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CPR-2 > Pediatric HTN, Renal, and Cardio > Flashcards

Pediatric HTN, Renal, and Cardio Flashcards

(56 cards)

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1
Q

For children age 1-13 yo, normal BP is < what percentile?

A

<90th percentile

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2
Q

Which percentile range and BP elevation is considered stage 1 HTN in a child aged 1-13 yo?

A

≥95th percentile to <95th percentile + 12 mmHg

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3
Q

Which percentile range and BP elevation is considered stage 2 HTN in a child aged 1-13 yo?

A

≥95th percentile + 12 mmHg

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4
Q

A healthcare professional can make a diagnosis of HTN in a child or adolescent if what criteria are met?

A

Ausculatory confirmed BP readings ≥95th percentile at 3 different visits

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5
Q

In some children, the 4th Karotkoff sound never goes away and the “muffled” sounds can be heard all the way to zero, how should this be interpreted?

A

4th sound is used for DBP

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6
Q

In older, school age children, prevalence of primary HTN has increased hand-in-hand with what?

A

Obestity epidemic

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7
Q

The most prominent evidence of mild, chronic, untreated HTN in a child is the presence of what?

How is it detected?

A
  • Left-ventricular hypertrophy (LVH)
  • Echocardiography
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8
Q

How does a BP cuff that is too small vs. too big affect the measure BP?

A
  • Cuff too small = artificial elevation of BP
  • Cuff too big = artifical depression of BP
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9
Q

How many RBC’s/hpf in 3 consecutive fresh, centrifuged specimens obtained over a span of weeks is indicative of hematuria?

A

5+ RBC’s/hpf in 3 consecutive tests

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10
Q

What are 4 drugs that can color the urine?

A
  • Rifampin
  • Nitrofurantoin
  • Pyridium
  • Sulfa drugs
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11
Q

A newborn presents with brick red color in the diaper, this is most likely due to?

A

Uric acid crystals due to dehydration

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12
Q

If you collect a UA from a child and there seems to be blood in the specimen, what must you do next?

A

Confirm that the color is actually blood by doing microscopy

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13
Q

What is the RBC morphology associated with glomerular hematuria?

A

Dysmorphic RBC’s

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14
Q

What is the color of the urine associated with glomerular hematuria?

A

May be red or brown

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15
Q

What is an ominous finding in conjunction w/ hematuria?

A

Hematuria + proteinuria

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16
Q

What are 5 common causes of gross hematuria in a child?

A
  • UTIs
  • Trauma
  • Bleeding disorders
  • Renal stones
  • Cystitis –> viral (adenovirus) = hemorrhagic cystitis
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17
Q

What is the prognostic indicator of long term renal damage in children w/ Henoch-Schonlein Purpura?

A

Development of PROTEINURIA along w/ hematuria

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18
Q

How long will a child with Henoch-Schönlein Purpura feel sick?

A

Will feel sick for a long time

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19
Q

In a child w/ asymptomatic (isolated) hematuria, why is it important to ask about family hx?

A

There is entitiy known as benign familial hematuria (thin basement membrane disorder)

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20
Q

Increased urine levels of which ion may be a cause of asymptomatic microscopic hematuria in a child?

A

HYPERcalcuria

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21
Q

Children with asymptomatic (isolated) hematuria should be regularly monitored for?

A

Regularly monitored for proteinuria and HTN

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22
Q

Urine Ca-to-Creatinine ratio of >_____ is indicative of excess calcium excretion and could be cause of asymptomatic hematuria.

A

>0.2

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23
Q

What is march hematuria?

May be seen in a child presenting after what?

Study These Flashcards
A
  • After vigorous exercise, it is not unusual to see some RBC’s in the urine
  • May be seen in young person who comes in for PE after sport’s practice
24
Q

If a child can void on command, how may a urine sample be collected for suspected UTI?

