Stony Brook Children’s Pediatric Primary Care Clinic Curriculum
Health Supervision II
September 2015
Some 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, MD
All other materials developed by Susan Walker, MD
Goal: Become familiar with the AAP's recommendations for preventive pediatric health care
Objectives:
1. Understand and apply the AAP guidelines for screening for and evaluation of iron deficiency
anemia
2. 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 level
3. Understand and apply the AAP recommendations for hypertension and dyslipidemia
screening
ABP Content Specifications covered in this session:
Iron deficiency
1. Identify non-hematologic effects of iron deficiency
2. Understand the etiology of iron deficiency
3. Recognize the clinical findings associated with iron deficiency in patients of
various ages
4. Plan the appropriate diagnostic evaluation of iron deficiency
5. Plan the appropriate management of iron deficiency
Lead
Understand the importance of a screening examination for lead during early periodic screening
evaluations
Recognize the multiple sources of exposure to lead
Understand the outcomes associated with lead poisoning
Plan appropriate management of an increased blood lead concentration
Cholesterol, lipids
Understand the importance of cholesterol/lipid screening examinations
Recognize the clinical features associated with hypercholesterolemia/hyperlipidemia, and
evaluate appropriately
Know the risk factors associated with hypercholesterolemia/hyperlipidemia
Know the risk factors associated with coronary artery disease
Understand the recommendations of the National Cholesterol Education Program for Children
Blood pressure
Understand when to screen for an increased blood pressure and how to interpret the results
Understand the appropriate technique, including appropriate cuff size, for measuring blood
pressure
Pre-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:
https://www.health.ny.gov/publications/2501/
3. 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 evaluation
4. "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 10.3
RBC 4.85
Hemoglobin 9.6 (L)
Hematocrit 29.0 (L)
MCV 69.0 (L)
MCH 19.9 (L)
MCHC 33.1
RDW 25.0 (H)
Platelets 730 (H)
MPV 7.3
4. 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 157
TG 120
HDL 47
What 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?