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03. Cardiopulm Renal > Pediatric HTN (Newman) > Flashcards

Pediatric HTN (Newman) Flashcards

1
Q

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

A

<90th percentile

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

Normal BP children >13 y/o

A

<120/<80 mmHg

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6
Q

What age should you begin monitoring BP?

A

3 years old (younger with congenital issues)

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7
Q

When is a child diagnosed with HTN?

A

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

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8
Q

dietary approaches to stop HTN

A

DASH diet

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9
Q

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

A

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

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10
Q

Blood pressure readings with aortic coarctation

A
  • high BP in legs

- low BP in arms

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11
Q

pulse pressure

A

SBP - DBP

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12
Q

When does pulse pressure go down?

A

septic shock

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13
Q

white coat HTN

A

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

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14
Q

masked HTN

A

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

*ambulatory blood pressure monitoring helpful

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15
Q

Karotkoff sounds

A 
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

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16
Q

What is HTN in school age children related to?

A

obesity epidemic

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17
Q

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

A

LVH, seen on echocardiography

18
Q

what happens when the blood pressure cuff is too small?

A

artificial elevation of blood pressure

19
Q

what happens when the blood pressure cuff is too large?

A

artificially lowered BP

20
Q

definition of hematuria

A

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)

21
Q

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

A

myoglobin, hemoglobin

22
Q

Things that color the urine red (5)

A

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

23
Q

what has worse prognosis than hematuria?

A

hematuria with proteinuria

24
Q

Describe post infectious acute glomerulonephritis

A

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
25
Q

Treatment post infectious acute glomerulonephritis

A

supportive care

26
Q

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

A

development of proteinuria with hematuria could indicate long term renal damage

27
Q

hypercalciuria definition

A
  • usually idiopathic

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

28
Q

Signs and Sxs of UTI in children

A
  • fever
  • decreased intake
  • strong smelling urine
  • dark urine
  • stomach pain
  • frequency, urgency, loss of control
  • dysuria
29
Q

acceptable methods for urine sample collection

A
  • clean catch urine if child can void on command

- otherwise: catheterization/suprapubic aspiration

30
Q

criteria for Dx UTI (3)

A

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

31
Q

most common urinary pathogens in children

A
  • E. coli
  • klebsiella
  • enterococcus
  • pseudomonas
  • staph saprophyticus
32
Q

imaging recommendations for UTI in boys

A

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

33
Q

imaging recommendations for UTI in girls

A

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

34
Q

most common causes obstructive uropathy in children

A

1) UPJ obstruction

2) Posterior urethral valves [only in boys]

35
Q

Grading of VUR in kids

A

graded 1 - 5

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

36
Q

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

A

not acutely ill and tolerating PO: cefixime and cefdinir

acutely ill or not tolerating PO: cephtriaxone

37
Q

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

A
  • dilating VUR
  • obstructive uropathy
  • renal abnormalities
  • impaired kidney function
  • HTN
  • bowel/bladder dysfunction is refractory to primary care measures
38
Q

most common holosystolic murmur

A

VSD

39
Q

describe hypertrophic cardiomyopathy murmur

A
  • harsh cresendo-decresendo systolic murmur
  • heard best at apex and LSB
  • increases in intensity when patient stands and with valsalva maneuver
40
Q

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

A
  • 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)
41
Q

most common congenital cyanotic heart defect with components

A

tetralogy of fallot (boot heart)

1) pulmonary stenosis
2) right ventricular hypertrophy
3) overriding aorta
4) VSD

03. Cardiopulm Renal (6 decks)

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