Study These Flashcards
A

Clean-catch urine

25
If a child is not able to void on command what 2 ways may you collect a urine sample that can be used for culture in suspected UTI?
- Catheterization - Suprapubic aspiration (SPA)
26
What is the recommendation for collecting a urine sample for child that can be culutured if you are going to start on Abx?
Collect the urine sample BEFORE starting meds
27
What type of urine samples are NOT appropriate for culuture?
Bag urine samples
28
If urine is collected by clean catch method, what criteria must be met for diagnosis of UTI?
Presence of both **pyruia** AND **at least 50,000 colonies/mL** of a single uropathogenic organism
29
If urine is collected by cathether what is the criteria that must be met for diagnosis of UTI?
- **Pyruria** and colony count of **50,000 CPM** or - 10,000-50,000 CPM **confirmed by repeat**
30
If urine sample is obtained by suprapubic aspiration, what criteria need to be met for diagnosis of UTI?
**Pyuria** and **ANY** growth on culture
31
Leukocyte esterase is a test looking for what? Tells you what?
- WBC's - Inflammation/infection in kidney or urinary tract
32
Urine Nitrate testing detects what? Used in screening of?
- Detects presence of certain types of bacteria - Screening for presence of UTI
33
*E. coli* in the urine can be detected with what screening test?
Urine nitrate testing
34
What is the recommended length for Abx treatment of a child with UTI who is febrile (pyelonephritis)?
10-14 days
35
When does a UTI prompt imaging of a boy vs. girls urinay tract?
- After the **first** UTI in **boys** - After **second** (or 3rd) in **girls**
36
What type of imaging is done in boys after the 1st UTI?
- Renal and bladder **ultrasound** - **VCUG** \*DO THEM BOTH!
37
What are the indications for performing VUCG in girl following a UTI?
- Any **anomalies detected** on RBUS - **Combo** of **temp \>39 °C** + pathogen **other than** *E. coli* - **Poor growth** and **HTN** is part of clinical presentation
38
Which grades of VUR in child should prompt referral to a specialist?
Grades **III-V**
39
List 6 indications in a pediatric pt w/ UTI that would prompt a referral to a specialist
- Presence of **VUR** (grades **III-V**) - **Obstructive** uropathy present - Renal **abnormalities** identified - Kidney **function** is impaired - Patient is **hypertensive** - Bowel and bladder dysfunction is **refractory** to primary care measures
40
1st line Abx choice in pediatric pt with UTI that is **not** acutely ill and tolerating (po)?
**Cephalosporins** like **cefixime** or **cefdinir** ## Footnote **(2nd or 3rd gen cephalosporin)**
41
If pediatric pt w/ UTI is acutely ill or not tolerating PO, which Abx should be given and via which route?
3rd gen. cephalosporin (**ceftriaxone**) via **parenteral route**
42
What do you use to listen to a diastolic murmur?
the bell of stethoscope usually lower pitched w/ rumbling character
43
What is a venous hum?
functional/innocent murmur caused by flow of venous blood from head and neck into thorax heard continuously while child is sitting should disappear when pressure placed on jugular, head is turned, or lying supine
44
What is the only sound heard in diastole that does not warrant a referral to cardiology?
venous hum
45
What is a Still's murmur and what characterizes it?
vibratory functional murmur best heart at apex of heart and LL sternal border best heard with **bell** **decreases** in intensity when **standing**
46
What is the relationship btw standing and the sound of a pathalogic murmur? Exception to rule?
most pathologic murmurs don't change significantly with standing EXCEPTION: hypertrophic cardiomyopathy (HOCM) - harsh, crescendo-decrescendo **systolic** murmur best heard at apex and left SB - **increases** in intensity upon standing - **increases w/ valsalva**
47
What are the key features of innocent murmurs?
seven S's: Sensitive Short duration Single Small (limited to small area and non-radiating) Soft Sweet Systolic
48
When do you refer to a cardiologist in the setting of a heart murmur?
\*anytime child is symptomatic\* grade 4 or above diastolic increased intensity when pt stands (HOCM) femoral pulses are weak heart sounds are obscured clicks Fam Hx of sudden death at young age abnormal or extra heart sounds (except S3) conditions predisposing to congenital heart lesion if you get "that feeling"
49
What heart defects are associated w/ Down's Syndrome? Why do you need to make sure you get an echo in these kids?
midline things: ASD, VSD, etc if ASD is untreated --\> can get pulm HTN that is irreversible once it starts
50
What sound is characteristic of an ASD?
fixed splitting of S2
51
What are the cyanotic congenital heart dzs?
5T's Truncus arteriosus Transposition of great vessels Tricuspid atresia Tetralogy of fallot Total anomalous pulm vascular return
52
What are the 4 acyanotic congenital heart dzs?
ASD VSD PDA Coarctation of aorta
53
What are the lesions you look for in the hospital when a baby has just been born?
ductal-dependent lesions: hypoplastic left heart syndrome pulmonary atresia 5Ts (all the R--\> L shunting ones)
54
How do you check for ductal-dependent heart lesions?
O2 sats are checked pre-ductal (in arm) and post-ductal (in leg) 95% in both and 3% or less difference --\> all good \<90% in either --\> send to cardio 90-95% or \>3% difference --\> repeat in one hour --\> if better, ok; if same --\> do it again --\> if same, failed screen and must do more workup
55
what is the study of choice to evaluate a heart murmur?
echocardiogram with doppler
56
What is the most common cyanotic congenital heart defect?
tetralogy of fallot (pulm stenosis + R ventricular hypertrophy + overriding aorta + VSD)

CPR-2 (28 decks)

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