7. Pediatric HTN

Question 1

What occurs when a patient with BP levels >95th percentile occur in a physicians office or clinic, but is normotensive outside a clinical setting?

Answer 1

White-Coat Hypertension

Question 2

What occurs when a patient with BP levels >95% outside of the office or clinic, but is normotensive in the clinical setting?

Answer 2

Masked hypertension

Question 3

What has caused an increased prevalence of primary hypertension in older school aged children?

Answer 3

Obesity

Question 4

Left ventricular hypertrophy LVH is the most prominent evidence of target organ damage in children and adolescents, what is the primary tool for assesing prevalence or absence of LVH?

Answer 4

ECHOCARDIOGRAPH NOT EKG

Question 5

What occurs in the following situations…
Blood pressure cuff is too small..?
Blood pressure cuff is too large..?

Answer 5

Small = artificial elevation of the BP

Large+ artificial lowering of the BP

Question 6

What is the presence of 5 or more RBCs per high power field in 3 consecutive fresh centrifuged specimens obtained over the span of a few weeks?

Answer 6

Hematuria

Question 7

The following do what?
Rifambin
Nitrofurantion
Pyridium
Sulfa drugs
Beets
Rhubarb
Fruit Juices

Answer 7

COLOR THE URINE

Question 8

In newborns, uric acid crystals in the urine cause a brick red color in the diaper, which is mainly caused by?

Answer 8

Dehydration

Question 9

Urinanalysis are often done as part of a pre-participation physical at usually what age?

Answer 9

5

Question 10

A UA can only tell you if there is myoglobin and hemoglobin within the urine, what do you need to order to tell if there are RBCs?

Answer 10

UA with micro*

Question 11

What is characterized by recent strep throat, follow by hematuria, HTN, edema, proteinuria, +ASO titer, low serum complement C3, and deposition of immune complexes in glomeruli?

Answer 11

Post Infectious Acute Glomerulonephritis

Question 12

How does one treat post infectious acute glomerulonephritis?

Answer 12

Supportive Care!

Question 13

What disease is characterized by hematuria, abdominal pain, blood stool, palpable purpura, hives, emisis, diarrhea?

Answer 13

Henoch Shonlein Purpura

IgA vasculitis

Question 14

In HSP, the development of proteinuria along with hematuria is prognostically indicative of potential long term?

Answer 14

RENAL DAMAGE

Tx: steroids work only once

Question 15

What can be expected with the following presentations...
Fever with no cause found on PE************
Decreased intake
Smelly Urine
Dark Urine
Stomach Pain
Frequency/Urgency
Dysuria
Loss of control

Answer 15

UTI in children

***if fever with no explanation after PE then UTI - get urinalysis

Question 16

What are the two most common genitourinary abonormalities associated with UTIs that do not respond to therapy?

Answer 16

Ureteropelvic Junction Obstruction (UPJ)

Posterior Urethral Valves (PUV) - MALES ONLY

Question 17

In obtaining a urine sample when UTI is suspected, what is needed from the child in order to obtain a clean catch urine sample?

Answer 17

The child to void on command

Question 18

If the child is unable to void on command, one can perform suprapubic aspiration, or what, which is the most common?

Answer 18

Catheterization

Question 19

What urine samples are only helpful if they are negative, and are NOT appropriate for culture?

Answer 19

Bag urine samples

*obtain urine before giving abx

Question 20

For Dx of UTI, urine obtained by clean catch with the presence of both what, and at least 50,000 colonies per ml of a single uropathogenic organism?

Answer 20

Pyuria

Question 21

For dx of UTI, urine obtained via catheter, pyuria and how much colonies per ml CPM must be present?

Answer 21

50,000 or 10-15000 confirmed by repeat culture

Question 22

What enzyme is present in the urine, and is positive when WBC is high in the urine, signaling inflammation and infection in the kidney or urinary tract?

Answer 22

Leukocyte Esterase

Question 23

When screening for the presence of UTI, what is positive due to certain types of bacteria, including **E.COLI **, Klebsiella, Proteus, Pseudomonas, etc?

Answer 23

Nitrate

Question 24

What is the most common bacterial cause of UTI in children? What is the most common bacterial cause of ear infection or pneumonia in children?

Answer 24

UTI: E Coli

Ear infection/Pneumonia: Steptococcus Pneumonia

Question 25

If a child is not acutely ill and tolerating by mouth, try oral antibiotics like what, which kills gram negative species?

Answer 25

First Gen Cephalosporin (cefixime/cefdinir)

Question 26

If a child is acutely ill or not tolerating PO, the give parenteral what, adding ampicillin if enterococcus is suspected?

Answer 26

Third generation cephalosporin (ceftriaxone)

Question 27

When would one image the urinary tract of a boy? of a girl?

Answer 27

Boys: after the first UTI (bc very uncommon for boys to get) girls: after the second or third

Question 28

Imaging for UTIs is a renal and bladder ultrasound including VCUG if anaomlies are seen. What does VCUG stand for?

Answer 28

Voiding cystourethrography

Question 29

``` VCUG is used to test for vesicoureteral reflux.... Grade 1 VUR: half ureter Grade 2: Ureter and pelvis Grade 3: Ureter, pelvis, calyces Grade 4/5:? ```

Answer 29

major dilitation of the ureter and kidney

Question 30

``` All of the following should direct you to do what? VUR grade 3-5 obstructive uropathy present renal abnormalities kidney fucntion impaired HTN ```

Answer 30

REFFERAL TO UROLOGIST/NEPHROLOGIST

Question 31

What type of murmur decreases in intensity when the child stands? NOTE: most pathologic murmurs do not change significantly with standing

Answer 31

Stills murmur (vibratory functional murmur) innocent*

Question 32

What is the one murmur which increases in intensity when standing and increases with valsalva maneuver, known as a harsh crescendo-decresecendo systolic murmur heard best at the LSB and apex?

Answer 32

Hypertrophic cardiomyopathy

Question 33

The most common holocystolic murmur is due to a VSD, what type of murmurs are almost alway pathologic?

Answer 33

DIASTOLIC murmurs

Question 34

``` The following should direct you to do what? grade 4 murmur diastolic murmur symptomatic murmur heart sounds obscured femoral pulses weak Clicks fam hx of sudden death at young age Extra heart sounds except S3 in young ```

Answer 34

REFER TO CARDIOLOGIST

Question 35

What is the most common defect in downs?

Answer 35

ASD: fixed splitting of S2 VSD: holosystolic

Question 36

The follow are what type of congenital heart diseases? Truncus Arteriosus Transposition of great vessels Tricuspid Atresia Tetralogy of Fallot Total anomalous pulmonary vascular return

Answer 36

Cyanotic Right to Left shift

Question 37

``` The follow are what type of congenital heart diseases? ASD VSD PDA Coarctation of the aorta ```

Answer 37

Acyanotic Left to Right shift

Question 38

Dx of critical congenital heart disease in the nursery using oxygen saturation, what are the types of lesions that are looked for?

Answer 38

ductal dependent lesions (all cyanotic)

Question 39

If the pulse oximetry of a newborn on the right foot or hand is less than 90%, or is the O2 saturation is 90-95 in hand/foot or >3% difference between both after 3 screenings, what occurs?

Answer 39

baby has failed screening and needs further workup

Question 40

``` The follow is a Ddx for what kind of baby? Fever Hypovolemia RDS **CARDIAC LESION** ```

Answer 40

Tachypnea

Question 41

What is the most common cyanotic congenital heart defect, which pulmonary stenosis, RVH, overriding aorta, and ventricular septal defect?

Answer 41

Tetrology of Fallot TOF*