Urinary, Cardio, anemia, endocrine Flashcards
1
Q
biggest worry in kids with UTI?
A
hydronephrosis and renal scarring
2
Q
what is Vesicoureteral Reflux?
A
abnormal flow of urin from bladder into the upper urinary tract, is a congential anomaly and depends on the valve in the ureter that is supposed to prevent reflux
3
Q
what relationship does the position of the ureter tunnel have to do with the likelihood of reflux?
A
the shorter the tunnel, the more likely reflux is
as children grow the tunnell elongates, so can grow out of VUR
4
Q
what classifies severe VUR?
A
massive dialation of ureter, renal pelvis, and calyces
5
Q
Grade I VUR
A
reflux into ureter
6
Q
Grade II VUR
A
reflux to the kidney
7
Q
Grade III VUR
A
Reflux to kidney with dilation of ureter
8
Q
Grade IV VUR
A
reflux with dilation of ureter and mild blunting of renal calyces
9
Q
Grade V VUR
A
reflux with dilation of ureter and blunting of renal calyces
10
Q
visible anomalies known to be associated with renal anomalies
A
myelomeningocele
prune belly syndrome
vater syndrome
eat deformities
11
Q
how does VUR almost always present?
A
as a UTI
12
Q
most common clinical presentation of VUR in ages 0-2
A
fever w/out obvious source of infection
13
Q
what is a marker of risk in URI of renal damage?
A
fever
14
Q
clinical presentation/ symptoms of VUR in newborns
A
irritability fever (often the only thing) jaundice anorexia vomiting diarrhea symptoms: respiratory distress renal failure flank masses urinary ascites UTI Failure to thrive
15
Q
clinical presenation/symptoms of VUR in infants, toddlers, and preschoolers
A
Fever vomiting diarrhea abdominal pain symptoms: URI nocturnal enuresis failure to thrive
16
Q
symptoms of VUR in children and adolescents
A
cystitis
dysuria
frequency
urgency
17
Q
symptoms of pyelonephritis
A
fever (high in infants) flank pain abd pain CVA tenderness vomiting
18
Q
symptoms of cystitis
A
usually afebrile or low grade
few systemic signs
dysuria, urinary incontinence or retention, hematuria
may have cloudy urine
19
Q
how is leukocyte esterase on urinalysis useful?
A
it helps distingush asympomatic bacteriuria from those with true UTI, if it is negative it is asymptomatic bacteruria
20
Q
what is the key to distinguishing true UTI? from asymptomatic bacteriuria?
A
the presence of pyuria
21
Q
if positive nitrites in urinalysis what does it rule IN?
A
UTI, has few false positives
22
Q
in the new UTI guideline the CFUs required to diagnose UTI is now what?
A
50,000
23
Q
usual choices of ABX for UTI?
what should guide the decision?
A
augmentin, cephalosporin, bactrim
local sensitivity patterns
24
Q
infants with fever and UTI need to have what done?
A
renal and bladder US
25
when should a RBUS be performed on an infant with UTI (less than age 2)?
W/ in 1st two days of treatment
26
when is VCUG indictated?
if RBUS shows hydronephrosis, scarring, findings that suggest high grade VUR r obstructive uropathy
OR if recurrence of febrile URI
27
what can a VCUG NOT evaluate?
obstruction of flow of urine from the kidneys
28
what appearance will a ureterocele have on a urogram in VUR?
cobra-head
29
a VCUG should not be performed when?
there is an active, untreated UTI
30
What does a DSMA scan detect?
pyelonephritis, renal scarring, and thinning of the renal cortex
can give an estimation of the percentage of renal function of each kidney
31
what does an IVP detect? when is it usually done?
detects scarring and evaluates renal function
| if VCUG positive
32
when can you treat UTI with bactrim (at what age?)
2mos (some say 3mo)
33
if suspicious of pyelonephritis what antibxs should be used?
3rd gen cephalosporins like rocephin
34
what anitbx is considered 1st line therapy for febrile child with UTI with pending culture
rocephin
35
which fluorquinolone is allowed in kids and at what age?
cipro: age 6 and older
36
duration of antibiotic therapy for:
* cystitis:
* pyleonephritis:
* 10 days
| * 14 days
37
when should follow up cultures for UTI be obtained?
