Read Online Pediatric Examination and Board Review by Robert Daum, Jason Canel - Free Book Online
Authors: Robert Daum, Jason Canel
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by both the examination and the family history. The important features of the history include a past medical history of urinary tract infections, cardiovascular surgeries, weakness or cramps, medication use, and tobacco use. Important features of the family history include history of hypertension or premature heart disease. The important features of the physical examination include accurate blood pressure recordings in 4 extremities, assessment for heart murmurs or bruits, assessment of peripheral pulses, assessment of renal tenderness, and a thorough eye examination. The usual initial laboratory evaluation includes a urinalysis, serum electrolytes including blood urea nitrogen (BUN) and creatinine, and possibly a 12-lead ECG, chest radiograph, and echocardiogram. A cholesterol level and a lipoprotein analysis are indicated in select cases. If there is severe hypertension and end-organ involvement or hypertension refractory to therapy, then tests evaluating for secondary causes of hypertension can be performed.
5. (A) Additional management in patients with hypertension includes nonpharmacologic interventions such as exercise proscription, weight reduction, avoidance of tobacco or oral contraceptive pills, and reduction of dietary salt intake. In severe hypertension or persistent hypertension despite nonpharmacologic interventions, pharmacologic agents are often used that include diuretics, beta-blockers, and vasodilators.
6. (C) Beta-blockers are often used in conjunction with diuretics or in conditions where hyperthyroidism results in hypertension. However, they are contraindicated for use in patients with asthma (can precipitate bronchospasm), diabetes (prevents manifestation of symptoms of hyperglycemia), and in patients with bradycardia.
7. (A) A hypertensive emergency requires immediate reduction of blood pressure usually within minutes to hours. Hypertensive crises can be associated with neurologic signs or congestive heart failure. Administration of parental medications is important for the acute treatment of hypertensive emergencies. These medications include diazoxide, nitroprusside sodium, diuretics, IV nifedipine, hydralazine, or labetalol. Phentolamine is usually reserved for patients with pheochromocytomas.
8. (A) Hypercholesterolemia is a major risk factor for coronary artery disease. Several long-term prospective studies have shown that lowering serum cholesterol levels decreases the risk for coronary artery disease in the future. This has prompted a more aggressive approach to screening and therapy for hypercholesterolemia in young patients. The current recommendations for serum cholesterol screening include the child of a single parent with a cholesterol level greater than 240 mg/100 mL or if the history is unobtainable but there is a suspicion of hypercholesterolemia. The recommendations to perform a serum cholesterol level and lipoprotein analysis include children with parents or grandparents with a history of coronary angioplasty or coronary artery bypass surgery, men younger than 55 years of age, women younger than 65 years of age, and children with parents or grandparents with a documented myocardial infarction among men younger than 55 years of age or women younger than 65 years of age.
9. (D) Serum cholesterol levels can be measured in the nonfasting state anytime after the age of 2 years. If serum cholesterol levels are higher than 200 mg/dL, lipoprotein analysis is indicated. Lipoprotein analysis requires the patient to be fasting for 12 hours before the testing.
LDL = (total serum cholesterol) − (HDL)
− (triglyceride concentration × 0.2)
Low-density lipoprotein (LDL) levels <110 mg/dL, in the presence of elevated cholesterol levels, should be repeated in 5 years. If the LDL level is 110-129 mg/dL, a Step 1 diet is recommended. If the LDL level is higher than 130 mg/dL, then a Step 1 or Step 2 diet is recommended with consideration of
5. (A) Additional management in patients with hypertension includes nonpharmacologic interventions such as exercise proscription, weight reduction, avoidance of tobacco or oral contraceptive pills, and reduction of dietary salt intake. In severe hypertension or persistent hypertension despite nonpharmacologic interventions, pharmacologic agents are often used that include diuretics, beta-blockers, and vasodilators.
6. (C) Beta-blockers are often used in conjunction with diuretics or in conditions where hyperthyroidism results in hypertension. However, they are contraindicated for use in patients with asthma (can precipitate bronchospasm), diabetes (prevents manifestation of symptoms of hyperglycemia), and in patients with bradycardia.
7. (A) A hypertensive emergency requires immediate reduction of blood pressure usually within minutes to hours. Hypertensive crises can be associated with neurologic signs or congestive heart failure. Administration of parental medications is important for the acute treatment of hypertensive emergencies. These medications include diazoxide, nitroprusside sodium, diuretics, IV nifedipine, hydralazine, or labetalol. Phentolamine is usually reserved for patients with pheochromocytomas.
8. (A) Hypercholesterolemia is a major risk factor for coronary artery disease. Several long-term prospective studies have shown that lowering serum cholesterol levels decreases the risk for coronary artery disease in the future. This has prompted a more aggressive approach to screening and therapy for hypercholesterolemia in young patients. The current recommendations for serum cholesterol screening include the child of a single parent with a cholesterol level greater than 240 mg/100 mL or if the history is unobtainable but there is a suspicion of hypercholesterolemia. The recommendations to perform a serum cholesterol level and lipoprotein analysis include children with parents or grandparents with a history of coronary angioplasty or coronary artery bypass surgery, men younger than 55 years of age, women younger than 65 years of age, and children with parents or grandparents with a documented myocardial infarction among men younger than 55 years of age or women younger than 65 years of age.
9. (D) Serum cholesterol levels can be measured in the nonfasting state anytime after the age of 2 years. If serum cholesterol levels are higher than 200 mg/dL, lipoprotein analysis is indicated. Lipoprotein analysis requires the patient to be fasting for 12 hours before the testing.
LDL = (total serum cholesterol) − (HDL)
− (triglyceride concentration × 0.2)
Low-density lipoprotein (LDL) levels <110 mg/dL, in the presence of elevated cholesterol levels, should be repeated in 5 years. If the LDL level is 110-129 mg/dL, a Step 1 diet is recommended. If the LDL level is higher than 130 mg/dL, then a Step 1 or Step 2 diet is recommended with consideration of
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