Pediatric HTN (Newman)

Question 1

2017 CPG definition of normal BP for children aged 1-13 y/o

Answer 1

<90th percentile

Question 2

2017 CPG definition of elevated BP for children aged 1-13 y/o

Answer 2

90th percentile to <95th percentile or 120/80 to <95th percentile

Question 3

2017 CPG definition of Stage 1 HTN for children aged 1-13 y/o

Answer 3

> 95th percentile to 95th percentile + 12 mmHg or 130/80 - 139/89

Question 4

2017 CPG definition of Stage 2 HTN for children aged 1-13 y/o

Answer 4

> 95th percentile +12 mmHG or >140/90

Question 5

Normal BP children >13 y/o

Answer 5

<120/<80 mmHg

Question 6

What age should you begin monitoring BP?

Answer 6

3 years old (younger with congenital issues)

Question 7

When is a child diagnosed with HTN?

Answer 7

auscultatory confirmed BP readings >95th percentile (>130/80 in 13 y/o) at 3 different visits

Question 8

dietary approaches to stop HTN

Answer 8

DASH diet

Question 9

For what level of blood pressure do you refer a child to emergency care?

Answer 9

> 180/120 or >30 mmHg above the 95th percentile

Question 10

Blood pressure readings with aortic coarctation

Answer 10

• high BP in legs

- low BP in arms

Question 11

pulse pressure

Answer 11

SBP - DBP

Question 12

When does pulse pressure go down?

Answer 12

septic shock

Question 13

white coat HTN

Answer 13

patient with BP levels >95th percentile in a physician’s office or clinic who is normotensive outside a clinical setting

*ambulatory blood pressure monitoring helpful

Question 14

masked HTN

Answer 14

patient with BP levels in >95% outside of office or clinic, but who is normotensive in the clinical setting

*ambulatory blood pressure monitoring helpful

Question 15

Karotkoff sounds

Answer 15

1st sound: SBP
2nd sound:
3rd sound:
4th sound: sound muffled
5th sound: silence, cuff pressure drops below DBP

*sometimes muffled sounds heard all the way to zero –> 4th sound DBP in this case

Question 16

What is HTN in school age children related to?

Answer 16

obesity epidemic

Question 17

What can develop in children with untreated HTN and how is it diagnosed?

Answer 17

LVH, seen on echocardiography

Question 18

what happens when the blood pressure cuff is too small?

Answer 18

artificial elevation of blood pressure

Question 19

what happens when the blood pressure cuff is too large?

Answer 19

artificially lowered BP

Question 20

definition of hematuria

Answer 20

presence of 3 or more RBC per high powered field in 3 consecutive, fresh centrifuged specimens obtained over the span of a few weeks (can be gross or microscopic)

Question 21

What can cause a positive result on a urine dipstick that isn’t a red blood cell?

Answer 21

myoglobin, hemoglobin

Question 22

Things that color the urine red (5)

Answer 22

1) drugs (rifampin, nitrofurantoin, pyridium, sulfa drugs)

2) foods (beets, rhubarb, fruit juices)
3) dehydration
4) newborns have uric acid crystals in urine
5) bilirubin

Question 23

what has worse prognosis than hematuria?

Answer 23

hematuria with proteinuria

Question 24

Describe post infectious acute glomerulonephritis

Answer 24

recent strep throat followed by:

• (gross) hematuria
• HTN (Na+ and water retention)
• swelling and edema
• proteinuria of varying degree
• elevated ASO titer
• low serum C3
• deposition IgG in glomeruli

Question 25

Treatment post infectious acute glomerulonephritis

Answer 25

supportive care

Question 26

prognostic indicator of long-term renal damage in children with Henoch- Schonlein Purpura

Answer 26

development of proteinuria with hematuria could indicate long term renal damage

Question 27

hypercalciuria definition

Answer 27

- usually idiopathic | - urine Ca2+ to Creatinine ratio of moe than 0.2 is indicative of excess Ca2+ excretion

Question 28

Signs and Sxs of UTI in children

Answer 28

- fever - decreased intake - strong smelling urine - dark urine - stomach pain - frequency, urgency, loss of control - dysuria

Question 29

acceptable methods for urine sample collection

Answer 29

- clean catch urine if child can void on command | - otherwise: catheterization/suprapubic aspiration

Question 30

criteria for Dx UTI (3)

Answer 30

clean catch: presence of pyuria and at least 50,000 colonies/ml of a single organism catheter: presence of pyuria and at least 50,000 colonies/ml or 10,000-50,00 confirmed by repeat Suprapubic aspiration: pyuria and any growth

Question 31

most common urinary pathogens in children

Answer 31

- E. coli - klebsiella - enterococcus - pseudomonas - staph saprophyticus

Question 32

imaging recommendations for UTI in boys

Answer 32

after first UTI get renal/bladder US, include VCUG if anomalies are identified, otherwise get after 2nd UTI

Question 33

imaging recommendations for UTI in girls

Answer 33

after 2nd or 3rd in girls get renal and bladder US and get VCUG if anomaly is identified

Question 34

most common causes obstructive uropathy in children

Answer 34

1) UPJ obstruction | 2) Posterior urethral valves [only in boys]

Question 35

Grading of VUR in kids

Answer 35

graded 1 - 5 | - grades 3-5 should be referred to a specialist because there is dilation of the ureter

Question 36

appropriate first-line antibiotic choices for the empiric treatment in a child with a UTI/pyelonephritis

Answer 36

not acutely ill and tolerating PO: cefixime and cefdinir acutely ill or not tolerating PO: cephtriaxone

Question 37

indications for referral of a pediatric patient with a UTI to a specialist

Answer 37

- dilating VUR - obstructive uropathy - renal abnormalities - impaired kidney function - HTN - bowel/bladder dysfunction is refractory to primary care measures

Question 38

most common holosystolic murmur

Answer 38

VSD

Question 39

describe hypertrophic cardiomyopathy murmur

Answer 39

- harsh cresendo-decresendo systolic murmur - heard best at apex and LSB - increases in intensity when patient stands and with valsalva maneuver

Question 40

Use of O2 saturation in newborns to detect critical congenital heart disease in newborns

Answer 40

- must wait 2 days for ductus arteriosus to close to confirm there is no duct-dependent heart anomaly (baby would become cyanotic and die with closure)

Question 41

most common congenital cyanotic heart defect with components

Answer 41

tetralogy of fallot (boot heart) 1) pulmonary stenosis 2) right ventricular hypertrophy 3) overriding aorta 4) VSD