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CPR-2 > Pediatric HTN, Renal, and Cardio > Flashcards

Pediatric HTN, Renal, and Cardio Flashcards

1
Q

For children age 1-13 yo, normal BP is < what percentile?

A

<90th percentile

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2
Q

Which percentile range and BP elevation is considered stage 1 HTN in a child aged 1-13 yo?

A

≥95th percentile to <95th percentile + 12 mmHg

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3
Q

Which percentile range and BP elevation is considered stage 2 HTN in a child aged 1-13 yo?

A

≥95th percentile + 12 mmHg

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4
Q

A healthcare professional can make a diagnosis of HTN in a child or adolescent if what criteria are met?

A

Ausculatory confirmed BP readings ≥95th percentile at 3 different visits

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5
Q

In some children, the 4th Karotkoff sound never goes away and the “muffled” sounds can be heard all the way to zero, how should this be interpreted?

A

4th sound is used for DBP

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6
Q

In older, school age children, prevalence of primary HTN has increased hand-in-hand with what?

A

Obestity epidemic

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7
Q

The most prominent evidence of mild, chronic, untreated HTN in a child is the presence of what?

How is it detected?

A
  • Left-ventricular hypertrophy (LVH)
  • Echocardiography
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8
Q

How does a BP cuff that is too small vs. too big affect the measure BP?

A
  • Cuff too small = artificial elevation of BP
  • Cuff too big = artifical depression of BP
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9
Q

How many RBC’s/hpf in 3 consecutive fresh, centrifuged specimens obtained over a span of weeks is indicative of hematuria?

A

5+ RBC’s/hpf in 3 consecutive tests

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10
Q

What are 4 drugs that can color the urine?

A
  • Rifampin
  • Nitrofurantoin
  • Pyridium
  • Sulfa drugs
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11
Q

A newborn presents with brick red color in the diaper, this is most likely due to?

A

Uric acid crystals due to dehydration

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12
Q

If you collect a UA from a child and there seems to be blood in the specimen, what must you do next?

A

Confirm that the color is actually blood by doing microscopy

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13
Q

What is the RBC morphology associated with glomerular hematuria?

A

Dysmorphic RBC’s

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14
Q

What is the color of the urine associated with glomerular hematuria?

A

May be red or brown

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15
Q

What is an ominous finding in conjunction w/ hematuria?

A

Hematuria + proteinuria

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16
Q

What are 5 common causes of gross hematuria in a child?

A
  • UTIs
  • Trauma
  • Bleeding disorders
  • Renal stones
  • Cystitis –> viral (adenovirus) = hemorrhagic cystitis
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17
Q

What is the prognostic indicator of long term renal damage in children w/ Henoch-Schonlein Purpura?

A

Development of PROTEINURIA along w/ hematuria

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18
Q

How long will a child with Henoch-Schönlein Purpura feel sick?

A

Will feel sick for a long time

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19
Q

In a child w/ asymptomatic (isolated) hematuria, why is it important to ask about family hx?

A

There is entitiy known as benign familial hematuria (thin basement membrane disorder)

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20
Q

Increased urine levels of which ion may be a cause of asymptomatic microscopic hematuria in a child?

A

HYPERcalcuria

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21
Q

Children with asymptomatic (isolated) hematuria should be regularly monitored for?

A

Regularly monitored for proteinuria and HTN

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22
Q

Urine Ca-to-Creatinine ratio of >_____ is indicative of excess calcium excretion and could be cause of asymptomatic hematuria.

A

>0.2

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23
Q

What is march hematuria?

May be seen in a child presenting after what?

A
  • After vigorous exercise, it is not unusual to see some RBC’s in the urine
  • May be seen in young person who comes in for PE after sport’s practice
24
Q

If a child can void on command, how may a urine sample be collected for suspected UTI?

A

Clean-catch urine

25
Q

If a child is not able to void on command what 2 ways may you collect a urine sample that can be used for culture in suspected UTI?

A
  • Catheterization
  • Suprapubic aspiration (SPA)
26
Q

What is the recommendation for collecting a urine sample for child that can be culutured if you are going to start on Abx?

A

Collect the urine sample BEFORE starting meds

27
Q

What type of urine samples are NOT appropriate for culuture?

A

Bag urine samples

28
Q

If urine is collected by clean catch method, what criteria must be met for diagnosis of UTI?

A

Presence of both pyruia AND at least 50,000 colonies/mL of a single uropathogenic organism

29
Q

If urine is collected by cathether what is the criteria that must be met for diagnosis of UTI?

A
  • Pyruria and colony count of 50,000 CPM

or

  • 10,000-50,000 CPM confirmed by repeat
30
Q

If urine sample is obtained by suprapubic aspiration, what criteria need to be met for diagnosis of UTI?

A

Pyuria and ANY growth on culture

31
Q

Leukocyte esterase is a test looking for what?

Tells you what?

