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Flashcards in endo Deck (53):
1

markers in type 1 DM

islet cell antibodies, antibodies to glutamic acid decarboxylase, islet cells and insulin

2

features type 1 DM

2 peaks- pre school and teenagers. children present - few weeks history of polyuria, polydipsia, weight loss

3

other features type 1 DM

enuresis, skin sepsis, candida, infection

4

late features type 1 DM

DKA

5

features DKA

vomiting, dehydration, abdominal pain, Kussmauls breathing (hyperventilation),hypovolaemic shock, coma, death, drowsy, acetone breath

6

diagnosis type 1

random >11, glycosuria, ketonuria. fasting >7 or incr HbA1c

7

rapid acting insulin analogues

insulin lispro, glulisine, aspart

8

long acting insulin analogues

detemir, glargine

9

when should you give short acting regular insulin before meals

15-30 mins before meal

10

why should you rotate injection sites with insulin

prevent lipohypertrophy or lipoatrophy

11

onset rapid acting insulin

30-60m

12

onset long acting insulin

1-2h

13

what are the insulin regimens

basal bolus or continuous pump

14

how does basal bolus work

3x daily short acting boluses, 1x long acting bolus

15

what happens first in puberty for girls

breast development- 8.5-12.5 years

16

when does pubic hair growth and rapid height spurt occur (female)

after breast development

17

when does the menarche occur

2.5 years after puberty

18

what happens first in puberty for males

testicular enlargement >4ml

19

what follows testicular enlargement

pubic haisr- 10-14 years

20

when does height spurt occur in males

testicular vol 12-15ml

21

what causes closure of the growth plates

sex hormones- females have their height spurt earlier when have menarche so stop growing after that, whereas males continue growing for a while and then have their growth spurt

22

what is short stature

height below 2nd centile or 0.4th (3rd)

23

causes of short stature

familial, IUGR, extreme prem, constitutional delay of growth and puberty, endo- hypothyroid, decr GH, decr IGF1, steroid excess, nutritional deficiency, chronic illness, psychosocial deprivation, chromosomal

24

GH treatment

biosynthetic GH, recombinant IGF1

25

investigations in short stature

X ray wrist and hand for bone age, FBC (anaemia, crohns), creat and electrolytes, ca, po, alp, TSH, karyotype, endomysial and anti TTG (coeliac), CRP and ESR, IGF1, 0900 cortisol and dexamethasone suppression test

26

causes of tall stature

obesity, hyperthyroid, excess sex steroids, excess adrenal androgen steroids, gigantism. marfans, klinefelter, maternal diabetes, primary hyperinsulinism, beckwith syndrome

27

when does the posterior fontanelle close

8 weeks

28

when does the anterior fontanelle close

12-18 months

29

what is microcephaly

head circumference

30

causes microcephaly

familial, autosomal recessive condition, congenital infection, after insult to the brain

31

what is macrocephaly

>98th centile head circumference

32

causes macrocephaly

tall stature, familial, incr ICP, hydrocephalus, chronic subdural haematoma, tumour

33

how old are you to be delayed puberty

14 years females, 15 years male

34

causes of delayed puberty

constitutional delay in growth and puberty; low gonadotrophin release, high gonadotrophin release

35

what can cause low gonadotrophin release

systemic- CF, crohns, anorexia, excess physical activity. hypothalamic- pituitary disorders-panhypopituitarism, tumour

36

what can cause high gonadotrophin release

chromosomal, steroid hormone enzyme deficiencies, acquired damage- surgery, chemo,radio

37

what are the two mechanisms for precocious puberty

gonadotropin dependent- premature activation of the axis. gonadotropin independent- excess sex steroids

38

when is the growth spurt females

12 years

39

when is the growth spurt males

14 years

40

staging of breast development

BI- prepubertal; BII- breast bud; BIII- smooth contour; BIV- areola and papillae project above breast; BV- adult

41

staging pubic hair growth male and female

PHI- pre pubertal; PHII- sparse pigmented long straight along labia or base of penis; PHIII- dark coarser curlier; PHIV- filling out towards adult distribution; PV- adult

42

staging genital development male

GI- preadolescent, GII- lengthening of penis, GIII- further growth in length and circumference, GIV- glans penic, scrotal skin darkening; GV- adult genitalia

43

is an organic cause more likely in males or females for precocious puberty

more likely in males

44

causes precocious puberty females

familial, idiopathic. organic causes- dissonance, rapid onset, neuro signs eg neurofibromatosis

45

causes precocious puberty males

intracranial tumour, gonadotropin release, small testes- adrenal cause, unilat- gonadal tumour

46

age of precocious puberty in females

8

47

age of precocious puberty in males

9

48

gonadotropin dependent causes of precocious puberty

CNS abnormalities- hydrocephalus, infection, tumours; hypothyroid

49

gonadotropin independent causes of precocious puberty

adrenal- tumours, congenital adrenal hyperplasia; ovarian and testicular tumours; exogenous sex steroids

50

management precocious puberty

GnRH analogues for dependent, inhibitors of sex steroids in independent

51

what is the term for prem breast development

thelarche

52

when does thelarche take place

6m-3y. doesn't pass stage 3. absence axillary and pubic hair growth and growth spurt. self limiting

53

what is premature pubarche (adrenarche)

pubic hair develops