CLIPP 4

Question 1

A BMI greater than the percentile for age is considered obese.

Answer 1

95th

Question 2

weight and height ages

Answer 2

weights or heights at which the patient’s weight or height would plot at 50th %tile

Question 3

core ADHD sx

Answer 3

inattention, hyperactivity, impulsivity that often lead to issues at home/school - need sx in 2+ settings, typically dx before 7 yo

Question 4

what is one of the most common chronic health conditions in kids

Answer 4

adhd

Question 5

when should objective vision and hearing tests start

Answer 5

vision - at 3yo

hearing - at birth and then resume at 4yo

Question 6

ADHD and sleep hygiene

Answer 6

people w/ adhd might have poor sleep hygiene but aren’t overly tired

Question 7

childhood depression can convert into

Answer 7

bipolar disorder

Question 8

learning disorders manifest as and can lead to

Answer 8

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

Question 9

Oppositional defiant disroder vs conduct disorder

Answer 9

ODD - hostility towards authority, defiance, negativity

Conduct disorder - more severe, habitual rule breaking, aggression, stealing, truancy, lying, destruction

Question 10

which other mental disorder has highest comorbid rates w/ adhd

Answer 10

ODD/CD

Question 11

what % of kids respond to adhd meds like sustained release methyphenidate

Answer 11

80%

Question 12

4 adverse effects of stimulants

Answer 12

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

Question 13

cv risk with stimulants?

Answer 13

higher in adults probably, and also seen in kids w/ heart disease that is known.

Question 14

children’s TOTAL MEDIA time should be limited to __ daily

Answer 14

1-2 hours of quality programming

Question 15

avg child watches __ hr tv/day, and __ hr total media time/day

Answer 15

3, 6.5

Question 16

what does maternal diabetes and high birth weight put you at risk for

Answer 16

obesity

Question 17

is breastfeeding a risk factor for obesity

Answer 17

no - feeding helps prev obeisty

Question 18

early menarche associated with

Answer 18

bmi >85th%

Question 19

slipped capital femoral epiphysis

Answer 19

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

Question 20

most prominent risk factor in dvpt of type 2 dm

Answer 20

obesity

Question 21

steatohep 3 sx

Answer 21

hypERechoioc liver, fatty infiltration and fibrosis on bx, elevated transaminases

Question 22

type 1 vs 2 DM as related to insulsin

Answer 22

type 1 = deficiency

ype 2 = resistant

Question 23

4 diagnostic criteria for DM

Answer 23

2h OGTT glucose of >=200 after loading w 75g, fasting 8+hours of >=126, sx of hypergly+random =>200, a1c >= 6.5%

Question 24

is age helpful to distinguish between type 1 vs 2 DM

Answer 24

no - type 2 now dx earlier but type 1 often in early childhood

Question 25

though most pt w/ type _ dm do not present in dka (bc typically not absolute insulin def), often have __ at dx

Answer 25

2, ketonruia

Question 26

presentation course in type 1 vs 2 dm

Answer 26

type 1 is more acute, type 2 more indolent and can be accidental

Question 27

pediatrics DM screening

Answer 27

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

Question 28

three things impacting BP readings

Answer 28

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

Question 29

approp bp cuff size

Answer 29

bp cuff should cover 2/3 of upper arm and internal bladder should encircle 80-100% of circ

Question 30

prehypertension in adol

Answer 30

bp >=120/80 but %tile <95

Question 31

BP percentile	Classification
< 90th
90th-95th
95th-99th plus 5 mm Hg	 
> 99th plus 5 mm Hg

Answer 31

normal
Prehypertension
Stage 1 hypertension
Stage 2 hypertension

Question 32

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.

Answer 32

do not

Question 33

meds in pediatric htn

Answer 33

typically reserved for children with Stage 2 HTN, children with secondary hypertension, and children with evidence of target-organ effects

Question 34

causes of 2ndary htn in kids

Answer 34

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

Question 35

rotavirus vaccine sched

Answer 35

started by 15w and finished by 8m, no catchup

Question 36

influenza schedule for 1st immunization

Answer 36

w either type of flu vaccine, need 2 doses in first year of getting it, 1 m apart if 9 yo or younger

Question 37

who is a catch up hepA vaccine recommended for

Answer 37

babies>23 m who live in areas where vaccines target older kids, at incr risk of infection or who want hepA immunity

Question 38

endocrine causes that cause weight gain also typically would have ___ that we look for

Answer 38

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.

Question 39

prochaskas stages of change

Answer 39

precontemplation, contemplation, determinatino, action, maintenance, relapse

Question 40

elevated urinary VMA, urinary HVA, urinary metanephrines, and serum glucose

Answer 40

pheo

Question 41

Catecholamine excess

Answer 41

pheo or NB, test urine

Question 42

overweight vs obese %ile

Answer 42

A child is considered overweight when his or her BMI is between the 85th and 95th percentile for age. Obesity is considered > 95th percentile.

Question 43

what can steroids do to BP

Answer 43

increase - acts like cortiol–>fight or flight–>raise BP. amphetamines on the other hand, mimc NE.

Question 44

childhod depression can –>

Answer 44

bipooalr

Question 45

anti social personality disorder

Answer 45

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.

Question 46

conduct disorder vs anti social

Answer 46

conduct if before age 15

Question 47

rhetts

Answer 47

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.