Pediatric Hypertension (Newman)

Question 1

issue with the 4th report

Answer 1

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

Question 2

how were normative BP tables commissioned

Answer 2

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

Question 3

3 domains of evidence based medicine

Answer 3

clinical judgement

relevant scientific evidence

patients’ values and preference

Question 4

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

Answer 4

> 3 years old if they have risk factors

Question 5

diagnostic criteria for HTN in kids?

Answer 5

auscultatory confirmation of BP above 95th percentile at 3 visits

Question 6

BP reading for 13 yr old or older for HTN

Answer 6

130/80

Question 7

is BP normalized after repeat readings <90th percentile then

Answer 7

no additional action is needed

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

Question 8

in office if BP is elevated

Answer 8

lifestlye recommendations then recheck in 6 mo

Question 9

if BP is elevated after 6 mo

Answer 9

check UE and LE BP and recheck in 6mo

Question 10

after 12 mo if BP is still elevated

Answer 10

ABPM

diagnostic evaluation

referral

Question 11

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

Answer 11

return to annual screening

Question 12

White Coat hypertension

Answer 12

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

Question 13

masked hypertension

Answer 13

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

Question 14

what is helpful in both white coat syndrome and masked hypertension

Answer 14

ABPM

Question 15

karkotoff sound 1, 4, and 5

Answer 15

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

Question 16

most prominent evidence of target organ damage of kids

Answer 16

LVH

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

Question 17

does a urine dipstick indicate presence of RBC?

Answer 17

nope

Question 18

drugs that can colour urine

Answer 18

rifampin
nitrofurantoin
pyridium
sulfa drugs

Question 19

foods that can colour urine

Answer 19

beets
rhubarb
fruit juices

Question 20

what in a newborn diaper can look like blood?

Answer 20

uric acid crystals

or

bilirubin

Question 21

when is a UA first commonly done?

Answer 21

5 yr check up

Question 22

when is UA often done beyond the first common time

Answer 22

part of pre-participation physical

Question 23

what is more ominous than hematuria

Answer 23

hematuria and proteinuria

hematuria alone can be benign

Question 24

how often is there an underlying cause to gross hematuria

Answer 24

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

Question 25

causes of gross hematuria

Answer 25

``` UTI Trauma Bleeding disorders Renal Stones Cystitis ```

Question 26

common cause of viral cystitis

Answer 26

adenovirus

Question 27

Post infectious acute glomerulnophephritis is treated how?

Answer 27

supportive care, these kids recover

Question 28

Signs and symptoms of henoch-shonlein purpura

Answer 28

Gross hematuria Abdominal pain May have bloody stools Purpuraare usually present over the buttocks, lower legs and elbows Hives Emesis and nausea diarrhea

Question 29

kids with henoch-shonlein purpura will feel

Answer 29

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

Question 30

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

Answer 30

25% but should still be regularly monitored for proteinuria and HTN

Question 31

hypercalcuria

Answer 31

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

Question 32

hypercalciuria is usually

Answer 32

idiopathic and yield calcium oxalate crystals in urine

Question 33

march hematuria

Answer 33

after vigorous exercise repeat test when sedentary

Question 34

signs and symptoms of UTI in kids

Answer 34

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

Question 35

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

Answer 35

fever without explanable symptoms

Question 36

Caucasian disposition to UTI compared to African American

Answer 36

2-4x higher

Question 37

what congenital obstruction is only found in males

Answer 37

posterior urethral valves

Question 38

two major congenital obstructions we care about

Answer 38

ureteropelvic junction obstruction posterior urethral valves

Question 39

when are bag samples useful

Answer 39

only if negative

Question 40

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

Answer 40

50,000

Question 41

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

Answer 41

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

Question 42

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

Answer 42

ANY growth

Question 43

nitrate is a good testing for what in urine

Answer 43

presence of UTI

Question 44

most common pathogin for UTI in kids

Answer 44

E. Coli

Question 45

other gram-negative pathogens for UTI

Answer 45

klebsiella proteus enterococcus pseudomonas

Question 46

gram-positive bacteria that cause UTI

Answer 46

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

Question 47

1st generation cephalosporines are good for

Answer 47

gram positive

Question 48

cefrtriaxone is a

Answer 48

3rd generation cephalosporin

Question 49

what should you use for UTI

Answer 49

``` 3rd generation (through IV) 2nd generation (oral) ``` cephalosporin

Question 50

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

Answer 50

renal and bladder US looking for abnormalities/obstruction/secondary dilation specifically for vesicoureteral reflux

Question 51

what is renal scarring

Answer 51

loss of renal parenchyma between the calyces and the renal capsule

Question 52

long term complications of renal scarring

Answer 52

HTN decreased renal function proteinuria endstage renal disease

Question 53

when should the primary care refer to a specialist

Answer 53

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

Question 54

Holosystolic murmur is usually

Answer 54

VSD

Question 55

diastolic murmurs are usually

Answer 55

pathologic

Question 56

venous hum in kids

Answer 56

only diastolic murmur that does not warrant referral to cardiology

Question 57

Hypertrophic cardiomyopathy how do they change

Answer 57

increases in intensity when patient stands increases in intensity with valsava maneuver opposite normal

Question 58

CCHD in neborns

Answer 58

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

Question 59

most common cyanotic defect

Answer 59

tetralogy of fallot

Question 60

defects associated with ToF

Answer 60

pulmonary stenosis RV hypertrophy overriding Aorta VSD

Question 61

how does ToF look on x-ray

Answer 61

like a boot