3: Paediatric aspects of diabetes and endocrinology

Question 1

What type of diabetes is common in children?

Answer 1

Type 1 diabetes

Question 2

In what emergency situation can children be newly diagnosed with Type 1 diabetes?

Answer 2

DKA

Question 3

Type 1 diabetes in children has a strong ___ component.

Answer 3

genetic

Question 4

What sort of precipitating event can trigger Type 1 diabetes in children?

Answer 4

Viral illness

Question 5

In the pre-diabetes change, what biochemical abnormality can be detected in children?

Answer 5

Production of islet cell autoantibodies

Question 6

What are the signs of hyperglycaemia in children?

Answer 6

Four Ts

tired

thirsty

toilet (bedwetting)

thin (weight loss)

Question 7

What are major signs of DKA in children?

Answer 7

Vomiting

Abdominal pain

Kussmaul breathing +/- pear drop breath

Question 8

A fasting blood glucose of over ___ mmol/L is diagnostic of Type 1 diabetes.

Answer 8

7 mmol/L

Question 9

A random blood glucose of over __ mmol/L is diagnostic of diabetes.

Answer 9

11.0 mmol/L

Question 10

Apart from symptoms, what do you need to diagnose a child with DKA?

Answer 10

pH < 7.3

Ketonuria

Question 11

What is a fatal complication of DKA in children?

Answer 11

Cerebral oedema

Question 12

What is the most common symptom of new onset diabetes in children?

Answer 12

Bedwetting

(noctural enuresis)

Question 13

What tests would you perform on a child who you suspect has diabetes?

Answer 13

Random blood glucose

Urinalysis

Question 14

As cerebral oedema is a fatal complication of DKA in children, what must be administered carefully?

Answer 14

Fluids

Question 15

In DKA, fluids and insulin are administered based on the ___ of the child.

Answer 15

weight

Question 16

In DKA of patients under 18 years, when is insulin given?

Answer 16

1 hour after fluids

Question 17

A goal of diabetes treatment in children is ensuring they have normal ___ and development and their education isn’t disrupted.

Answer 17

normal growth and development

normal education

Question 18

What are the HbA1c targets in children?

Answer 18

< 48 mmol/mol in first year after diagnosis

< 58 mmol/mol thereafter

Obviously the lower the better

Question 19

What microvascular screens are done for children in diabetes clinics?

Answer 19

BP

Retinal screening

Urinalysis

Question 20

What are the blood glucose targets

a) before meals
b) 2hrs after meals
c) at bedtime?

Answer 20

a) Before meals: 4-7 mmol/L

b) After meals: 5-9 mmol/L

c) Bedtime: 4-7 mmol/L

Question 21

What type of insulin therapy are children with Type 1 diabetes offered?

Answer 21

CSII

(insulin pump)

Question 22

What new technology avoids the use of skin prick tests to measure blood glucose?

Answer 22

Glucose sensor

Question 23

What thyroid abnormalities may babies be born with?

Answer 23

Dysplastic, absent or abnormal-site thyroids

Question 24

Congenital thyroid diseases may also be caused by problems with the ___ gland.

Answer 24

pituitary gland

Question 25

What are some signs of congenital thyroid disease?

Answer 25

**Delayed jaundice** **Poor feeding, normal weight gain** **Hypotonia** (reduced muscle strength) **Skin and hair changes**

Question 26

Which general test is carried out on Day 5 after birth to diagnose a variety of diseases in babies?

Answer 26

**Guthrie test**

Question 27

Where can ectopic thyroid be found?

Answer 27

**Sublingual**

Question 28

What is the result of untreated hypothyroidism in babies?

Answer 28

**Cretinism**

Question 29

What are some signs of hypothyroidism in children?

Answer 29

**Slow growth, delayed puberty** **Poor general health** **Learning difficulties**

Question 30

What will a thyroid function test look like in a hypothyroid child?

Answer 30

**High TSH** **Low T3/T4**

Question 31

How is paediatric hypothyroidism treated?

Answer 31

**Levothyroxine**

Question 32

What are some signs of hyperthyroidism in children?

Answer 32

**Behavioural problems, sleep disturbance** **Goitre** **Face, eye signs** **Tachycardia, palpitations** **Early puberty**

Question 33

What will a thyroid function test look like in a hyperthyroid child?

Answer 33

**Low TSH** **High T3/T4**

Question 34

How is paediatric hyperthyroidism treated?

Answer 34

**Beta blocker** for autonomic symptoms **Anti-thyroid drugs** - e.g carbimazole +/- **Radio-iodine, surgery**

Question 35

What is the most common **primary** cause of underactive adrenal glands in children?

Answer 35

**Congenital adrenal hyperplasia**

Question 36

What is the most common **secondary** cause of underactive adrenal glands in children?

Answer 36

**Pituitary disease** **High dose steroid therapy**

Question 37

What is overproduction of steroids by the adrenal glands caused by?

Answer 37

**Cushing's disease / syndrome**

Question 38

Children with adrenal problems will present with overly ___ features.

Answer 38

**masculinised**

Question 39

Problems with the hypothalamic-pituitary-gonadal axis e.g in congenital adrenal hyperplasia can produce ___ genitalia in children.

Answer 39

**ambiguous**

Question 40

What are some causes of ambiguous genitalia in children?

Answer 40

**Congenital adrenal hyperplasia** **Genetic disease** **Congenital defects**

Question 41

How is the sex confirmed when a baby has ambiguous genitalia?

Answer 41

**Karyotyping**