2nd: 72 hours
3rd: 4-7 days after abx completed
38
what if VUR is determined on VCUG?
may be on prophylactic ABX for 6mos to 2 years
| will have yearly VCUG
39
what does cranberry juice do for a UTI?
decreases bacterial adherence to bladder wall
40
when to refer to physician for UTI?
```
child <2 years
elevated BP
febrile UTI
flank pain or CVA tenderness
evidence of sexual abuse or trauma
```
41
when to refer to peds urologist
VUR noted or suspected on RUS or VCUG
suspicion of foreign body in urinary tract
boy or prepubertal girl w/ recurrent UTI or child having fist documented UTI when imaging sudies are unobtainable
hematuria persisting after resolution of infection
42
definition of prehypertension in kids
systolic or diastolic BP between 90th and 95th [ercentiles for age, gender and height
43
definition of perhypertension after the age of 12
BP b/t 120/80 and the 95th percentile
44
how is hypertension staged?
extent to which BP exceeds the 95th percentile , determines treatment, management, and urgency
45
stage 1 hypertension?
BPs that range from the 95th percentile to 5mm hg above the 99th percentile
46
stage 2 hypetension?
BPs that are higher then 5mm hg above the 99th percentile
47
which type of hypertension is more common in adolescents?
primary
48
which type of HTN is more common in preadolescents?
secondary
49
lab studies/ tests for pt with HTN?
```
Ambulatory BP
UA/ culture
CBC
serum electrolytes, BUN, Cr, Ca
uric acid
fasting lipids
maybe CXR, EKG
ECHO
renal ultrasound
```
50
Labs are normal in what type of HTN?
| what is the exception?
primary
| uric acid, usually elevated in kids with essential htn
51
what is the most common cause of HTN in children??
Renal disease
52
the younger the child and the higher the BP what diagnosis of what type of HTN is mostly likely
secondary
53
what are indications for antihypertensive drug therapy in children?
```
symptomatic hypertension
secondary hypertension
hypertensive target organ damage
diabetes
persistent HTN after non pharmacologic tx
```
54
what are goals of treatment for HTN in children:
for those with uncomplicated primary:
for those with chronic renal disease, diabetes, or hypertensive target organ damage
* less than 95th percentile for age, gender, and height
| * less than 90th percentile
55
TChol levels
normal
boarderline
elevated
< or = 170
170-199
>or = 200
56
LDL levels
normal
boarderline
elevated
< or = 110
110-129
> or = 130
57
TTriglycerides levels
normal
boarderline
elevated
< or = 100
100-140
> 140
58
what is Archus corneae?
physical finding in hyperlipidemia: depositis of cholesterol creating a thin white circular ring on the outer edge of the iris
59
what is tendon xanthoma?
thickened tissue due to fat deposits surrounding the achilles and extensor tendor
60
what is xnthelasma?
yellowish deposits of cholesterol surrounding the eye
61
palmar xantoma?
pale lines on creases of palms
62
eruptive xanthomas?
papular yellowish lesions with red base that occur on bttocks, elbows, and knees
63
how old must child be for statin treatment in hyperlididemia?
at lease 10 years
64
when would you treat with statins in children?
if LDL> 160 and family hx of premature CAD
| when LDL? 190 w/out family hx of premature CAD or if there are other risk factors for CHD like HTN or obesity
65
what is kawasaki's disease?
an idiopathic, multisystem diesease in young children: characterized by vasulitis of small and medium sized blood vessels
66
what is required for diagnosis of kawasakis disease?
fever for more than 5 days despite antibx + 4 classic symptoms
OR
persistent fever + 3 classic symptoms and coronary artery abnormalities
67
classic symptoms/ criteria for Kawasakis disease/
* nonexudative conjunctival infection
*polymorphous nonvesicular rash
*mucosal involvement of upper respiratory tract
*edema or erythema of hands and feet
cervical adenopathy of at least 1.5cm in diameter
68
what classifies as mucosal involvement in the criteria for Kawasakis
erythemia, fissures of the lips, crusting of the lips and mouth, or strawberry tongue. rarely exudative pharyngitis and discrete oral lesions are rare
69
atypical Kawasakis:
presentation?
who is it more common in?
may have less than 4, but still may develop aneurysms
more common in children less than 1 year: will see: irritability, diarrhea, abd pain, vomiting w/ coronary artery disease
70
complications of KD?
aneurysms, these may thrombose and cause MI and death
| pancarditis often present in 1st 10 days, pericardial effusions may accompany
71
when are aneurysms usually noted in KD?
