Endo Flashcards by A A

3.2kg, phallus short and chordee, and urethra is visible at base of phallic strucutrre and has mass like testis in inguinal canal

Female CAH,
 B male CAH, 
C gonadal dysgensis 
D-turner 
E undervirilized male

undervirilized male

How well did you know this?

Not at all

Perfectly

4yo M has pubic hair, tanner 3. His testis 2ml bilat. Testoerone 7.8 (n is 1.8) and bone age 7 yr
A- central precocious, 
B CAH, 
C craniopharynioma
 D cushing,
E premature adrenarche

B CAH,

How well did you know this?

Not at all

Perfectly

4yo M has pubic hair, tanner 3. His testis 2ml bilat. Testoerone 7.8 (n is 1.8) and bone age 7 yr
A- central precocious, 
B CAH, 
C craniopharynioma 
D cushing, 
E premature adrenarche

CAH

if bone age is advanced by more then 2 years, then think adrneal origin
- not premature adrenarche in this case cuz BA is advanced

How well did you know this?

Not at all

Perfectly

15yo with lack of puberty. Height is third centile, pubic hair is tanner 1, and testis 6ml bilaterally. His bone age 12yo

MOST LIKELY - constituional growth delay (esp with the bone age delay)

How well did you know this?

Not at all

Perfectly

6yo black girl, with breast and pubic hair with no vaginal bleeding.
a-Non classical CAH (should be JUST virilization if CAH)
b-Normal puberty onset given racial background
c-Autonomous functioning ovarian cyst
d- Central precocious puberty,

next test to confirm LH/FSH

Central precocious puberty,

How well did you know this?

Not at all

Perfectly

Child has autoimmune thyroiditis, want to monitor therapeutic treatment of levo, how do you do this?

a) TSH
b) FT4
c) T4
d) Thyroid peroxisome

a) TSH

How well did you know this?

Not at all

Perfectly

For adolescent girls, which would be the most concerning in terms of height velocity

a) Tanner stage 2, growing 6cm/year
b) Tanner stage 3, growing 4cm/year
c) Tanner stage 4, growing 5cm/year
d) Tanner stage 5, growing 1cm/year

Tanner 3 at 4 cm

How well did you know this?

Not at all

Perfectly

Which of the following is most consistent with a boy who is tanner 3?
Increased axillary hair
Voice deepening
Pubic hair is becoming curly

pubic hair curly

How well did you know this?

Not at all

Perfectly

10 year old girl with an enlarged thyroid, diffuse nontender. T4 6.6 TSH >50, thyroid antibodies positive. What is your next step in management?

Start methimazole
Order thyroid ultrasound
Order radionuclide scan
Start levothyroxine

tart levothyroxine

How well did you know this?

Not at all

Perfectly

A 7 year old boy has had type 1 diabetes for the last 3 years. If this does not result in
excessive hypoglycemia, what should the target be for his HbA1C?
a. 6.5%
b. 7.0%
c. 7.5%
d. 8.0%

c. 7.5%

Goal
<6 : 8
6-12 :< 7.5
teens : <7

How well did you know this?

Not at all

Perfectly

A neonate’s newborn screen shows a TSH of 45. What is the NEXT step in management?

a. Book a visit for a physical exam
b. Order a TSH + free T4
c. Order a radionuclide thyroid scan

Order a TSH + free T4

How well did you know this?

Not at all

Perfectly

A 13yo boy has become more withdrawn over the last year and seems only interested in his
friends and his computer. He has difficulty waking up in the morning and seems tired. Which
is the next step in management?
a. TSH
b. Tox screen
c. Refer to psychology

a. TSH

How well did you know this?

Not at all

Perfectly

6 yo girl is referred to you for short stature. She is growing on the 3rd %, weight on the 50%. Her physical exam is normal. Her growth velocity is 3 cm/year and her bone age is 4 years. What is the most likely diagnosis?

a. Growth hormone deficiency,
b. Turner syndrome
c. Achrondrodysplasia

a. Growth hormone deficiency,

How well did you know this?

Not at all

Perfectly

Teenage girl with pigmented tongue, hyponatremia.  What is the best way to make a definitive
diagnosis?
a.     ACTH level
b.     AM cortisol
c.     ACTH stim test
d.     17 OHP

c. ACTH stim test

How well did you know this?

Not at all

Perfectly

A child is noted to be drinking ++ water and has very dilute urine. What is the most likely diagnosis?

a. Psychogenic polydipsia -
b. SIADH
c. Diabetes

psychogenic or diabetes

Psychogenic polydipsia - hyponatremia, low urine osmolality

b. SIADH - would have concentrated urine and decreased u/o with hyponatremia
c. Diabetes (DM would cause high SPecific gravity,
d. DI could give this picture..)

How well did you know this?

