Screening
Diagnosis
Name that Diagnosis!
Treatment
Name that Celebrity!
100
What is 3 years old.
At what age should a child without co-morbid conditions be screened for hypertension?
100
80%
What is the percentage of children with hypertension <10 years of age who have renal disease?
100
Coarctation of the aorta
6 week old ex FT female with poor weight gain, HR 135, RR 70, UE Blood pressure 125/65, CRT 4s, liver edge palpable 2 cm below right costal margin, 1/6 heart murmur, CXR shows cardiomegaly, RVH, non-specific ST wave changes and tachycardia.
100
1. Aerobic exercise (30-45 minutes/day) 2. Weight reduction (if overweight) 3. Increased fresh vegetables, fruits and low fat dairy 4. Salt restriction 5. Maintain adequate intake of potassium 6. Cessation of smoking
What are 3 non-pharmacologic interventions for Hypertension?
100
Bill Clinton
Who is the 3rd youngest president who also suffers from hypertension (but would likely deny it if asked)?
200
1. History of Prematurity 2. History of LBW or NICU stay 3. CHD, Kidney disease, or GU abnormality 4. Recurrent UTI, Hematuria, Proteinuria 5. Transplant of solid organ or BM 6. Malignancy 7. Medications: steroids, decongestants, NSAIDs, B-adrenergic agonists
Name 3 co-morbid conditions for which children of any age should routinely have BP checked?
200
10%
What is percentile of children <10 years with essential hypertension?
200
Essential Hypertension -In this age group (12-18)- most common cause (85-95%) -LVH seen in 40-60%
15 yo obese male with BP of 135/90 at WCC. Repeat blood pressure measurements 3 months later 142/95. Work up including CBC, CMP, FLP, plasma renin, RUS wnl. Echo reveals mild LVH.
200
Beta Blockers
What is the class of antihypertensive drugs that should be avoided in children with asthma?
200
Randy Jackson
"Yo-yo!" This American Idol judge has hypertension and diabetes.
300
1. Accomodate to prevous reading by automatically inflating to 30 mmHg above expected SBP reading 2. No normative data on oscillometric meaurements in children 3. Measures SBP and DBP based on the point of maximal oscillation during deflation (or mean intra arterial pressure) using algorithms that are not available from manufacturers and vary from one device to another. (SBP and DBP are calculated measurements) 4. Needs periodic calibration every 3 months to 2-3 years
What is one limitation of oscillometric machines?
300
1. Steroids 2. Decongestants 3. OCPs 4. Beta adrenergic agonists/theophylline 5. Erythropoietin 6. Cyclosporine/tacrolimus 7. Rebound after discontinuation of antihypertensives
What are three medications that can cause Hypertension?
300
Renal Artery Stenosis. RUS nl, captopril renal radionucleotide scan revealed unilateral renal artery stenosis. Renal aretery narrowing causes release of renin, resulting in vasoconstriction in efferent arterioles and systemic vasoconstriction. Fibrodysplastic lesions are most common renovascular abnormality identified. Preterm neonates who have HTN frequently have undergone umbilical artery catheterization that causes emboli to renal a. Within this age group, 60-80% of have renal disease. Look for abdominal bruits, secondary sexual characteristics.
14 mo male with increased WOB, increased RR. Hx of asthma. On PE: HR 150, RR 66, BP 120/83, alert but tachypneic, 2/6 systolic murmur. Femoral pulses 2+, Liver edge is palpable. Echo shows LVH. CBC, U/A, CMP, BUN, creatinine wnl. CXR with cardiomegaly. Plasma renin activity and aldosterone levels elevated.
300
1. Symptomatic hypertension 2. Secondary hypertension 3. Evidence of end-organ damage (LVH, hypertensive retinopathy, microalbuminuria) 4. Diabetes (type 1 and 2) 5. Hypertension that persists despite lifestyle and dietary modifications
Who gets treated for hypertension? Name two.
300
Joe Montana
This retired 49ers football player and 3 time superbowl MVP suffers from hypertension.
400
80-100%, 40%
Blood pressure cuff bladder length should be ____ percentage of the arm circumference and width should be ___ percentage of arm circumference at midpoint between acromion-olecranon distance?
400
1. Weight loss 2. Sweating 3. Flushing 4. Fevers 5. Palpitations 6. Muscle cramps 7. Weakness or constipation
What are 3 symptoms that would indicate endocrine etiology of Hypertension?
400
Post Strep Glomerulonephritis. -develops 10-14days after pharyngitis or 3-6 weeks after skin infection -reduction in GFR-->fluid retention-->HTN--> gross and microscopic hematuria and proteinuria -can be asymptomatic -rarely develops renal failure -supportive management (anti-hypertensives, diuretics)
17 yo female with a hx of asthma presents with wheezing. Despite bronchodilator and oral corticosteroids prescribed 1 day ago, she continues to have cough and wheeze. 3 weeks ago she completed 10 day course of amoxicillin for GAS pharyngitis. On PE, RR 30, HR 129, BP 152/76 mm Hg, expiratory wheezes in all lung fields. CXR reveal edema and pleural effusions.
400
ACE inhibitors or ARBs.
What is the drug of choice for child with Diabetes Mellitus?
500
1. 90th-95th 2. 95-99th +5mmHg 3. >99th+5mmHg
What are the percentiles of SBP and DBP that define Prehypertension, Stage 1 Hypertension, and Stage 2 Hypertension
500
1. Bruit 2. Skin lesions (cafe au lait, neurofibromas, lesions of tuberous sclerosis, striae, hirsuitism, butterfly rash, palpable purpura 3. Thyromegaly 4. Abdominal mass 5. Edema 6. Pregnancy 7. Retinopathy
What are 3 exam findings that could be a clue to the etiology of Hypertension?
500
Pheochromocytoma. MRI of pelvis revealed mass within bladder wall. Plasma dopamine and urinary homovanillic acid levels elevated.
11 yo previously healthy male develops severe, sudden, bilateral, throbbing headaches several times/day for past 2 weeks. Heaches seem to be precipitated by urination. Resolve when he lies down for 15 minutes. Denies visual disturbances, nausea, or sweating. HR 80, BP 125/65. Otherwise nl exam. Recent CT of head negative.
500
1. ACE inhibitors 2. ARBs -teratogenic in nature -unless reliable use of contraceptives or abstinence can be ensured
Which 2 medications classes should be avoided in adolescent females?
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