12-28 days after onset, rare after 28 days
72
how can pancarditis in KD present?
as CHF
73
kawasakis physcial exam findings
```
red mouth and throat
strawberry tongue
red, swollen, racked lips
bulbar conjunctivitis w/ out exudate
at lease one cervical node 1.5cm or lardger
generalized polymorphous red rash
induration of hands and feet
periungual and groin desquamation may occur
```
74
CBC findings in kawasakis
WBC usually elevated w a shift to the left
| thrombocytosis usually in 2nd week
75
tx of kawasakis
IVIG: one dose over 10 hours
high dose ASA 80-100mg of aspirain in 4 doses: continued until day 14 or when child has been afebrile for 48 hours, then is decreased and is d/c when platelet cont is normal (about 6- 8 weeks)
steroids (methylprednisolone may be useful can be given inconjunction with IVIG or those who dose respond to IVIG)
76
children typically show improvement how long after IVIG
2 days
77
most common cause of anemia in children?
| age groups and why?
iron deficiency
6-24month: loss of maternal iron stores, increased growth needs
adolescents: menstration
78
what can temprarily decres HgB and WBC and increase platelets? so what should you do?
viral infections: postpone anemia testing for 2 weeks
79
absolute neutrophil counts of ______ significantly increases a childs risk of developing a life threatening infection
> 500
80
s/s of anemia
pallor, fatigue, heart failure, jaundice
81
s/s of polycythemia
irritability, cyanosis, seizures, jaundice, stroke, HA
82
s/s of neutropenia
fever, pharyngitis, oral ulceration, cellulitis, lymphadenopathy, bacteremia
83
s/s of thrombocytopenia
petechiae, ecchymosis, GI bleeding, epistaxis
84
s/s of coagulopathy
bruising, hemarthrosis, mucosal bleeding
85
s/s of thrombosis
PE, DVT
86
what is the only function of RBC's?
to carry Hgb
87
what are the two types of anemia?
anemia of Acute blood loss
| grandual anemia w/ no loss of blood volume
88
s/s of grandual anemia?
HA, dimmed vision, loss of appetitie, nausea, constipation, heart failure, pallor, tachycardia, murmurs, dyspnea, fatigability, dizziness and fainting , tinnitus
89
"cytic" refers to RBC ______?
size
90
"chromic" refers to RBC ______?
Hgb content
91
what does hypochromic, microcytic anemai mean?
low hgn in the cell and the size is small
92
what is normocytic anemia associated with?
systemic illness that impairs bone marrow sythesis of RBCs
93
what is associated with macrocytic anemias?
Viramin B12 and folic acid dificiencies
94
what causes hypochromic microcytic anemia?
inadequate production of Hgb
95
which RBC indices is used to determine if cells are normocytic, microcytic, or macrocytic?
Mean corpuscular Volume
96
what diseases cause decreased values of RBCs
Anemia, neoplastic disease, hemorrhage, lupus, addisons, theumatic fever, subactue endocarditis, chronic infection
97
what diseases cause increased values of RBCs
erythrocytosis, renal disease, extra renal tumors, living in high altitudes, pulmonary disease, CVD, alveolar hypoventilation, tobacco use, and dehydration
98
what does MCV tell you?
voume occupied by a single RBC
99
what MCV values consider the RBCs normocytic?
82-98
| although, higher in infants & newborns and elderly
100
MCV values mean RBCs are microcytic?
< 82, more RBCs in a given volume
101
MCV values mean RBCs are macrocytic?
> 100: less RBCs in a given volume
102
decreased levels of Hgb found in what?
```
anemias
hemorrhage
hemolytic anemias
hypothyroidism
liver disease
```
103
increased levels of Hgb found in what?
