CLIPP 4 Flashcards
A BMI greater than the percentile for age is considered obese.
95th
weight and height ages
weights or heights at which the patient’s weight or height would plot at 50th %tile
core ADHD sx
inattention, hyperactivity, impulsivity that often lead to issues at home/school - need sx in 2+ settings, typically dx before 7 yo
what is one of the most common chronic health conditions in kids
adhd
when should objective vision and hearing tests start
vision - at 3yo
hearing - at birth and then resume at 4yo
ADHD and sleep hygiene
people w/ adhd might have poor sleep hygiene but aren’t overly tired
childhood depression can convert into
bipolar disorder
learning disorders manifest as and can lead to
problem involving academic skills - many states require documentation of normal IQ and discrepant academic performance , can lead to behavioral problems, screen for adhd and LD as they can have comorbidity
Oppositional defiant disroder vs conduct disorder
ODD - hostility towards authority, defiance, negativity
Conduct disorder - more severe, habitual rule breaking, aggression, stealing, truancy, lying, destruction
which other mental disorder has highest comorbid rates w/ adhd
ODD/CD
what % of kids respond to adhd meds like sustained release methyphenidate
80%
4 adverse effects of stimulants
appetiet suppression, slowing of grwhto velocity that diminished by year 3 but no compensatory mechanism seen, insomnia esp early on in meds, and tic disorder that can stop if you stop the med
cv risk with stimulants?
higher in adults probably, and also seen in kids w/ heart disease that is known.
children’s TOTAL MEDIA time should be limited to __ daily
1-2 hours of quality programming
avg child watches __ hr tv/day, and __ hr total media time/day
3, 6.5
what does maternal diabetes and high birth weight put you at risk for
obesity
is breastfeeding a risk factor for obesity
no - feeding helps prev obeisty
early menarche associated with
bmi >85th%
slipped capital femoral epiphysis
displacement of the femoral head from the femoral neck through the physeal plate
- onset is in puberty in obese pt w/ delayed pubertal onset
- sx is antalgic gait to avoid referred pain, and limited ROM on internal rotation of hip
- dx on X-ray of pelvis which shows widening of physses
most prominent risk factor in dvpt of type 2 dm
obesity
steatohep 3 sx
hypERechoioc liver, fatty infiltration and fibrosis on bx, elevated transaminases
type 1 vs 2 DM as related to insulsin
type 1 = deficiency
ype 2 = resistant
4 diagnostic criteria for DM
2h OGTT glucose of >=200 after loading w 75g, fasting 8+hours of >=126, sx of hypergly+random =>200, a1c >= 6.5%
is age helpful to distinguish between type 1 vs 2 DM
no - type 2 now dx earlier but type 1 often in early childhood
though most pt w/ type _ dm do not present in dka (bc typically not absolute insulin def), often have __ at dx
2, ketonruia
presentation course in type 1 vs 2 dm
type 1 is more acute, type 2 more indolent and can be accidental
pediatrics DM screening
if ovweright (BMI>85%ile, weight:ht >85th, or weight >120% for height) + any of 2 following: signs of insulin resistance (actanthosis nigricans, pcos, dyslipidemia, htn), maternal hx of diabetes or gestational dm during pregnancy, fam hx of type 2 in first or second degree rel, race/ethnicitiy (asian/pacific islander, NA, AA, hispanic) -screen at 10 or onset of puberty (whichever is first), q3years and can use hgba1c, ogtt, or fasting glucose
three things impacting BP readings
white coat htn, using cuff too small or inappropriately normal cuff (obese 9 yo can’t use normal 9yo cuff), or positioning arm below heart - should be at level of heart
approp bp cuff size
bp cuff should cover 2/3 of upper arm and internal bladder should encircle 80-100% of circ
prehypertension in adol
bp >=120/80 but %tile <95
BP percentile Classification < 90th 90th-95th 95th-99th plus 5 mm Hg > 99th plus 5 mm Hg
normal
Prehypertension
Stage 1 hypertension
Stage 2 hypertension
Guidelines ___ recommend a diagnostic work-up for a secondary cause of hypertension for children with blood pressure values in the prehypertension range unless there is a concern for a possible underlying cause in the patient’s medical history, exam, or family history.
do not
meds in pediatric htn
typically reserved for children with Stage 2 HTN, children with secondary hypertension, and children with evidence of target-organ effects
causes of 2ndary htn in kids
umbilical access when neonate –>renovasc dz, uti, coartc, fmaily hx (ask about dialysis as away to see how bad end organ damage got), excess catecholamines as in pheo or NB
rotavirus vaccine sched
started by 15w and finished by 8m, no catchup
influenza schedule for 1st immunization
w either type of flu vaccine, need 2 doses in first year of getting it, 1 m apart if 9 yo or younger
who is a catch up hepA vaccine recommended for
babies>23 m who live in areas where vaccines target older kids, at incr risk of infection or who want hepA immunity
endocrine causes that cause weight gain also typically would have ___ that we look for
limited growt–>short stature, whereas obesity stimulates statural growth and leads to tall stature for age. It also typically advances bone age and leads to early puberty.
prochaskas stages of change
precontemplation, contemplation, determinatino, action, maintenance, relapse
elevated urinary VMA, urinary HVA, urinary metanephrines, and serum glucose
pheo
Catecholamine excess
pheo or NB, test urine
overweight vs obese %ile
A child is considered overweight when his or her BMI is between the 85th and 95th percentile for age. Obesity is considered > 95th percentile.
what can steroids do to BP
increase - acts like cortiol–>fight or flight–>raise BP. amphetamines on the other hand, mimc NE.
childhod depression can –>
bipooalr
anti social personality disorder
inability to conform to societal norms, disregard of the rights of others, and often criminality. These individuals often exhibit impulsiveness due to their lack of consideration of the consequences of their actions. Males are affected more than females. However, a diagnosis of anti-social personality disorder can be made only in individuals older than 15 years, earlier than which a diagnosis of conduct disorder is appropriate.
conduct disorder vs anti social
conduct if before age 15
rhetts
X-linked pervasive developmental disorder seen only in females; affected males die in utero or at birth. The characteristic symptoms involve regression of language and development, mental retardation, ataxia and hand-wringing. This disorder is typically diagnosed much sooner, at about age 1-4.
