Healthy Growth -Fahim Flashcards
You are called to the nursery to evaluate a newborn. The infant was delivered at 39 weeks gestation via emergent C-section due to non-reassuring fetal heart tones. On exam, the infant weighs 2.3 kg, placing him in the 5th percentile, height is 18 inches (10th %ile). His head seems large for his body. There is a paucity of subcutaneous fat. The infant is at risk for developing: A. Hip Subluxation B. Polycythemia C. Hyperglycemia D. Hyperthermia
B. Polycythemia
–> not enough O2 –> make more RBC
A 3 yo boy is brought in for delayed milestones. Over the past year, he has received physical and speech therapies for motor and speech delays. He can walk up and down the stairs and run currently. He has a vocabulary of 25 words and cannot make 2-word sentences. He makes poor eye contact and does not engage other children. Head circumference, length and weight are each at 5th %ile. Facial exam shows small palpebral fissures, absent philtrum and a thin upper lip border. What is his underlying pathology? A. Fragile X gene mutation B. In Utero Alcohol Exposure C. In utero CMV exposure D. In utero phenytoin exposure. E. chromosome 21 nondisjunction
B. In utero alcohol exposure
When should a baby re-gain their birth weight?
2 weeks
When should an infant’s birth weight double? Triple?
double=5 months
triple=1 year
How much weight should an infant be gaining at 0-3 months? 6-9 months? 12-36 months?
0-3=30 g (1 oz)/day
6-9 months= 15 g (1.2 oz) / day
12-36 months=8 g =1/4 oz/day
What are drugs of abuse in pregnancy associated with?
Preterm birth
Low birth weight (<2500g)
Growth restriction
How long does it take an infant to double in birth LENGTH?
3-4 years
What is the best way to measure height?
standiometer=stand against a wall
How is BMI calculated and interpreted for children and teens? What is considered normal, underweight, obese, and severely obese?
Must graph BMI for age percentile
Normal= 5-85%
Underweight = 95th %ile
Severe obesity=>99%
how is head circumference measured?
Occiput to the mid forehead
avg at birth=35 cm
A 1 year old full-term boy is brought in for poor weight gain and delayed milestones. Since birth, he has tried various formulas due to diarrhea and recently switched to cow’s milk. He currently drinks 20oz of whole milk and eats table food 3-4 times daily. His stools are loose and greasy and he has recurrent nosebleeds. He has been hospitalized 3 times for bronchiolitis. He is in the 10th percentile for height and the 5th percentile for weight. What is the underlying cause for his growth failure? A. Child neglect B. Chronic parasite infection C. Constitutional growth delay D. Inadequate dietary intake E. Fat malabsorption
E. Fat malabsorption
pt has CF
A 15 year old girl is brought by her mother, who is concerned about hearing her daughter vomit in the bathroom twice last week. The girls is a gymnast preparing for a competition and says she vomited because she was nervous. She admits she is afraid to eat because she is “too fat.” Her last menstrual period was 4 months ago. Her body mass index is 16 kg/m2. She is emaciated and pale. Which of the following is the most likely diagnosis?
A. Adjustment disorder
B. Anorexia nervosa
C. Bulimia nervosa
D. Eating disorder not otherwise specified
E. Somatization disorder
B. anorexia nervosa
BMI 15% below average or 17 or less and anxiety about gaining weight
A 13 year old girl is brought to the pediatrician for a routine visit. Her mother says that she eats less than her first daughter did at this age, but has a varied diet. Physical exam shows mild pallor. Laboratory results are as follows: Hemoglobin: 9.6 g/dL Hematocrit: 29% MCV 70fL
Which additional findings are likely to be present in this patient?
A. Abnormal hemoglobin electrophoresis
B. Circulating nucleated RBCs
C. Elevated mean corpuscular hemoglobin concentration
D. Elevated red cell distribution width
E. High indirect bilirubin
D. Elevated red cell distribution width
Iron deficiency –> microcytic anemia
How many calories does a 4-8 yo child need /day?
1200-1400
What are the 3 types of proteins?
Complete (provides ALL essential amino acids)
Incomplete (low in 1 (+) essential amino acids)
Complementary (2+ incomplete protein sources that provide adequate amounts of ALL essential amino acids)
When should cows milk be introduced to a child’s diet? How much is the maximum amount? Why?
whole milk at 1 year old. limit to 24 ounces because of risk of anemia
When should children start to eat cereals?
4-6 months==> other sources of nutrients to ensure micronutrients in diet
When can 2% cows milk be given to children?
2 years old
Are trans fats good for you?
no
Trans=trouble
created in food processing to keep food fresh longer
-increase LDL and decrease HDL
A 21 year old woman presents for a routine physical. Her exam shows amildly overweight woman but is otherwise remarkable. A fasting lipid panel shows an LDL of 310 mg/dL, HDL of 42mg/dL, and triglyceride level of 382 mg/dL. Her doctor suspects familial hypercholesterolemia and initiates treatment. Soon after, she presents with myalgias. Labs show elevated AST, ALT, and creatine kinase. Which intervention is likely responsible for her myalgias? A. Niacin therapy B. Hormone replacement therapy C. LDL apheresis D. Liver transplant E.Statin medication
E.Statin medication
statins inhibit HMG-CoA reductase –> upregulate hepatic LDL receptors –> inc binding to LDL and VLDL -> dec circulatory levels
What are the 4 types of fat?
- trans=trouble (food processing)
- saturated fat
- cholesterol
- unsaturated (Utmost pleasure) (Monounsaturated fat, omega-6 polyunsaturated fat, omega-3 polyunsaturated fat)
What can a higher intake of K+ help do?
attenuate the adverse effects of Na+ on blood pressure
What % of children and adolescents eat too much salt?
90-97%
