endo

Question 1

markers in type 1 DM

Answer 1

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

Question 2

features type 1 DM

Answer 2

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

Question 3

other features type 1 DM

Answer 3

enuresis, skin sepsis, candida, infection

Question 4

late features type 1 DM

Answer 4

DKA

Question 5

features DKA

Answer 5

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

Question 6

diagnosis type 1

Answer 6

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

Question 7

rapid acting insulin analogues

Answer 7

insulin lispro, glulisine, aspart

Question 8

long acting insulin analogues

Answer 8

detemir, glargine

Question 9

when should you give short acting regular insulin before meals

Answer 9

15-30 mins before meal

Question 10

why should you rotate injection sites with insulin

Answer 10

prevent lipohypertrophy or lipoatrophy

Question 11

onset rapid acting insulin

Answer 11

30-60m

Question 12

onset long acting insulin

Answer 12

1-2h

Question 13

what are the insulin regimens

Answer 13

basal bolus or continuous pump

Question 14

how does basal bolus work

Answer 14

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

Question 15

what happens first in puberty for girls

Answer 15

breast development- 8.5-12.5 years

Question 16

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

Answer 16

after breast development

Question 17

when does the menarche occur

Answer 17

2.5 years after puberty

Question 18

what happens first in puberty for males

Answer 18

testicular enlargement >4ml

Question 19

what follows testicular enlargement

Answer 19

pubic haisr- 10-14 years

Question 20

when does height spurt occur in males

Answer 20

testicular vol 12-15ml

Question 21

what causes closure of the growth plates

Answer 21

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

Question 22

what is short stature

Answer 22

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

Question 23

causes of short stature

Answer 23

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

Question 24

GH treatment

Answer 24

biosynthetic GH, recombinant IGF1

Question 25

investigations in short stature

Answer 25

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

Question 26

causes of tall stature

Answer 26

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

Question 27

when does the posterior fontanelle close

Answer 27

8 weeks

Question 28

when does the anterior fontanelle close

Answer 28

12-18 months

Question 29

what is microcephaly

Answer 29

head circumference

Question 30

causes microcephaly

Answer 30

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

Question 31

what is macrocephaly

Answer 31

>98th centile head circumference

Question 32

causes macrocephaly

Answer 32

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

Question 33

how old are you to be delayed puberty

Answer 33

14 years females, 15 years male

Question 34

causes of delayed puberty

Answer 34

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

Question 35

what can cause low gonadotrophin release

Answer 35

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

Question 36

what can cause high gonadotrophin release

Answer 36

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

Question 37

what are the two mechanisms for precocious puberty

Answer 37

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

Question 38

when is the growth spurt females

Answer 38

12 years

Question 39

when is the growth spurt males

Answer 39

14 years

Question 40

staging of breast development

Answer 40

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

Question 41

staging pubic hair growth male and female

Answer 41

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

Question 42

staging genital development male

Answer 42

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

Question 43

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

Answer 43

more likely in males

Question 44

causes precocious puberty females

Answer 44

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

Question 45

causes precocious puberty males

Answer 45

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

Question 46

age of precocious puberty in females

Answer 46

8

Question 47

age of precocious puberty in males

Answer 47

9

Question 48

gonadotropin dependent causes of precocious puberty

Answer 48

CNS abnormalities- hydrocephalus, infection, tumours; hypothyroid

Question 49

gonadotropin independent causes of precocious puberty

Answer 49

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

Question 50

management precocious puberty

Answer 50

GnRH analogues for dependent, inhibitors of sex steroids in independent

Question 51

what is the term for prem breast development

Answer 51

thelarche

Question 52

when does thelarche take place

Answer 52

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

Question 53

what is premature pubarche (adrenarche)

Answer 53

pubic hair develops