Pediatric Hypertension

Question 1

What defines a normal blood pressure in kids?

Answer 1

Less than the 90th percentile for that child’s height percentile and age

Question 2

What defines stage 1 HTN in children?

Answer 2

Greater or equal to 95th percentile to < 95th percentile + 12 mmHg

Question 3

What defines Stage 2 HTN in children?

Answer 3

Greater than or equal to 95th percentile + 12 mmHg

Question 4

Should BP be higher in the arms or legs and what are consequences if this is not true?

Answer 4

BP should be 10 - 20 mmHg higher in the legs

If not be concerned of coarctation of the aorta

Question 5

How many times do you have to record HTN in a patient before it can be confirmed that the patient indeed has HTN?

Answer 5

3 times during 3 separate visits

Question 6

Primary HTN is the predominant cause of HTN in US children. Describe the characteristics of primary HTN

Answer 6

• Greater than or equal to 6 years of age
• family hx of HTN
• obesity or overweight

Question 7

“Is his BP ok??” What’s the rule of thumb for children 1 - 10 years of age for determining the lower limit of BP?

Answer 7

must be < 70 + (age x 2)

Question 8

Describe White-Coat HTN

Answer 8

Patient presents with a BP > 95th percentile, but is actually normotensive outside the clinical setting

Try to obtain these patients BP outside the clinical setting (ex. Take at home, take at walgreens)

Question 9

What is Masked HTN?

Answer 9

Opposite of White-Coat HTN

patient w/ BP > 95th percentile outside a clinical setting, but normotensive in the clinical setting

Question 10

At what point are Karotkoff sounds absent?

Answer 10

During Diastole

This should be the point at which the swooshing of blood should no longer be heard but if present all the way to zero we call it the “4th Karotkoff sound”

Question 11

In older, school age children, prevalence of primary hypertension has increased hand-in-hand with the _______ __________

Answer 11

Obesity epidemic

Question 12

What is the most definitive way of determining that a patients BP has been high for an extended period of time leading to left ventricular hypertrophy

Answer 12

echocardiogram

Question 13

Define hematuria

Answer 13

Prescence of 3 - 5 RBCs per high power field in 3 consecutive fresh specimens over span of a few weeks

Question 14

What foods might color the urine?

Answer 14

1. Beets
2. Rhubarb
3. Fruit juices

Question 15

What drugs might color the urine?

Answer 15

1. Rifampin
2. Nitrofurantoin
3. Pyridium
4. Sulfa drugs

Question 16

Why might a newborns diaper appear bloody in color?

Answer 16

due to uric acid crystals in the urine of a newborn (brick red color)

Newborn requires only hydration

Question 17

If you want to determine that blood seen in urine is from RBCs what must you order?

Answer 17

UA w/ microscopy

Question 18

Distinguish glomerular from extra-glomerular hematuria

Answer 18

Glomerular:

• dysmorphic RBCs

Extra-glomerular:

• More normal appearing RBCs and intact

Question 19

Hematuria is not as ominous as hematuria and ________ put together

Answer 19

Proteinuria

Question 20

Lupus

Answer 20

Think glomerulonephritis

most specifically: mesangial proliferative lupus nephritis (class II)

Question 21

Henoch - Schonlein Purpura

Answer 21

• Immune complex vasculitis (IgA)
• purpura everywhere (buttocks, lower legs, elbows)
• follows a viral infection
• Will have gross hematuria
• can have proteinuria also —> will progress to end stage renal disease

Question 22

In HSP the development of _________ along with hematuria is prognostically indicative of potential long term _______ _________

Answer 22

Proteinuria; renal damage

Question 23

Occurs in males only, dilation of the bladder, ureters, and kidneys

Answer 23

Posterior Urethral Valves (PUV)

Question 24

What is the best way of obtaining a specimen from a child?

Answer 24

Catheterization

suprapubic aspiration

Bag urine only helpful if negative

Question 25

What does a postive leukocyte esterase on a dipstick indicate?

Answer 25

WBCs in urine

Question 26

What does a positive nitrate indicate on dipstick?

Answer 26

Prescence of bacteria:

• Proteus
• E coli
• Klebsiella
• Enterobacter
• Citrobacter

Question 27

In children, if treating a UTI empirically what must the treatment cover?

Answer 27

E. coli because it is the most common bacteria cause of UTI in children

Cephalosporins (cefixime or cefdinir)

Question 28

When do you image a child’s urinary tract?

Answer 28

After first UTI in Boys:

• Renal US and VCUG (voiding cystic uriagram)

After second/third UTI in girls:

• Renal and VCUG unless some serious symptom shit