Not at all

Perfectly

Male teen who is football player. Has gynecomastia, hepatitis, and jaundice. Most likely taking:
Anabolic steroids
Growth hormone
Creatine

anabolic

How well did you know this?

Not at all

Perfectly

Father 175 cm. Mother 155 cm. What is Midparental height for a boy?
165
167
169
171

171

How well did you know this?

Not at all

Perfectly

Best test for nutritional Vit D deficiency
Ca
1,25 Vit D
25 Vit D
PTH

25 vit D

Longer half life
calcitriol (1,25 OH Vit D-active form)
calcidiol is the 25 OH form that is stable (before kidney converts) and best TEST

How well did you know this?

Not at all

Perfectly

A four year old girl presents with new onset diabetes mellitus. Her initial labs reveal a glucose of 18, pH 7.14, bicarb 11. Her neurologic examination and level of alertness are initially normal. However, after 2 hours of insulin infusion, she suddenly becomes lethargic and unresponsive. What is the most appropriate initial action?

    	1) Obtain bedside glucose reading
    	2) Draw calcium, magnesium and phosphate levels
    	3) Start IV antibiotics
    	4) Give mannitol

Obtain bedside glucose reading

How well did you know this?

Not at all

Perfectly

A 6 yo girl with precious puberty symptoms (vaginal bleed, accelerated growth), multiple Cafe Au Lait, bone abnormalities. What to test to order?

a. Genetic test for NF1
b. Echo for rhabdomyoma
c. Screen for other endocrinopathy

screen for other-
McCune-Albright Syndrome (MAS) is a rare disorder defined as the triad of peripheral precocious puberty, irregular café-au-lait (“Coast of Maine”) skin pigmentation, and fibrous dysplasia of bone

This mutation leads to continued stimulation of endocrine function (eg, precocious puberty, thyrotoxicosis, gigantism or acromegaly, Cushing syndrome, and hypophosphatemic rickets)

How well did you know this?

Not at all

Perfectly

metabolic acidosis after fasting with URTI. No ketones. Hypoglycaemia. Mildly raised LFTS.

FAOD
Mitochrondrial
Hyperinsulinism

Study These Flashcards

FAOD

13 year old girl presents to the ED with a generalized tonic clonic seizure.  Her parents say she’s been drinking a lot of water recently.  Her labs: Na 118, Cl 86, osm 262, Urine Na 20, serum urine osm 68.  What’s the MOST likely diagnosis?
T1DM 
Psychogenic polydipsia
SIADH -
Adrenal insufficiency

Study These Flashcards

normal serum osm =300
normal urine osm is 1/2 that
its psychogenic

T1DM (N urine osm)
Psychogenic polydipsia
SIADH - concentrated urine
Adrenal insufficiency (?) - hypoglycemia, hyponatremia, hyperkalemia, ketosis, shouldn’t have dilute urine

What is the best way to monitor effectiveness of thyroid replacement in autoimmune thyroiditis?
A.	T4
B.	free T4
C.	T3
d.  TSH

Study These Flashcards

TSH

2 year female with onset of thelarche. Bone age and stature 3 years. What do you tell her mom?
Will resolve
Gradual progression to puberty
Fast progression to puberty

Study These Flashcards

Will resolve

13 year old female who had menarche at 11. Presents with menomethorrhagia, Hgb 84. Most likely cause? 1. Von Willebrands 2. Increased Progesterone 3. Decreased Estrogen 4. Prolonged endometrial buildup

Von Willebrands

``` 8 year old (no description of his health). Parents with DM2, when to screen for DM2? Now At puberty At 10 With more risk factors ```

≥3 risk factors in nonpubertal or ≥2 risk factors in pubertal children [Grade D, Consensus] Obesity (BMI ≥95th percentile for age and gender) Member of a high-risk ethnic group (e.g. Aboriginal, African, Asian, Hispanic or South Asian descent) Family history of type 2 diabetes and/or exposure to hyperglycemia in utero Signs or symptoms of insulin resistance

108. At what BMI should the pediatrician provide intervention? a. 75th %ile b. 85th %ile c. 95th %ile d. 99th %ile

85th centile

``` Child with perineoscrotal hypospadias, enlarged phallus, non-palpable testicles. a.congenital adrenal hyperplasia b. 5-alpha reductase deficiency c.partial androgen insensitivity d nrmal male ```

CAH

6 year old child with pubic hair. Bone age 6 1/2 years. Most likely dx? a. craniopharyngioma b. benign premature adrenarche

b. benign premature adrenarche

6 year old child who was growing 2 cm/year, height now <5th percentile and 50% for weight. Bone age 4 years. Diagnosis? a. Celiac disease b. GH deficiency c. Turner syndrome INV- w/u includes IGF1, IGFBP3 (binding protein 3), and bone age (after ruled out Turner and skeletal dysplasia

