Chronic Disease Flashcards
Cystic fibrosis genetics and epidemiology:
Autosomal recessive; whites; boys = girls
What are two findings that suggest CF in both kids and adults?
Kids: Nasal polyps under 12
Adults: Allergies
What are three metabolic findings of CF?
- Hyponatremic hypochloremic dehydration
- Metabolic alkalosis
- DM
What are the two options for the newborn screen?
IRT
DNA
What number is a positive sweat chloride?
60 mEq/L
What two things should you supplement a CF patient with for diet?
- Fat soluble vitamins (DEAK)
- Pancreatic enzymes
Median age of survival:
40
Most common rheumatologist disease:
Juvenile Idiopathic Arthritis
What is the race that is most commonly affected by JIA? Age distribution?
Native Americans; BIMODAL (1-3), (8-10)
Who is affected more with JIA?
Girls 2-3x more
What can be a finding in all types of JIA? What increases the risk for uveitis?
Uveitis - circumlimbal; if ANA positive you are at increased risk for this
Symptoms must be present for how long to diagnose JIA?
6 weeks
Most common form of JIA?
Oligioarticular (4 or fewer joints involved for 1-6 months)
Two types of oligoarticular JIA?
- Persistent (better): Never develop more than 4 joints, 75% remission
- Extended: 5+ joints involved after the first 6 months
What type of joints does Polyarticular JIA affect? What are the two types?
Smaller, symmetrical, 5+ joints in the first 6 months of illness
Rh (-): More common and early in childhood
Rh (+): Adolescent females, resembles RA
Type of JIA associated with the most mortality or morbidity:
Systemic, fever spikes 1-2x daily for at least two weeks (may accompany or proceed the joint pain)
What will occur with the fever spikes in those with systemic JIA?
A discrete salmon colored macule pattern on the trunk and extremities
What is Enthesitis Related arthritis (JIA)?
Inflammation where the tendon inserts at the bone - to Dx need at least (2)
What are two other findings in those with psoriatic arthritis (JIA)?
- Oncycolysis - nail pitting
- Dactylitis - swelling
Peak onset for those with Enthesitis-Related arthritis:
Middle childhood
What imaging study can be helpful with JIA?
MRI; but a clinical diagnosis so not needed
Initial mild treatment for those with JIA:
NSAIDS
For additional JIA management, what else can be used? (3)
- Methotrexate (anti-RA)
- Etanerecept (tumor necrosis)
- Corticosteroids - for the eyes and injections for the joints (not long term)
When do detection of DM1 antibodies show up and when do you see destruction and clinical presentation?
Antibodies circulate 5-10 years before clinical presentation
- Clinical signs show up when 80-90% of the beta cells are destroyed
Type1 disease onset and epidemiology:
Bimodal: 4-6, 10-14
Boys and girls are equal
Common in whites
Type2 disease onset and epidemiology:
- Girls
- American Indians –> Pacific Islanders –> AA
Four criteria for the diagnosis of diabetes:
- A1C >6.5%
- Fasting plasma glucose >126
- Two hour glucose >200
- Random >200 + crisis
When do you screen for DM?
Every 3 years starting at age 10 or when they hit puberty
You are at risk for diabetes with the following four things:
- FH
- At risk race
- Acathosis nigricans, dyslipidemia, HTN, PCOS
- Maternal gestational diabetes
Glycemic control can be more difficult during what three things?
- Exercise
- Adolescence
- Acute illness
Initiate kids on insulin with T2DM when any of the four apply:
- DKA
- Glucose levels >250
- A1C >9%
- When you can’t tell if they have type 1 or 2
BMI > ___ = obese
BMI > ___ = Overweight
>95% = Obese >85% = Overweight
What is the main reason kids gain weight?
Reduced energy expenditure
Highest risk factor to a child for obesity under the age of 10:
Parental obesity
What ages do kids add on fat cells for life?
3-7
The majority of childhood obesity is from:
Exogenous causes - energy intake vs. expenditure
What are three endocrine issues that can cause obesity?
- Hypothyroidism
- Cushing’s
- GH def.
What are three things obesity causes?
- Early menstruation
- CAD
- OSA
When should you start anticipatory guidance for obesity?
6 months
Digital screen recs:
<2: None
2-5: 1 hr a day
>6: Use discretion
Age 2-11 weight loss and >11 weight loss limits:
2-11: No more than 1 pound/week
>11: No more than 2 pounds/week
