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Paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

When does a diabetes 1 patient become symptomatic?

A

When >90% of the beta cells are destroyed

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2
Q

What are the classical sx of diabetes?

A

Polyuria
Polydipsia
Blurred vision
Weight loss
Glycosuria
Ketonuria

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3
Q

How do you confirm the diagnosis of diabetes in a child?

A

SYMPTOMATIC PLUS

Fasting glucose >7
OR
2 hour post prandial glucose >11.1
OR
HbA1C>6,5%

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4
Q

How do you confirm Type 1 DM?

A

Islet antigen 2 antibodies
Glutamic acid decarboxylase antibodies (GAD)

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5
Q

What are the counter-regulatory hormones causing increased glucose?

A

Catecholamines
Glucagon
Cortisol
Growth hormone

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6
Q

What are clinical features of ketoacidosis?

A

Acidotic breathing
Nausea
Vomiting
Abdominal pain
Decreased LOC
Coma

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7
Q

What is the biochemical criteria for diabetic ketoacidosis?

A

hyperglycaemia >11
Venous pH <7.3
Serum bicarbonate <15
Ketonuria

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8
Q

What is Kussmaul breathing?

A

Abnormal breathing pattern characterised by rapid deep breathing at a constant pace

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9
Q

How do you manage ketoacidosis?

A

> IV 0,9% saline asap (10-20ml/kg bolus given over 1hr)
Deficit + maintenance replaced over 36-48hrs

> insulin 0,1units/kg/hr -> when glucose drops to less than 11, dextrose fluids added
add potassium to IV fluids when giving insulin

> discontinue fluids when patient stable and improved acidosis and ketonaemia

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10
Q

What are complications of DKA and how is it managed?

A

Cerebral oedema
>headache
>altered mental status
>vomiting
>HT
>inappropriate bradycardia

Management
>IV mannitol 1-2g/kg

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11
Q

How do you calculate the total daily insulin requirement?

A

0,5 x total weight in kg
*you can adjust this according to response

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12
Q

What different types of insulin are there?

A

Rapid
Short
Intermediate
Long
Premixed

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13
Q

What are the advantages of an insulin pump?

A

> Can adjust according to your schedule of travelling, working, exercise
can deliver in small doses in those extremely sensitive
avoid dawn phenomenon
durable and lasts years

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14
Q

What are the disadvantages of the insulin pump?

A

> wearing it can be unsettling
expensive costs
higher risk ketoacidosis (long acting insulin not used)
infection of infusion site
requires user input

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15
Q

Describe the Dawn Phenomenon

A

Normal glucose until +-3am where they become hyperglycaemic due to release of counter-regulatory hormones eg GH and reduced tissue sensitivity to insulin and decreased endogenous insulin release.

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16
Q

Describe the Somogyi effect

A

Nocturnal hypoglycaemia due to excess amounts of exogenous insulin and then rebound hyperglycaemia due to stimulated counterregulatory hormones. Wake up with hyperglycaemia

17
Q

What is the dose of insulin needed per day?

A

Dependent on length of action
>0,5-0,6 units total insulin per kg per day
>long acting = 40-50% of total insulin x1 a day
>short acting = 50-60% divided between meals

18
Q

What are possible reasons for higher insulin doses?

A

> illness
less activity
gain in weight
medication that changes insulin sensitivity
emotional stress
puberty

19
Q

What are possible reasons for less insulin requirements?

A

> loss of weight
increased activity
exercise
renal impairment

20
Q

When do you test effects of long acting and short acting insulin?

A

Long acting = before breakfast
Short acting = 2hrs after meal

Once every 1-2 weeks at 2-3am for Dawn and Somorgi effect

21
Q

What are the symptoms of hypoglycaemia?

A

Sweating
Trembling
Dizziness
Mood changes
Hunger
Headaches
Blurred vision
Extreme tiredness and paleness

22
Q

What are the symptoms of hyperglycaemia?

A

Dry mouth
Extreme thirst
Polyurea
Drowsiness
Frequent bed wetting
Stomach pain

23
Q

What is hypoglycaemia and How do you manage hypoglycaemia?

A

Hypoglycaemia = BG<3
1)give sugar containing drink/snack
2)glucose 10-20g given and glucose rechecked in 10-15mins. Repeat if needed
3) if still not recovered/unconscious = IM or subcut glucagon

24
Q

What are the long term cx of diabetes?

A

Micro vascular
>retinopathy
>neuropathy
>neohropathy
>cardiomyopathy

Macro vascular
>stroke
>coronary artery disease
>diabetic myomecrosis
>peripheral vascular disease

Neuropsychological cx
Poor growth
Delayed puberty
Eating disorders
Stress on family

25
Q

What is Maturity Onset Diabetes of the Young?

A

Any of several forms of diabetes caused by mutations in an autosomal dominant gene disrupting insulin production

No positive antibodies
Very low insulin requirement needed

26
Q

What are the clinical features of congenital hypothyroidism?

A

Umbilical hernia
Hypothermia
Course facial features
Macroglossia
Hypotonia
Prolonged jaundice
Pale, mottled skin
Winder posterior fontanelle
Constipation
Feeding problems
Hoarse cry
Developmental delay
Goitre

27
Q

What is the clinical features of aquifer hypothyroidism?

A

Short stature
Goitre
Obesity
Constipation
Delayed puberty
Cold peripheries
Cold intolerance
Dry skin
Bradycardia
Slow-relaxing reflexes
Puffy eyes with loss of lateral 1/3 of eyebrow
Deterioration in schoolwork
Learning difficulties

28
Q

What are the causes of congenital hypothyroidism?

A

Maternal thyrotoxic drugs during pregnancy
Thyroid hypoplasia
Thyroid APL Asia
Dyshormonogenesis
TSH receptor defect
Secondary or tertiary hypothyroidism (TRH and TSH deficiency

29
Q

What are the causes of acquired hypothyroidism?

A

Primary
>iodine deficiency
>neck irradiation
>thyroid surgery
>goitrogens
>autoimmune thyroiditis
>anti thyroid drugs

Secondary or tertiary
>cranial irradiation
>neurosurgery
>craniopharyngioma/other tumors

30
Q

How do you manage hypothyroidism?

A

Thyroxine orally lifelong

31
Q

What are the clinical features of hyperthyroidism?

A

SWEATING

Sweating
Weight loss
Emotional
Appetite increased
Tremor/tachycardia
Intolerance of heart/irregular menses/irritability
Nervousness
Goitre and GIT problems

32
Q

What are the causes of hyperthyroidism?

A

Graves’ disease = 95% of cases

Other rare causes
>TSH secreting pituitary tumor
>toxic adenoma
>hashitoxicosis
>toxic multinodular goitre

33
Q

What is the management of Graves’ disease?

A

Carbimazole
Failed medical therapy = radioactive iodine
Failed = surgery

34
Q

What is the definition of disorders of sexual development?

A

A condition in which the chromosomal, gonadal or anatomical sex is atypical

35
Q

What is precocious puberty?

A

The development of secondary sexual characteristics in
Girls <8
Boys <9

Paediatrics (13 decks)

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