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CPR II Exam 3 > Pediatric Hypertension (Newman) > Flashcards

Pediatric Hypertension (Newman) Flashcards

1
Q

issue with the 4th report

A

it likely normalizes BP upward due to inclusion of many kids that were overweight or obese

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2
Q

how were normative BP tables commissioned

A

based only on BP readings from 50,000 normal weight children

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3
Q

3 domains of evidence based medicine

A

clinical judgement

relevant scientific evidence

patients’ values and preference

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4
Q

when should you start checking BP at every patient encounter for kiddoes

A

> 3 years old if they have risk factors

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5
Q

diagnostic criteria for HTN in kids?

A

auscultatory confirmation of BP above 95th percentile at 3 visits

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6
Q

BP reading for 13 yr old or older for HTN

A

130/80

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7
Q

is BP normalized after repeat readings <90th percentile then

A

no additional action is needed

counsel on lifestlye recommendation and recheck BP at next well-care visit

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8
Q

in office if BP is elevated

A

lifestlye recommendations then recheck in 6 mo

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9
Q

if BP is elevated after 6 mo

A

check UE and LE BP and recheck in 6mo

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10
Q

after 12 mo if BP is still elevated

A

ABPM

diagnostic evaluation

referral

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11
Q

if BP normalizes at any point in the 3 visit screening series

A

return to annual screening

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12
Q

White Coat hypertension

A

patient wtih BP >95th% in office but will normalize outside of clinical setting

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13
Q

masked hypertension

A

BP levels >95th % outside of clinic or office but is normotensive in clinical setting

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14
Q

what is helpful in both white coat syndrome and masked hypertension

A

ABPM

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15
Q

karkotoff sound 1, 4, and 5

A

1 systolic BP

4 sound is muffled

5th silce as cuff pressure falls below BP

if the 4th sound goes away when it emerges is used as DBP

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16
Q

most prominent evidence of target organ damage of kids

A

LVH

is reported in 34-48% of kids with mild, untreated elevated BP

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17
Q

does a urine dipstick indicate presence of RBC?

A

nope

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18
Q

drugs that can colour urine

A

rifampin
nitrofurantoin
pyridium
sulfa drugs

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19
Q

foods that can colour urine

A

beets
rhubarb
fruit juices

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20
Q

what in a newborn diaper can look like blood?

A

uric acid crystals

or

bilirubin

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21
Q

when is a UA first commonly done?

A

5 yr check up

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22
Q

when is UA often done beyond the first common time

A

part of pre-participation physical

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23
Q

what is more ominous than hematuria

A

hematuria and proteinuria

hematuria alone can be benign

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24
Q

how often is there an underlying cause to gross hematuria

A

56% of the time, is often red or tea coloured

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25
Q

causes of gross hematuria

A 
UTI
Trauma
Bleeding disorders
Renal Stones
Cystitis
26
Q

common cause of viral cystitis

A

adenovirus

27
Q

Post infectious acute glomerulnophephritis is treated how?

A

supportive care, these kids recover

28
Q

Signs and symptoms of henoch-shonlein purpura

A

Gross hematuria

Abdominal pain

May have bloody stools

Purpuraare usually present
over the buttocks, lower legs and elbows

Hives

Emesis and nausea

diarrhea

29
Q

kids with henoch-shonlein purpura will feel

A

crummy for a long time and should be followed up with UA for RBC and protein until clear

30
Q

what % of patients will no longer demonstrate hematuira 5 years later

A

25%

but should still be regularly monitored for proteinuria and HTN

31
Q

hypercalcuria

A

urine Ca:Creatinine ration >0.2 is indicative of excess Ca excretion

32
Q

hypercalciuria is usually

A

idiopathic and yield calcium oxalate crystals in urine

33
Q

march hematuria

A

after vigorous exercise

repeat test when sedentary

34
Q

signs and symptoms of UTI in kids

A

Fever (with no identifiable cause on PE)

Decreased intake

Strong smelling urine

Dark urine

Stomach pain

Frequency

Urgency

Dysuria

Loss of control

Sometimes emesis, sometimes diarrhea

35
Q

when should you always consider running a urine culture on a kid

A

fever without explanable symptoms

36
Q

Caucasian disposition to UTI compared to African American

A

2-4x higher

37
Q

what congenital obstruction is only found in males

A

posterior urethral valves

38
Q

two major congenital obstructions we care about

A

ureteropelvic junction obstruction

posterior urethral valves

39
Q

when are bag samples useful

A

only if negative

40
Q

clean catch how many colonies per mL need to be present of a single organism

A

50,000

41
Q

catheter how many colonies per mL need to be present of a single organism

A

10,000-50,000 CPM confirmed by repeat is enough for criteria

42
Q

suprapubic aspiration how many colonies per mL need to be present of a single organism

A

ANY growth

43
Q

nitrate is a good testing for what in urine

A

presence of UTI

44
Q

most common pathogin for UTI in kids

A

E. Coli

45
Q

other gram-negative pathogens for UTI

A

klebsiella
proteus
enterococcus
pseudomonas

46
Q

gram-positive bacteria that cause UTI

A

S. Saprophyticus
Enterococcus (esp with catheter)
S. Aureus (rare)

47
Q

1st generation cephalosporines are good for

A

gram positive

48
Q

cefrtriaxone is a

A

3rd generation cephalosporin

49
Q

what should you use for UTI

A 
3rd generation (through IV)
2nd generation (oral)

cephalosporin

50
Q

After the first UTI in boys and second (sometimes third) in girls what should you do

A

renal and bladder US looking for abnormalities/obstruction/secondary dilation

specifically for vesicoureteral reflux

51
Q

what is renal scarring

A

loss of renal parenchyma between the calyces and the renal capsule

52
Q

long term complications of renal scarring

A

HTN

decreased renal function

proteinuria

endstage renal disease

53
Q

when should the primary care refer to a specialist

A

dilating veicoureteral reflux (grades 3-5)

obstructive uropathy is present

renal abnormalities are identified

kidney function is impaired

patient is hypertensive

bowel and bladder dysfunction is refractory to primary care measures

54
Q

Holosystolic murmur is usually

A

VSD

55
Q

diastolic murmurs are usually

A

pathologic

56
Q

venous hum in kids

A

only diastolic murmur that does not warrant referral to cardiology

57
Q

Hypertrophic cardiomyopathy how do they change

A

increases in intensity when patient stands

increases in intensity with valsava maneuver

opposite normal

58
Q

CCHD in neborns

A

just a screen

if infant fails dig deeper for why they have decreased O2 sats

59
Q

most common cyanotic defect

A

tetralogy of fallot

60
Q

defects associated with ToF

A

pulmonary stenosis
RV hypertrophy
overriding Aorta
VSD

61
Q

how does ToF look on x-ray

A

like a boot

CPR II Exam 3 (13 decks)

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