```
polycythemia
CHF
COPD
excessive fluid intake
extreme physical exercise
```
104
what is the panic value for hemoglobin
5.0: heart failure and death
105
what can hgb > 20 cause?
clogging of capillaries
106
what does hematocrit measure?
the percentage by voume of packed RBCs in whole blood (packed cell volume PCV)
107
what can cause decreased hematocrit?
```
anemia
neopastic disease
hemolytic diseases
adrenal insufficiency
chronic disease
```
108
what can cause increased hematocrit?
erythrocytosis
polycythemia vera
shock
living in high altitudes
109
what can a HCT < 20 cause?
cardiac failure and death
110
what can a HCT of > 60 cause?
spontaneous clotting
111
what is mean corpuscular Hgb concentration?
average concentration of hgb in the RBC
112
what is mean corpuscular hemoglobin?
a measure of the average weight of Hgb/ RBC
113
what can Mean corpuscular hgb help measure?
response to therapy for anemia
114
what can mean corpuscular hemoglobin help diagnose?
the severly anemic
increased in macrocytic anemia and newborns
decrased in microcytic anemia
115
what does RDW meaasure?
the degree of abnormal variation in RBC size
116
what is a reticulocyte count?
% of immature RBCs
117
what can reticulocyte count help distinguish?
anemias cause by bone marrow failure from those caused by hemorrhage or hemolysis
118
what is reticulocytosis?
| what can it help recongnize?
increased RBC production as the bone marrow replaces cells lost of prematurely destroyed cells
otherwise occult disease like hidden chronic hemorrhage or unrecongnized hemolysis (sickle cell, thalassemia)
119
what does a reduce reticulocyte count mean?
bone marrow is not producing enough RBCs
120
what classification anemia involves low MCV and MCHC?
| what anemias fall into this category?
microcytic, hypochromic: ie: cells are small cells are pale
IDA
thalassemia
121
what classification of anemia involves high MCV and normal MCHC?
what anemias fall into this category?
Macrocytic, normochromic
cells are large, normal amount of Hgb: normal color
anemias of folate and vit B12 deficency
Refractory anemia
122
what classification of anemia involves normal MCV and MCHC?
| what anemias fall into this category?
normocytic, normochromic anemia
normal size and color/ volume of Hgb
a broad spectrum of anemias
123
what classification is IDA?
hypochromic, microcytic
124
what is most common type of anemia?
IDA
125
what are the high risk groups of IDA in pediatric populations?
infants fed a high volume of cows milk
| teenage girls menstruating
126
no infant should consume more than how many oz of formula a day?
32oz
127
when are premies' maternal iron stores usually depleted Vs a normal, full term infant?
2mos vs 4-6 mos
128
what is the most common age group for anemia to maifest?
9-24 months
129
what is important to remember about iron deficiency and lead?
in iron deficiency, lead absoption occurs more easily
130
what is the first value to fall in iron deficiency?
Ferritin
131
What is Ferritin and what does it reflect?
a protein that bind iron for storage, it reflects the amount of iron stores
132
what ferritin level indicates iron deficiency?
<10
133
what is TfR1? what does it detect?
| If it is elevated what does that mean?
serum transferrin receptor 1: detects iron deficiency at cellular level (is what trasfers iron into the cell)
there is a decrease in iron stores, there is an upregluation to better compete for iron
134
what is CHr?
| what does it do?
reticulocyte Hgb concentration
a measure of iron available to cells recently released from the bone marrow
has been shown to be strongest predictor of ID in kids
135
when diagnosing IDA what labs need to be ordered? (if Hgb <11?
what about diagnosis of iron deficiency w/ out anemia?
same for both:
Ferritin + CRP
OR
CHr
136
what is an alternative approach to diagnosing IDA if stable patient, mild anemia, cause seems dietary, compliance with therapy is likely and follow up is assured?
supplement with iron and monitor response
137
what increase in HgB after 1 month of therapy with supplementation of iron signifies the presence of ID?
1g/dL
138
treatment of IDA?
decrease milk intake to 16oz/day
3-6mg/kg/day in 2-3 doses of iron supplementation
transfusion only when Hgb <7
treat underlying cause
139
SEs of iron supplementation
```
temporary staining of teeth
contstipation or occausionally diarrhea
toxic in overdose
will cause greenish/ black stool discoloration
GI upset if taken on empy belly
```
140
f/up in IDA?
