \_\_\_\_\_\_ * NYC: Phone Numbers ADD to BB or SMART PHONE * **\_ _ \_** * _ \_ _ - NEW - YORK (Out of City) * TTY 212-504-4115 (Hearing Impaired) * National #: 1800-79907233

Answer 40

* Physical * Emotional * Somatic * numbers * Phone # * **311** * 212 NEW YORK

Question 41

What is super important to do if you find something on a pt who has suffered domestic violence?

Answer 41

Documentation

Question 42

When you get home... ## Footnote * Develop an "\_\_\_\_ plan" in advance for you and your children * Know exactly _____ you could go even in the middle of the night - and how to get there * Pack an "\_\_\_\_\_ bag" in case you have to leave home in a hurry. Either hide it yourself or give it to a friend to keep for you * Pack t\_\_\_\_ articles, m\_\_\_\_\_, an extra set of ____ to the house and car, an extra set of cl\_\_\_\_\_\_ for you and your children, and a t\_\_\_ for each child * Have extra ca\_\_, loose _____ for phone calls, check\_\_\_\_, or s\_\_\_\_\_ account book hidden or with a friend.

Answer 42

* "exit plan' * where * "overnight bag" * toilet, meds, keys, clothing, toy * cash, loose change, checkbook, savings

Question 43

When you get home...cont... ## Footnote * Pack important p\_\_\_\_\_ and _____ records (the originals or copies), such as ___ \_\_\_ cards, b\_\_\_ certificates, g\_\_\_\_ cards, p\_\_\_\_\_\_, w\_\_\_\_ authorization and any other imm\_\_\_\_\_ docs, v\_\_\_\_\_ registration cards, m\_\_\_\_\_ cards and recods, ______ license, r\_\_\_\_ receipts, title to the car and proof of in\_\_\_\_\_, etc. * Notify your _____ if you think it is safe * Family Violence _____ Fund

Answer 43

* papers, financial, social security, birth, green, passports, work, immigration, voter, medical, drivers, rent, insurance * neighbors * Prevention

Question 44

Health Maintenance ## Footnote * How often PE in this age group? Blood Testing? * ___ A/B--remember C prevalence * T _ testing? * T \_/T\_\_\_ * H _ \_ * V\_\_\_\_\_?\* * F _ \_ * **M\_\_\_\_\_\_\_\_ (Know Immunization Schedule)** * **​(2)** * AAFP - most common recommendation

Answer 44

* *For NORMAL, HEALTHY young adults, PE and blood work every 3y is fine* * Hep * TB * Td/Tdap * HPV * Varicella * FLU * **Meningococcal** * **​**College freshmen living in dorms\* * Military recruits * \*\*if ppl aren't sure/we don't know if they've gotten varicella (from other countries) - make sure it is safe to administer - a lot of times we just draw TITERS\*\** * \*\*COLLEGE FRESHMEN, MILITARY RECRUITS\*\* need meningococcal*

Question 45

Health Maintenance Topics ## Footnote * Acc\_\_\_\_\_ * V\_\_\_\_\_\_ * Discuss ___ factors for illness * F\_\_\_\_\_\_ stressors * O\_\_\_\_\_ Hazards/Stressors * C\_\_\_\_\_ Screenings * De\_\_\_\_\_ * Chemical Agents * D\_\_\_ Use * Al\_\_\_\_ Use * T\_\_\_\_ Use

Answer 45

* Accidents * Violence * risk * Financial * Occupational * Cancer * Depression * Chemical * Drug * Alcohol * Tobacco *NPs stand out from MD in PA in our education!*

Question 46

Community Agencies ## Footnote * DOH/HIV/Immunization and Planned \_\_\_\_\_\_ * Ps\_\_\_ ER - where are they? * PCAP and WIC - what is it? * D\_\_\_\_\_ Screening * V\_\_\_\_\_ Screening * _____ Precinct * Ph\_\_\_\_-TARGET

Answer 46

* Department of Health/HIV/Parenthood * Psych * Prenatal care assistance program, Women infants and children to get supplemental food and nutrition * Dental * Vision * Police * Pharmacy