Cases 5 & 6 - 16 yo WCC PPE

Question 1

What does HEEADSSS stand for?

Answer 1

H - Home | E - Educ/employment | E - Eating d/o | A - Activities | D - Drugs | S - Sexuality | S - Suicide risk/depr | S - Safety (TEXT/DRIVING!, fights, car, weapons)

Question 2

Finger marks of bulimia called?

Answer 2

Russell’s sign

Question 3

First systemic sx of anorexia? Progression of sx from there?

Answer 3

Bradycardia (+/- postural hypotension), electrolyte imbalances, arrhythmias, circulatory collapse, death

Question 4

Review Tanner stages for pubic hair, breast and penile development.

Answer 4

See sheet in Peds folder

Question 5

Labs to order for bleeding d/o work-up?

Answer 5

CBC w/ retic count; Periph smear; PT & PTT; Platelet function test; Factor VIII activity; vWF antigen; vWF activity (aka Ristocetin cofactor)

Question 6

Define syncope?

Answer 6

transient, usually brief, loss of conscioussness and postural tone d/t decr cerebral perfusion

Question 7

List the maneuvers in the 2 minute ortho exam?

Answer 7

See sheet in Peds folder

Question 8

Dosing schedule for HPV4 vaccine?

Answer 8

First dose. A second dose is recommended two months after the first dose and the third dose six months after the first dose.

Question 9

Which murmurs in adolescents deserve further w/u?

Answer 9

Louder than grade III/IV; Any Diastolic murmur; Murmur that increases w/ standing or Valsalva

Question 10

vWF causes lengthening of the aPTT or PT/INR?

Answer 10

aPTT is mildly prolonged in 50% of vWD cases because vWF affects Factor VIII -> intrinsic pathway (tested by aPTT; Mnemonic: “the T’s are IN a relationship”)

Question 11

Inheritance pattern of vWD?

Answer 11

autosomal dominant (more common Types I & II); autosomal recessive (more rare and severe Type III)

Question 12

Inheritance pattern of hemophilia?

Answer 12

x-linked recessive

Question 13

Phosphorous supplementation for anorexia inpatients?

Answer 13

sodium phosphate 1.3 mEq/kg q8hr oral: to reduce risk

of refeeding syndrome [CHOC Guideline]

Question 14

What are the main s/sx of refeeding syndrome?

Answer 14

delirium, CP, heart failure often w/ hypo-phos and depletion of K+ and mag

Question 15

What is the ristocetin cofactor test?

Answer 15

vWF activity test; Low factor VIII activity, low vWF quantity, and low vWF activity confirms vWD

Question 16

How often is an EKG show something abnormal in a teen with hypertrophic cardiomyopathy?

Answer 16

> 90%, making EKG an “essential screening test” for HOCM

Question 17

Clinical presentation of precordial catch syndrome?

Answer 17

sudden, sporadic onset of sharp pain, usually along left sternal border; often exacerbated w/ deep inspiration. Last secs->few mins; resolve spontaneously. Can often be “broken” w/ forced deep inspiration.