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61 Cards in this Set
- Front
- Back
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What is the relation between breastfeeding and weight gain?
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Extent and duration of breastfeeding inversely associated with risk of obesity in later childhood (possibly due to physiologic factors in human milk, feeding/parenting patterns)
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What environmental factors increase risk of obesity?
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Lack of safe places for physical activity
Inconsistent access to healthy food choices Low cognitive stimulation in home Low SES Family/parental dymanics |
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What is Pickwickian syndrome?
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Obesity hypoventilation syndrome (don't breathe rapidly or deeply enough)
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What are the pulmonary consequences of obesity?
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Restrictive lung disease, NOT reactive airway disease.
However, poorly controlled reactive airway disease, which in turn impairs exercise intolerance, may contribute to obesity. |
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What are the criteria for diabetes screening in children?
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BMI >85th percentile
Weight:Height >85th percentile Weight >120% ideal for height plus 2 of: -FMH DM2 in 1st/2nd degree relative -AA, Native American, Hispanic, Asian -Acanthosis nigricans, PCOS, HTN, dyslipidemia TEST EVERY 2 YEARS starting at age 10 |
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When should blood pressure be measured in children?
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Yearly at age 3
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Blood pressure percentiles for children.
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Normal: <90th
Pre-HTN: 90th-95th HTN 1: 95th-99th + 5 mmHg HTN2: 99th + 5 mmHg |
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What causes most blood pressure elevation in children?
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Primary HTN, for which obesity has been found to be an important correlate
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When should the flu vaccine be administered in 2 doses?
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In children under 9 years old; must be given 1 month apart
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What is weight age?
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Age at which weight plots at 50th percentile
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Formula for calculating BMI.
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kg/meters^2
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A BP cuff that is too large will give a falsely ___ measurement.
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Falsely low
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A BP cuff that is too small will give a falsely ____ measurement.
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Falsely high
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What is oppositional defiant disorder?
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Pattern of negativistic, hostile, and defiant behavior. Conduct disorder is a more severe disorder of habitual rule-breaking, characterized by a pattern of aggression, destruction, lying, stealing, and/or truancy. ODD and CD have high comorbidity rates with ADHD.
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What are causes of secondary hypertension in children?
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Renal parenchymal disease, coarctation of aorta
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Weight loss recommendation for obese/overweight children.
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Weight maintenance or slowing of weight gain until BMI <85th percentile
Don't lose more than 1 lb per month in pre-teens |
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What children are at cardiovascular risk when taking ADHD stimulant medications?
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Those with known heart disease (higher for adults--who account for about
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What is atopy?
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Genetic predisposition--compounded by environmental factors--leads to development of IgE-mediated response (allergic rhinitis, asthma, and/or atopic dermatitis) to common inhalational allergens (including housedust mites, animal dander, roaches, fungi, grass/ragweed pollens)
Children of an atopic parent have 30% inc'd risk for developing atopic disorder |
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Early vs Late asthmatic reactions
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Early (first hour): mast cells and eosinophils release PGs and LKs-->inc'd vasc perm, mucus hypersecretion, a rapid bronchoconstriction
Late asthmatic reaction: begins 2-3 hours later, peaks at 4-8 hours, resolves in 24 hours. Neutrophil, eosinophil, and lymphocyte infiltration of bronchial epithelium-->epithelial destruction, fibrotic remodeling, and hyperplaia of bronchial smooth muscle. Increase in hyperresonsiveness may persist for days to weeks after late reaction appears to have resolved |
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Where do children with Tb acquire the bug?
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In home of someone close to them; outbreaks may occur in daycare centers and schools
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What are the signs of Tb in children?
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>50% infants and children with radiographically evident dz have NO physical findings
Iinfants and toddlers likely to experience symptoms such as nonproductive cough, mild dyspnea, wheezing; severe cough and sputum production, together with systemic complaints such as fever, night sweats, and anorexia, usually signify intrapulmonary dissemination |
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What are the hallmark radiographic findings of Tb?
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Primary Complex
Hilar adenopathy Focal hyperinflation Atelectasis |
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When is a PPD considered positive?
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>5mm in high-risk children
>10mm in moderate-risk children >15mm in low-risk children |
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How is Tb cultured?
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From sputum, or from a first morning gastric aspirate
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Which cough etiologies are worse at night?
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Asthma
Allergies Sinusitis |
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When is AP diameter increased?
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Hyperinflated thorax is sign of chronic obstructive lung disease
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What are atopic shiners?
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Darkening of lower eyelids due to venous stasis
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What are Dennie-Morgan lines?
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Creases under lower eyelids from intermittent edema
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What is a habitual cough?
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Cough perpetuated from cough begun with viral URI. Irritation of airway leads to stimulation to cough.
Typically a loud, short, dry, brassy, spasmodic cough unchanged by exercise or temperature. Classically resolves during sleep. |
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Why is x-ray useful in child with chronic cough?