A
  • WBC’s
  • Inflammation/infection in kidney or urinary tract
32
Q

Urine Nitrate testing detects what?

Used in screening of?

A
  • Detects presence of certain types of bacteria
  • Screening for presence of UTI
33
Q

E. coli in the urine can be detected with what screening test?

A

Urine nitrate testing

34
Q

What is the recommended length for Abx treatment of a child with UTI who is febrile (pyelonephritis)?

A

10-14 days

35
Q

When does a UTI prompt imaging of a boy vs. girls urinay tract?

A
  • After the first UTI in boys
  • After second (or 3rd) in girls
36
Q

What type of imaging is done in boys after the 1st UTI?

A
  • Renal and bladder ultrasound
  • VCUG

*DO THEM BOTH!

37
Q

What are the indications for performing VUCG in girl following a UTI?

A
  • Any anomalies detected on RBUS
  • Combo of temp >39 °C + pathogen other than E. coli
  • Poor growth and HTN is part of clinical presentation
38
Q

Which grades of VUR in child should prompt referral to a specialist?

A

Grades III-V

39
Q

List 6 indications in a pediatric pt w/ UTI that would prompt a referral to a specialist

A
  • Presence of VUR (grades III-V)
  • Obstructive uropathy present
  • Renal abnormalities identified
  • Kidney function is impaired
  • Patient is hypertensive
  • Bowel and bladder dysfunction is refractory to primary care measures
40
Q

1st line Abx choice in pediatric pt with UTI that is not acutely ill and tolerating (po)?

A

Cephalosporins like cefixime or cefdinir

(2nd or 3rd gen cephalosporin)

41
Q

If pediatric pt w/ UTI is acutely ill or not tolerating PO, which Abx should be given and via which route?

A

3rd gen. cephalosporin (ceftriaxone) via parenteral route

42
Q

What do you use to listen to a diastolic murmur?

A

the bell of stethoscope

usually lower pitched w/ rumbling character

43
Q

What is a venous hum?

A

functional/innocent murmur

caused by flow of venous blood from head and neck into thorax

heard continuously while child is sitting

should disappear when pressure placed on jugular, head is turned, or lying supine

44
Q

What is the only sound heard in diastole that does not warrant a referral to cardiology?

A

venous hum

45
Q

What is a Still’s murmur and what characterizes it?

A

vibratory functional murmur

best heart at apex of heart and LL sternal border

best heard with bell

decreases in intensity when standing

46
Q

What is the relationship btw standing and the sound of a pathalogic murmur?

Exception to rule?

A

most pathologic murmurs don’t change significantly with standing

EXCEPTION: hypertrophic cardiomyopathy (HOCM)

  • harsh, crescendo-decrescendo systolic murmur best heard at apex and left SB
  • increases in intensity upon standing
  • increases w/ valsalva
47
Q

What are the key features of innocent murmurs?

A

seven S’s:

Sensitive

Short duration

Single

Small (limited to small area and non-radiating)

Soft

Sweet

Systolic

48
Q

When do you refer to a cardiologist in the setting of a heart murmur?

A

*anytime child is symptomatic*

grade 4 or above

diastolic

increased intensity when pt stands (HOCM)

femoral pulses are weak

heart sounds are obscured

clicks

Fam Hx of sudden death at young age

abnormal or extra heart sounds (except S3)

conditions predisposing to congenital heart lesion

if you get “that feeling”

49
Q

What heart defects are associated w/ Down’s Syndrome?

Why do you need to make sure you get an echo in these kids?

A

midline things:

ASD, VSD, etc

if ASD is untreated –> can get pulm HTN that is irreversible once it starts

50
Q

What sound is characteristic of an ASD?

A

fixed splitting of S2

51
Q

What are the cyanotic congenital heart dzs?

A

5T’s

Truncus arteriosus

Transposition of great vessels

Tricuspid atresia

Tetralogy of fallot

Total anomalous pulm vascular return

52
Q

What are the 4 acyanotic congenital heart dzs?

A

ASD

VSD

PDA

Coarctation of aorta

53
Q

What are the lesions you look for in the hospital when a baby has just been born?

A

ductal-dependent lesions:

hypoplastic left heart syndrome

pulmonary atresia

5Ts (all the R–> L shunting ones)

54
Q

How do you check for ductal-dependent heart lesions?

A

O2 sats are checked pre-ductal (in arm) and post-ductal (in leg)

95% in both and 3% or less difference –> all good

<90% in either –> send to cardio

90-95% or >3% difference –> repeat in one hour –> if better, ok; if same –> do it again –> if same, failed screen and must do more workup

55
Q

what is the study of choice to evaluate a heart murmur?

A

echocardiogram with doppler

56
Q

What is the most common cyanotic congenital heart defect?

A

tetralogy of fallot

(pulm stenosis + R ventricular hypertrophy + overriding aorta + VSD)

CPR-2 (28 decks)

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