Case 4: 8 Year Old Well Check

Front 1

Pro of BMI?

Back 1

The BMI better reflects the amount of body fat (compared to weight from muscle or bone) than weightfor-heightmeasurements.

Front 2

What is the weight age?

Back 2

Age at which the patient's weight would plot at the 50th percentile.

Front 3

What is the height age?

Back 3

Age at which the patient's height would plot at the 50th percentile.

Front 4

Core symptoms of ADHD?

Back 4

• Inattention
  
• Hyperactivity
  
• Impulsivity
  

Front 5

Prevelance of ADHD?

Back 5

8-10%

Front 6

Diagnosis of ADHD?

Back 6

clinical

Front 7

What are the important causes of school failure?

Back 7

• sensory impairment
  
• sleep disorder
  
• mood disorder
  
• learning disability
  
• conduct disorder
  

Front 8

What are the red flags for risk of learning disability?

Back 8

• hx of maternal illness or substance use during pregnancy
  
• complications at time of delivery
  
• hx of meningitis or other serious illness
  
• history of serious head trauma
  
• parental hx of learning disabilities or difficulty at school
  

Front 9

Some adverse effects of ADHD meds?

Back 9

• appetite suppression
  
• tic disorders
  
• insomnia
  
• decrease in growth velocity
  

Front 10

Which children, who are on ADHD meds, have an increased CV risk?

Back 10

children with known heart disease

Front 11

Which children, who are on ADHD meds, personality changes?

Back 11

Excessive dosing

Front 12

What percentage of children with ADHD respond to stimulant meds such as sustained released methylphenidate?

Back 12

80%

Front 13

What percentage of children are obese?

Back 13

15% of 6 to 19 year olds

Front 14

Risk factors for obesity?

Back 14

• high birth weight
  
• maternal diabetes
  
• obese parent
  
• obese parentS
  
• lower socioeconomic status
  
• genetic syndromes
  

Front 15

What genetic syndromes are associated with obesity?

Back 15

• Prader-Willi
  
• Bardet Biedl
  
• Cohen syndrome
  

Front 16

List the main complications of obesity?

Back 16

sleep apnea

dysplipiedmia

HTN

slipped capital femoral epiphysis

Type 2 DM

steatohepatitis

Front 17

Sleep apnea features

Back 17

cessation of breathing 15+ seconds

loud snore

laboured breathing

Front 18

Dyslipidemia features

Back 18

High triglycerides

low HDL

metabolic syndrome

Front 19

HTN associations

Back 19

frequent in overweight kids

1/3 of children with BMI > 95th percentile

Front 20

SCFE features?

Back 20

• onset of puberty
  
• obese patients
  
• delayed sexual maturation
  
• antalgic gait
  
• limited ROM of hip
  

Front 21

Type 2 DM

Back 21

obesity

Front 22

Steatohepatitis features

Back 22

obese adolescents

mild increase in liver transaminases

hyperechoic liver on US

fatty infiltrates and fibrosis on biopsy

Front 23

What percentage of all cases in childhood are type 2 DM?

Back 23

19%

Front 24

DM classification?

Back 24

by etiology

Front 25

Type 1 DM classification?

Back 25

insulin deficiency, due to autoimmune destruction of pancreatic beta cells

Front 26

Type 2 DM classification?

Back 26

• more heterogeneous but typically involves insulin resistance
• Type 2 DM has been recognized in children only recently. Although the data regarding incidence isinexact, the trend for Type 2 DM, like that of childhood obesity, is clearly rising.
  

Front 27

Diagnosis of diabetes?

Back 27

• HbA1c >/= 6.5%
  
• OR
  
• fasting >/= 7
  
• OR
  
• 2 hr OGTT 11
  
• in symptoms of hyperglycemia, >/= 11
  

Front 28

Presentation of DM?

Back 28

• weight loss
  
• DKA rare
  
• accidental diagnosis by routine screen
  
• type I more likely to present in early childhood
  

Front 29

DM in children, risks?

Back 29

• overweight
  
• FHx of Type 2 DM
  
• race/ethnicity
  
• signs of insulin resistance or conditions associated with insulin resistance
  
• maternal history of diabetes or gestational dm
  

Front 30

How to classify HTN in children?

Back 30

By BP percentile

Front 31

Prehypertension (children) BP percentile?

Back 31

90-95th percentile

Front 32

Stage 1 HTN (children) BP percentile?

Back 32

95th-99th plus 5 mm Hg

Front 33

Stage 2 HTN (children) BP percentile?

Back 33

> 99th plus 5 mm Hg

Front 34

Adolescent HTN?

Back 34

BP > 120/80 mm Hg

Front 35

Adolescent pre HTN?

Back 35

< 95th percentile

Front 36

endocrine disease that cause weight gain?

Back 36

these usually limit growth and lead to short stature

only 1% are overweight patients have endocrine problems

Front 37

How to address obesity in children?

Back 37

• inquire if weight is a concern for the parent or child
  
• talk about immediate and long term effects
  

Front 38

What are some causes of high BP measurements?

Back 38

• "white coat" hypertension
  
• position
  
• painful stimuli
  

Front 39

Proper placement of BP cuff?

Back 39

• 2/3 of upper arm covered
  
• internal bladder should encircle 80-100% of the arm circumference
  

Front 40

Screening for secondary HTN in children?

Back 40

• umbilical arteral or venous access
  
• UTI
  
• catecholamine excess
  
• family history of renal disease
  
• coarctation of aorta
  

Front 41

How does UTI cause HTN?

Back 41

renal scarring following infection

Front 42

Two diseases where catecholamine excess lead to HTN?

Back 42

• pheochromocytoma
  
• neuroblastoma
  

Front 43

What to look on during exam for coarctation of aorta?

Back 43

• femoral pulses
  
• document BP in lower extremity
  

Front 44

How to evaluate HTN?

Back 44

blood pressure monitoring

diet: low salt, decrease intake of high sodium foods (e.g. fast foods, Chinese foods, and salty snack foods)

Front 45

Management of prehypertension?

Back 45

• lifestyle change
  
• BP follow up in 6 mo
  

Front 46

Management of primary HTN?

Back 46

• Meds
  
• Dietary changes
  
• weight loss
  
• physical activity
  

Front 47

How to initially treat ADHD?

Back 47

• start a medication
  
• monitor for efficacy
  
• additional consults
  

Front 48

Weight management plan with family, what factors to address?

Back 48

Diet

Screen time

physical activity

Front 49

Diet recommendations for weight management?

Back 49

low cal snacks

sugar free beverages

Front 50

Screen time recommendations for weight management?

Back 50

• 2 hours a day, max
  
• no tv in bedroom
  

Front 51

Physical activity recommendations?

Back 51

60 minutes of moderate to vigorous physical activity a day