Exam 2 - HTN, HLD + Obesity

Question 1

What patients should have BP checked at every PC visit?

Answer 1

Obesity, renal disease, diabetes, heart disease, or meds known to elevate BP.

Question 2

Conditions where children younger than 3 years should have BP checked: slide 7

Question 3

Drugs in kids associated with elevated BP: slide 7

Question 4

Difference between screening and diagnostic BPs for kids

Answer 4

Screening uses initial oscillatory technique based on age.
If over limits in screening chart (90%), then compare against age AND gender AND height chart.

Question 5

age 1-13 stages of HTN slide 12!

Question 6

Age over 13 - stages of HTN slide 13

Question 7

Elevated BP - now what?

Answer 7

If initial BP is >90%, then perform 2 additional BP measurements on SAME visit and average them. If still >90%, then take 2 manual BPs and average them to define BP category. If BP is normal after repeat readings, then no additional action is needed.

Question 8

Repeat BP check in _____ for elevated BP after implementing ______

Answer 8

6 months
Lifestyle interventions.

Question 9

stage 1 HTN recheck in _____ after implementing _____. Recheck in _____ and refer to _______. If still in stage 1 after 3 visits, implement _________ and ______

Answer 9

1-2 weeks
Lifestyle interventions
3 months
Nutrition/ weight management
ABPM and diagnostic evaluation, treatment and consider specialty referral.

Question 10

Stage 2 HTN flow of care?

Answer 10

Asymptomatic - upper and lower extremity check
Lifestyle counseling and recheck in 1 week. May refer to sub specialty care within 1 week.
Still elevated in stage 2 at 1 week? ABPM, diagnostic eval, treatment initiation.
Symptomatic? ER.

Question 11

diagnostic eval for pediatric HTN

Answer 11

UA, chemistry, lipids, renal ultrasonography in those <6 years old or those with abnormal UA or renal fxn

obese (>95%): Hgb A1C, AST, ALT, fasting lipids

Fasting glucose, TSH, drug screening sleep study and CBC.

Question 12

What would you see if you were concerned about Coarct of aorta as cause for HTN?

Answer 12

Right arm BP 20mmHG greater than lower extremity.

Question 13

Secondary causes of HTN in kids

Answer 13

Renal and renovascular - stenosis, usually under age 6
Cardiac - Coarct of aorta, long-segment narrowing of abd aorta
Endocrine
Environmental exposures (lead, cadmium, mercury, phthalates - soaps, shampoos, tubing, plastics)
Neurofibromatosis
Medication related (OCP, CNS stimulants for ADD, NSAIDS, decongestants)

Question 14

_______ renal ultrasound is the one to order to rule out renal cause of secondary HTN

Answer 14

DOPPLER

Question 15

Goal for Tx in pediatric HTN

Answer 15

SBP and DBP to <90th percentile or <130/80 in teens.

Question 16

Lifestyle interventions for pediatric HTN

Answer 16

DASH diet
Physical activity - moderate to vigorous activity at least 3-5 days/week 30-60minutes per session
Wt loss
Stress reduction.

Question 17

Start pharmacological tx for peds HTN if:

Answer 17

Remain HTN after lifestyle modification
Symptomatic HTN
Stage 2 without clearly modifiable factor
Any stage associated with CKD or DM.

Question 18

See patients on pharm tx for HTN every ____ until BP controlled.

Answer 18

4-6weeks.

Question 19

Start _____ in female patients at risk for pregnancy

Answer 19

CCB - not ACE/ARB

Question 20

What are some risk factors for developing pediatric HLD?

Answer 20

BMI >95%
HTN
HLD <40
Hx Kawasaki dz, autoimmune dz or inflammatory d/o
DM
Renal disease
Smoking
Familial hypercholesterolemia.

Question 21

UNIVERSAL Screening recommendations for HLD (non-fasting, non-HDL)

Answer 21

Once at 9-11
Once at 17-21

Question 22

Selective TARGETED screening for HLD (family hx, unknown family hx or personal risk factors)

Answer 22

Early fasting lipid screening.

Question 23

Screening levels are the same for all children 2-18 yo - exce[t

Answer 23

Triglycerides - 0-9 have one level and 10-19.

Question 24

Pharmacological treatement for HLD is only for age _______

Answer 24

8 and older.

Question 25

1st line for HLD tx

Answer 25

Statins (rosuvastatin and pravastatin are approved for 8yo and older.

Question 26

Statins are contraindicated in ______

Answer 26

Pregnancy.

Question 27

Goal of lipid tx

Answer 27

LDL-C <130 but ideally under 110 OR a 50% reduction

Question 28

Hypertriglyceridemia puts patient at risk for:

Answer 28

Pancreatitis.

Question 29

Vibrates and omega 3 fatty acids can help with hypertriglyceridemai.

Question 30

Obesity in children ____

Answer 30

Over weight = 85-95%
Obese = >95%

Question 31

Review Peds specific CPG (AAP) and KAS PDFs