week 5 DB post

Case Scenario 1: Tommy is a 2-year-old brought into the clinic for his well-child examination. His hemoglobin in the clinic is 9g/dL, his serum iron is below normal, TIBC is elevated, and his iron saturation is low. Although in remission, Tommy's mother mentions she always worries about Tommy since he was diagnosed with infant ALL.

• Based on these results, what type of anemia does Tommy have? • What symptoms and physical exam findings might you expect to find? • What is the treatment for this condition? • Please give the name of medication, form, dosage, frequency to be given, and

describe what follow-up is needed. • What are some of the common causes for this type of anemia and what anticipatory

guidance will you give the parents? • How would you address his mother’s anxiety about Tommy’s past medical history of

ALL

Case Scenario 2: Margaret brought in her 11-year-old daughter Sandy for her well-child exam. Sandy has developed axillary and pubic hair and has been complaining of mild abdominal cramping off and on for 3 days. Margaret also mentions to you that she is concerned about allowing her daughter to participate in a sexuality educational course offered at school.

• What does the evidence say about providing sexuality education at school to children?

• Which approach should you take when taking a sexual history from Sandy? • What anticipatory guidance should you give Sandy about her body changes? • What anticipatory guidance should you give Margaret about teaching Sandy about

sex?

Case Scenario 3: Carlos is a 15-year-old with type 1 DM, diagnosed one year ago. Carlos is interested in trying out for a soccer team.

• What additional information should you know about Carlos? • Which diagnostic tests should you periodically monitor for this condition? • What anticipatory guidance and instructions will you give Carlos and his parents

about his participation in soccer, diet, and insulin management?

Case Scenario 4: You have a 9-year-old female patient who was newly diagnosed with hypothyroidism last month. She is here to see you for a well-child exam. The mother states that she has not filled the prescription because she wants to discuss alternative treatment options.

• How should you approach the mother on her use of complementary therapy? • What should you tell the mother about the need for levothyroxine medication? • What does the evidence say about complementary therapy for chronic diseases?

Week 5 Discussion Part I

Table 1 Classifications of Anemias

Table 2 Differentiate Common Childhood Leukemias

Complete the information.

Normocytic Microcytic Macrocytic Hemolytic Anemia

Description

Clinical Findings

Diagnostic Studies Management

Clinical Findings:

Acute Lymphocytic Leukemia (ALL)

Acute Myelogenous Leukemia (AML)

Occurrence

Managemen t

Table 3 Tanner Stages

Table 4 Delayed Puberty, Menarche, and Growth Spurts

Tanner Stages Girls (Breast Development)

Boys (Genital Development- testes/penis)

Stage I

Stage II

Stage III

Stage IV

Stage V

Answer the following questions.

How is precocious puberty defined for boys and girls?

What is considered delayed puberty in boys and girls?

What labs tests should be ordered for delayed puberty?

During what age ranges do growth spurts occur in boys and girls?

What is the average age of menarche in the United States?

Table 5 Differen-ate Types of Diabetes

Table 6

Hypothyroidism and Hyperthyroidism

Type 1 Diabetes Type 2 Diabetes

Age of onset

Gender

Race/Ethnicity

Obesity

Family History of DM

Insulin Secretion

Insulin Sensitivity

Onset

Ketosis, DKA

Hypertension

Acanthosis nigricans

Polycystic ovarian syndrome Islet Autoimmunity

Differentiate between hypothyroidism and hyperthyroidism

Clinical Findings Diagnostic Studies

Management

Hypothyroidism

Hyperthyroidism

Table 7

Drug Interac-on with Herbal Supplements

Please complete the table of common interactions between FDA-approved medications and herbal supplements

Drug Category Herb Effect of Herb on the Drug’s Action

Iron Tannin-rich herbs (e.g. caffeine containing herbs, cat’s claw, tea, uva, ursi)

Laxative, stimulant (e.g., bisacodyl)

Aloe, cascara sagrada, senna, yellow dock

NSAIDS Gastric irritant herbs (e.g. caffeine, rue, uva ursi) Nettles

Oral contraceptives Licorice, St. John’s wort

Salicylates (e.g. aspirin) Herbs that alkalinize urine (e.g. uva ursi) Tamarind Ginkgo, garlic

Theophyline St. John’s wort

Thyroid Hormone Horseradish Kelp