Case 4 - 8 yo WCC

Question 1

What is considered overweight for kiddo? Obese?

Answer 1

Based on BMI per age: BMI 85-95th %ile -> overwt; >95th %ile -> obese

Question 2

In what patient type is SCFE syndrome seen?

Answer 2

Slipped capital femoral epiphysis (SCFE) is most often seen in obese kids w/ late onset of puberty

Question 3

Dx criteria for DM?

Answer 3

HgA1c > 6.5% [OR] FBG > 126mg/dL [OR] 200mg/dL 2hr s/p 75g glucose bolus [OR] RBG > 200mg/dL + S/Sx

Question 4

Which kids should you screen for DM2? When?

Answer 4

Overweight/Obese (BMI >85th %ile) + 1 risk factor (Race, FMHx, GDM, S/Sx insulin resistance)

Question 5

A cuff that is too _____ gives an artificially elevated/lowered reading?

Answer 5

too large -> falsely low BP; too small -> falsely elevated BP

Question 6

DDx for secondary HTN in kids?

Answer 6

H/o Umbilical Arterial or Venous Access; H/o UTI; Catecholamine excess; coarctation – think about these when there is no family h/o of 1° HTN and/or the kid’s BP is well >99th %ile

Question 7

Staging HTN in children?

Answer 7

Use table of BP by sex & height: nl BP < 90th %ile, pre-HTN = 90-95th %ile; Stage 1 = 95-99th %ile; Stage 2 > 99th %ile

Question 8

Which kids should get a flu booster? Interval?

Answer 8

1st year of immunization–w/ either killed or live– >9 y/o need two doses; 1 month apart. After that, just 1 qYr

Question 9

What is Blount’s disease?

Answer 9

“Occurs in [obese] (we think? per CLIPP…) young children and adolescents. The cause is unknown but is thought to be due to the effects of weight on the growth plate. The inner part of the tibia, just below the knee, fails to develop normally, causing angulation of the bone.

Unlike bowlegs, which tend to straighten as the child develops, Blount’s disease is progressive and the condition worsen” [Wiki]

Question 10

When to start yearly HTN screening in kids?

Answer 10

3 y/o