Peds 4

Question 1

S/s: hyperpigmentation and hyperkeratosis, Lesions are dark, “velvety,” “dirty-looking” areas of thickened skin.

Dx?

Answer 1

Acanthosis nigricans

Question 2

What does acanthosis nigricans indicate?

Answer 2

Acanthosis nigricans is associated most commonly with obesity and may be a marker for insulin resistance (with or without polycystic ovary syndrome)

Question 3

What is included in a weight management plan?

Answer 3

• Diet: Recommend low-calorie snacks, especially fruits and vegetables, and sugar-free beverages (preferably water).
• Screen time: Total TV/video game/computer/phone time should have consistent limits and efforts made to ensure screen time does not take the place of adequate sleep, physical activity, and other behaviors essential to health. It is recommended that children not have TVs, computers, tablets, phones, or video games in their bedrooms.
• Physical activity: A child this age should have at least 60 minutes of moderate to vigorous physical activity a day.

Question 4

An 8-year-old boy is brought to clinic by his parents because they are concerned that he has not been doing his homework. His teacher recently called the parents to say that their son seems distracted in class, constantly interrupts other children when they are speaking, and is very fidgety. When you speak with the boy, he tells you that he did not know about the homework assignments and that he tries hard to pay attention in class. What is the next best step in management?

A. Do nothing, as this child’s behavior is normal
B. Find out more about his behavior at home and at school
C. Prescribe a stimulant medication for ADHD
D. Recommend group therapy for the child
E. Suggest behavior modification for the child and parenting classes

Answer 4

Find out more about his behavior at home and at school

Question 5

A previously healthy 8-year-old male is found to have a mildly elevated blood pressure during a routine health maintenance visit. Review of systems is negative. Vital signs are otherwise within normal limits. His physical exam is significant for obesity and is otherwise within normal limits. What is the most likely diagnosis?

A. Coarctation of the aorta
B. Hyperthyroidism
C. Pheochromocytoma
D. Primary hypertension
E. Renal artery stenosis

Answer 5

Primary hypertension

Question 6

A 7-year-old male presents to the clinic with reports of headaches and episodes of feeling sweaty and flushed. He also reports that at times he feels as if his heart is racing. He was full-term, had an uncomplicated birth, and has been otherwise healthy until now. On exam, his BP is 120/80 mmHg and is the same in his upper and lower extremities. His weight and height are in the 50th percentile for his age. What is the most likely cause of this patient’s hypertension?

A. Catecholamine excess
B. Coarctation of the aorta
C. Primary hypertension
D. Renal insufficiency due to renal scarring
E. Renal vascular disease

Answer 6

Catecholamine excess

Catecholamine excess (pheochromocytoma or neuroblastoma) should be suspected in a child who is hypertensive and has episodes of sudden sweating, flushing, or feels that his heart is racing. This patient is exhibiting these signs and urine catecholamine testing would be appropriate in this case.

Question 7

What is the calculation for BMI?

Answer 7

Weight(kg) / height(m)^2

Question 8

What’s the difference in BMI percentile for overweight vs obese?

Answer 8

Overweight is 85th to 94th percentile

Obese is >/= 95th percentile

Question 9

What are 5 red flags that might raise a clinician’s concern for learning disabilities?

Answer 9

1. Hx of maternal illness or substance abuse during pregnancy
2. Complications at time of delivery
3. Hx of meningitis or other serious illness
4. Hx of serious head trauma
5. Parental hx of learning disabilities or difficulty at school

Question 10

What are 3 adverse effects of ADHD medications?

Answer 10

Appetite suppression, Insomnia, Decrease in growth velocity

Question 11

What are 4 risk factors for childhood obesity?

Answer 11

• Lower SES
• Having an obese parent
• Genetic syndromes (such as Prader-Willi, Bardet-Biedl, and Cohen syndromes)
• prenatal/neonatal risk factors (high birth weight, low birth weight (SGA), maternal diabetes)

Question 12

What is the diagnostic criteria for diabetes? There are 4.

Answer 12

• HbA1c >/= 6.5% (48mmol/mol)
• Fasting plasma glucose >/= 126 mg/dL (7.0mmol/L)
• 2 hour plasma glucose >/= 200 mg/dL (11.1mmol/L) during oral glucose tolerance test
• In patient w/ sxs of hyperglycemia, random plasma glucose >/= 200 mg/dL

Question 13

What is the management plan for a child with elevated blood pressure (120/<20 to 129/<80)?

Answer 13

• Therapeutic lifestyle changes
• BP f/u in 6 months

No diagnostic workup for secondary cause needed unless concern for underlying cause

Question 14

What is the management for a child with primary HTN (when physical findings are only HTN and obesity)?

Answer 14

• Dietary changes
• Weight loss (if overweight)
• Physical activity

***Medications are typically reserved for children with stage 2 HTN