CBC in 1 month
| resolution in 3-6 months
141
good food sources of iron
better sources
best sources
\tuna, oatmeal, apricots, spinach, kale, greens
better: beef, fish, poultry, raisins, eggyoks, legumes, apricots, spinach, kale, greens.
BEST: breast milk, formula with iron, infant cereals or other iron fortified cereals, liver, prune juice
142
if MCV is low, what should you get to determine if its IDA?
ferritin
143
IDA is associated with a _______ reticulocyte count
decreased
144
if MCV is high what levels should you get next?
B12 and folate
145
iron supplementation dose at 4 months if exclusively or partially breastfed infants?
1mg/kg
146
recommended iron intake for 6-12mo of age?
11mg/day
147
recommended iron intake for 1-3 years?
7mg/day
148
supplementation for preterm infants with iron dose and duration
what is the exception?
2mg/kg/day until 12 months
| infants who received multiple transfusions of packed RBCS
149
what vitamins does poly vi sol contain?
A,B,C,D,E, iron and flouride
150
what vitamins does tri Vi sol contain?
A,D,C, Iron, Flouride
151
what are the most common vitamin deficiencies that result in anemia?
B12 and B9
152
why is vit deficiency anemia also called megalobalstic?
with deficiency erythroblasts become big, So MCV is high, macrocytic
153
lab values in megaloblastic anemia
hgb low
RBC disproportionately low
MCV is high (RBCs are large)
MCHC is normal
154
what test with differentiate folate def vs B12?
serum B12, normal in folate, decreased in b12 deficiency
155
good sources of folate
```
liver
mushrooms
oatmeal
peanut butter
red beans
soy
```
156
response to folate replacement should be evaluated when? what should you see?
reticulocytosis in 1 week
Hbg & HCt values increase in 1 week
HCT should be normal in 2 months
157
importance of folate?
RBCs cant reproduce without folate
158
what is pernicious anemia?
disoreder w/ failure to absorb B12, lack of intrinsic factor
159
how can you distinguish anemia of chronic disease from iron deficiency anemia?
ferritin level: is normal or elevated in anemia of chronic disease
160
what is type one diabetes also called?
autoimmune Type I DM
161
pathology of type I diabtetes
in genetically susceptible people: an environmental trigger causes an autoimmune-mediated destruction of B pancreatic cells leading to absolute insulin deficiency
162
what chromosome makes a person genetically susceptible to diabetes?
Chromosome 6
163
characteristics of DKA
hyperglycemia, ketosis, acidosis, osmotic diuresis, dehydration, shock and death
164
s/s of hypoglycemia
```
trembling
diaphoresis
tachycardia
lethargy
mental staus change
seizures
coma
```
165
what are the 3 P's of diabetes, why do they happen?
polyuria: from high osmolality
polydypsia: from water loss resulting from polyuria
polyphagia is because low sugar from excessive secretion: makes them feel hungry
166
s/s of type one diabetes
3 P's, nocturia, weight loss or failure to gain, fatigue, possible blurred vision
167
diagnosis of type I diabetes
FBS> or = 126
random blood sugar > or = 200
2 hour post prandial blood glucose > or = 200
also: glucosuria and ketonuria
anti insulin antibodies positive in > 90 %
HgB A1C > 6.5% (7 in kids)`
168
diagnosis of prediabetes:
FBS> 100
| 2 hour GTT> 140
169
D/D of polyuria in diabetes
URI, DI, renal glucouria, hypercalcemia
170
D/D of DKA
sepsis, pneumonia, acute abdomen, ASA poisoning
171
D/D of polydipsia
can be psychogenic
| DI
172
D/D of hyperglycemia
steroid use, stress or trauma
173
D/D of hypercalcemia
weight loss, fatigue, lethargy
174
what should you do in children presenting with vague symptoms especially during flu season?
urine dip
175
goals of therapy in diabetes?
