Flashcards in 7. Pediatric HTN Deck (41)
What occurs when a patient with BP levels >95th percentile occur in a physicians office or clinic, but is normotensive outside a clinical setting?
What occurs when a patient with BP levels >95% outside of the office or clinic, but is normotensive in the clinical setting?
What has caused an increased prevalence of primary hypertension in older school aged children?
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?
ECHOCARDIOGRAPH NOT EKG
What occurs in the following situations...
Blood pressure cuff is too small..?
Blood pressure cuff is too large..?
Small = artificial elevation of the BP
Large+ artificial lowering of the BP
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?
The following do what?
COLOR THE URINE
In newborns, uric acid crystals in the urine cause a brick red color in the diaper, which is mainly caused by?
Urinanalysis are often done as part of a pre-participation physical at usually what age?
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?
UA with micro*
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?
Post Infectious Acute Glomerulonephritis
How does one treat post infectious acute glomerulonephritis?
What disease is characterized by hematuria, abdominal pain, blood stool, palpable purpura, hives, emisis, diarrhea?
Henoch Shonlein Purpura
In HSP, the development of proteinuria along with hematuria is prognostically indicative of potential long term?
(Tx: steroids work only once)
What can be expected with the following presentations...
Fever with no cause found on PE************
Loss of control
UTI in children
***if fever with no explanation after PE then UTI - get urinalysis
What are the two most common genitourinary abonormalities associated with UTIs that do not respond to therapy?
Ureteropelvic Junction Obstruction (UPJ)
Posterior Urethral Valves (PUV) - MALES ONLY
In obtaining a urine sample when UTI is suspected, what is needed from the child in order to obtain a clean catch urine sample?
The child to void on command
If the child is unable to void on command, one can perform suprapubic aspiration, or what, which is the most common?
What urine samples are only helpful if they are negative, and are NOT appropriate for culture?
Bag urine samples
(*obtain urine before giving abx)
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?
For dx of UTI, urine obtained via catheter, pyuria and how much colonies per ml CPM must be present?
50,000 or 10-15000 confirmed by repeat culture
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?
When screening for the presence of UTI, what is positive due to certain types of bacteria, including ***E.COLI ***, Klebsiella, Proteus, Pseudomonas, etc?
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?
UTI: E Coli
Ear infection/Pneumonia: Steptococcus Pneumonia
If a child is not acutely ill and tolerating by mouth, try oral antibiotics like what, which kills gram negative species?
First Gen Cephalosporin (cefixime/cefdinir)
If a child is acutely ill or not tolerating PO, the give parenteral what, adding ampicillin if enterococcus is suspected?
Third generation cephalosporin (ceftriaxone)
When would one image the urinary tract of a boy? of a girl?
Boys: after the first UTI (bc very uncommon for boys to get)
girls: after the second or third
Imaging for UTIs is a renal and bladder ultrasound including VCUG if anaomlies are seen. What does VCUG stand for?
VCUG is used to test for vesicoureteral reflux....
Grade 1 VUR: half ureter
Grade 2: Ureter and pelvis
Grade 3: Ureter, pelvis, calyces
major dilitation of the ureter and kidney
All of the following should direct you to do what?
VUR grade 3-5
obstructive uropathy present
kidney fucntion impaired
REFFERAL TO UROLOGIST/NEPHROLOGIST
What type of murmur decreases in intensity when the child stands? NOTE: most pathologic murmurs do not change significantly with standing
Stills murmur (vibratory functional murmur) innocent*
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?
The most common holocystolic murmur is due to a VSD, what type of murmurs are almost alway pathologic?
The following should direct you to do what?
grade 4 murmur
heart sounds obscured
femoral pulses weak
fam hx of sudden death at young age
Extra heart sounds except S3 in young
REFER TO CARDIOLOGIST
What is the most common defect in downs?
ASD: fixed splitting of S2
The follow are what type of congenital heart diseases?
Transposition of great vessels
Tetralogy of Fallot
Total anomalous pulmonary vascular return
Cyanotic Right to Left shift
The follow are what type of congenital heart diseases?
Coarctation of the aorta
Acyanotic Left to Right shift
Dx of critical congenital heart disease in the nursery using oxygen saturation, what are the types of lesions that are looked for?
ductal dependent lesions (all cyanotic)
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?
baby has failed screening and needs further workup
The follow is a Ddx for what kind of baby?