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useful in r/o infiltrates, atelectasis, adenopathy, tracheal deviation, masses
Hyperinflation consistent with asthma or cystic fibrosis |
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What spirometry values differentiate obstructive from restrictive lung disease?
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Obstructive (asthma, CF) low FEV1/FVC
Restrictive (musch less common in children): Normal FEV1/FVC bc FEV1 and FVC are reduced proportionately |
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How should leukotriene receptor antagonists and leukotriene-synthesis inhibitors be used in asthma?
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Can be used in chronic asthma in addition to inhaled steroids; are much less effective than steroids and not recommended as monotherapy.
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Bare minimum developmental milestones.
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1 mo: lift head, track with eyes, coo
6 mo: sit up, raking grasp, stranger anxiety, babbles 9 mo: stands with assistance, 3 finger grasp, bye bye 12 mo: walk, 2 finger grasp, mama/dada (delayed if can only sit up; not delayed if can't walk) 24 mo: 2 step climbing, 2 words, 2 step commands, 6 blocks 3 year old: tricycle, three word sentences, brush teeth, draw circle 4 year old: hop, copy across, play with others |
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Typical vs Atypical Angina
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Typical: Substernal chest discomfort with characteristic duration/features; exertional in nature
Relief with rest or nitroglycerin Atypical: Diabetics, women, elderly presenting with weakness or shortness of breath on exertion WITHOUT chest pain |
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What is unstable angina?
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Serious condition; requires emergency care.
Occurs at rest or with increasingly less exertion. Worsening in severity, frequency, or duration. New onset (within last 4 to 6 weeks) |
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Diagnose:
Widened mediastinum on CXR |
Aortic dissection
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Diagnose:
Pericardial friction rub |
Pericarditis
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Diagnose:
Elevated b-type natriuretic peptide Enlarged heart on CXR |
Non-ischemic cardiomyopathy
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What are the criteria for diagnosis of metabolic syndrome?
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Waist circumference:
Men >40 in Women >35 in TG >150 HDL: Men <40 Women <50 BP >130/85 Fasting glucose >110 |
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Stress test vs Angiogram:
Who gets which? |
High pre-test probability: Negative stress test won't convince you pt doesn't have dz, so get an ANGIOGRAM
Intermediate pre-test probability Low pre-test--shouldn't have stress test bc unlikely to be positive |
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What test obtains ejection fraction?
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Echocardiogram
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All patients strive to LDL under _____.
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130
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HCTZ AEs
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Hyponatremia
Hypokalemia Elevated serum uric acid levels and may precipitate gouty attack |
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Lisinopril AEs
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Cough
Renal dysfn Angioedema Hyperkalemia |
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What is a high HDL?
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≥60
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What are common signs of sleep apnea?
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Snoring
Daytime somnolence Morning headaches |
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Xanthelasma vs Xanthoma
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Xanthelasma: on eyelides
Xanthomas: on extensor tendons These are plaques or nodules composed of lipid-laden histiocytes |
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How is basal metabolic rate calculated?
Caloric needs? |
Body weight in pounds x 10
Additional caloric needs by multiplying body weight by: 3 if sedentary 5 if moderate activity 7 for heavy activity 10 for intense |
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How is LDL cholesterol calculated?
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Total cholesterol - (HDL + TG/5)
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Fating/Random Glucose Cutoffs for:
Diabetes Pre-Diabetes |
Diabetes: Fasting >126, Random >200
Pre-Diabetes: Fasting 100-125 |
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How much daily caloric intake should be from saturated fats?
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<7%
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How much cholesterol should be consumed per day?
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<200 mg
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What is the most effective agent to increase HDL?
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Niacin (Nicotinic acid)
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What is the first line therapy for reducing triglycerides?
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Fibrates
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This drug inhibits absorption of cholesterol at the intestinal brush border.
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Ezetimibe
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How often should lipids be checked once a statin is started? Once a stable dose is achieved?
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Once started, check six weeks
Once stable, check every six to twelve months |
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What calorie deficit is necessary to lose 1 pound of weight?
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3500 calories
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What are the lower and upper limits of maximal heart rate for moderate exercise intensity?
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Lower limit is 50% of maximal HR (220-age)
Upper limit is 70% of maximal HR (220-age) |
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When should pharmacologic therapy for obesity be considered (BMI cutoffs)?
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BMI >30 or BMI>27 with risk factor such as HTN, DM, or HLD
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What is phentermine?
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Appetite suppression approved for short-term use (potential for addiction/withdrawal)
AEs: Tachycardia, HTN, restlessness, insomnia, tremor |
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When is bariatric surgery indicated (BMI cutoffs)?
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BMI>40 or BMI>35 with severe health complications; who have not succeeded in losing weight with other treatment methods
Procedures most commonly performed: Gastric bypass Adjustable gastric banding Vertical-banded gastroplasty |