FBS 80-120
PP< 180
Hgb A1C < 7.0 %
176
calorie requirments/ limitations in type I diabetes
infants and preschoolers: 1000 calories + 100 calories for each year of age
school age: 65cal/kg of ideal body weight
177
sources of simple sugars diabetics should carry around
```
need 15grams of fast acting CHO:
4 oz of OJ
5 life savers
3 glucose tabs
8 oz mnilk
4-6 oz of soda
2 tbsp raisins
```
178
what is given for hypoglycemia in those unable to swallow or respond
glucagon
179
glargine (lantis) is now approved down to what age?
6 years
180
novolog is now approved down to what age?
2 years
181
what is the dawn phenomenon?
fasting hyperglycemia due to release of growth hormone, cortisol, and adrenaline that occurs between 2 and 3 am
182
when should you refer/ consult in diabetes?
any new case w/ signs of ketosis should be hospitalized
any new cases to endocrinologist
all newly diagnosed in diabetes education program
refer to opthalmologist for baseline exam
183
yearly tests/ exams for diabetes?
```
eye exams
urine samples
cholesterol profile
thyroid studies
comprehensive chemistries
```
184
cause of type 2 diabetes
decreased insulin production
insulin resistance
hepatic glucose production
reduced glucose uptake by target tissue
185
what is insulin resistance?
when muscle, fat, and liver cells resist the insulin molecule on the cell membrane and outside the cell, the insulin does not initiate the usually chain of enzymatic reactions causing glucose levels to rise
in other words:
glucose must enter the cell to be utilized, needs insulin to enter the cell, w/out cellular response to insulin glucose cannot enter the cells to be utilized, so it stays in the blood
186
why is the onset of puberty an important factor in type II diabetes?
the release of pubertal hormones increases resistance to insulin and initiates hyperglycemia
187
clinical presentation of type II diabetes
```
BMI > or = 85th %tile
acanthosis nigricans
glycosuria
may have vagues sx like:
lethargy
fatigue
blurry vision
frequent urination
yeast infections
```
188
what does acanthosis nigricans mean?
insulin resistance
189
all children with BMI > or = 85th percentile should have what?
FBS
190
when should you screen for type II diabetes?
obese or overweight
family hx of diabetes
high risk ethnic group
polycystic ovary syndrome
191
what is critical in the treatment/management of type II diabetes?
regular aerobic activity
| weight loss/ stabilization
192
what age is metformin (glucophage) approved for?
> or = to 10 years
193
what do sulfonylureas do in type II diabetes?
increase endogenous insulin production and release
194
what do biguanides do in type II diabetes?
reduce hepatic glucose production
195
what do thiazolidinediones do in type II diabetes
improve peripheral insulin insensitivity
196
What do alpha glucosidase inhibitors do?
competitively inhibit intestinal glucose absorption
197
what is most common side effect with metformin?
GI upset, gets better after one month of treatment
198
what are the benefits of oral antidiabetic agents?
can reduce long term complications
| added: weight loss
199
what is Maturity onset diabetes in youth: MODY?
family of autosomal dominant syndromes caused by mutation of genes involved in the regluation of pancreatic dvmt or insulin secretion
onset before age of 25
has:
impaired insulin secretion but not total absence
variable degrees of insulin
200
presentation of MODY?
begins with mild to moderate hyperglycemia w/out ketoacidosis, may progressively worsen, may eventually need insulin
201
what is metabolic syndrome?
a consellation of metablolic characteristics that place one at higher risk for CV events: new guideline: having at least 3 of the 5 metabolic abnormalities
202
what are the 5 metabolic abnormalities that one must have 3 of to be diagnosed with metabolic syndrome/
```
central obesity (apple shape)
high BP
high triglycerides
low HDL cholesterol
insulin resistance
```
203
what are thought to be the two most important metabolic disturbances in metabolic syndrome?
abdominal obesity and insulin resistance
204
defining crieteria of abdominal obesity in metabolic syndrome by waist circumference:
Men:
Women:
Men: >40 in
Women: > 35in
205
defining criteria for triglycerides in metabolic syndrome?
> 150
206
defining criteria for HDL in metabolic syndrome?
Men:
Women?
Men: < 40
| Women< 50
207
defining criteria for BP in metabolic syndrome?
> or = 130/ > or = 85
208
defining criteria for FBS in metabolic syndrome?
> or = 110
209
what is the test for insulin resistance?
2 hour post prandial glucose tolerance test