INV- w/u includes IGF1, IGFBP3 (binding protein 3), and bone age (after ruled out Turner and skeletal dysplasia

6 year old child with vaginal bleeding, no foreign body, no exogenous estrogen sources. Has bone age of 7.5 years, 17-OPH normal, what is dx?1. Premature menarche CAH - usually virilization craniopharyngioma premature adrenarche

premature mearche r/o FB, urethral prolapse

What would be the difference between psychogenic polydipsia and diabetes insipidus? a. Dilute urine b. Diarrhea c. Hypernatremia

c. Hypernatremia

Conditions where there is a discrepancy between chronologic age and bone age a) .contistitional delay of gorwht and puberty b. failure to thrive c. psychosocial deprivation? d. malnutrition

constiutional delay of growth and puberty

what length of penile is question of dsd and cliteral issue remember 17 ohp increases in 48 hours and salt wasting takes a week

penile stretch of less then 2,5 cm clitoromegaly is 9mm or bigger and the AG ratio of more hten 0.5 concerning so far from vag bottom to anus then penis base to anus

what antibodies involed with graves and hashimoto

hashimoto- hypothyroidism - anti-tpo (thyroid peroxidase) and thyrogobulin antibodies graves . hyperthyroidism thyrotropin stimulating antibodies or TRAB treatment with methimazole

osteoporosis | concerning # history?

more then 2 long bone # by 10yo or 3 by 19 or any vertebral compression # more then 20% concerning for osteoporosis

``` management of dka ph<7.25, hc03 <15 rf for cerebral edema 1- young<5 2- new diagosis 3- high pc03 4-high urea 5- rapid hypotonic solition 6- insulin bolius 7- early insulin within hour of fluids 8-failure of Na to rise with treatment 9 - use of bicarb ```

1- small bolus if dehdrated 2- 1 hour ivf 5-7cc/kg of NS and add 40 if k<5.5 3- add slow insulin infusion 0.1 units per kg per hour lytes q4 and gas q2 4- add glu once glu <15 5- goal drop serum osm by <3 an hour6 6- ph normal and bicarb above 18 then switch to subcut insulin monitor lytes, osmolality, gas, cr/ur, anion gap

target goals for t1dm sugars and a1c and retinopahty, metabollic and nephropathy guidelines insulin rquirements are 0.5-1 u/kg/d pre pubertal and 1-2 adolescent age

if less then 6- target 8 (8,5) if alot of hypoglycemia with fbg 6-10 6-12 target 7.5 or 8 with hypogly and fbg 4-10 if 13 or older then <7 goal and fbg4-7. (remember if hemoglinopathy use fructosamine or albumin to measure control)

for hypoglycemia - give iv bolus 0.5g/kg,or 2ml/kg d10- or IM glucagon of 0.5-1mg - keep glu 8 or above. reduce insulin dose by 20% think abut celiac and addisons also counter reg hormones- glucagon, epi, cortisol, gh tsh and thyroperixodase levels are q2year if positive then q6 mo addison -if recc hypoglycemia or dec need for insulin wiht 8am serum cortisol. sodoum and potassium celiac if gi sx or fatigue anemia or poor weight and growth

complications of diabetes: retinopathy- check yearly at 15yo if had disease for 5 y renal dysfunction, check at 12yo ACR in AM--tx give ace inh (dietary protein restiction, control bp, control hypergly) htn check q6 mo dislipdiemia at 12 and 17 yo, or if >95th centile with fmhx of CAD or hyperlipid: fasting total chol. hdl, tg, ldl neuropathy- postpubertal screen 5y with disease with poor metbaolic control - questionnatire

``` screening guidelines for t2dm both cda fasting blood glu q2 years: for cda if prepub 3 rf, if post pubert 2 rf including 1-obestiy bmi 95 member of high risk ethicni, aborigial, africa, asia, south asia, hispanic fmhx or hyperglycemia exposure in utero insulin resistence-acanthrosis, htn, nafld ``` or use of atypicals

cps states do fasting gly, or random or ogtt if ALL; 1-high risk popn, 2 bmi 85, age 10 and 1 of; sednedary, gdm, 1/2nd degree relative, actanthrosis, dislipid, pcos or htn tx 6 mo life style as long as a1c<9, then metformin or if ketones then insulin screen from diagnosis and yearly - dyslipid, htn, nafld, nephropathy, neuropathy, pcos, retinopathy

hyperinsulinsm>5microU/ml with hypoglycemia remember prevents ffa and ketosis and have inappropriate response to glucagon normal gir6-8

if defect is in counter reg protein- hypopit- microcsph, and nystagmus, with midline issues - serum has KETONES and FFA ALSO ketotic hypoglycemia is diagosis of exclusion - 18mo-5yo usualy skinny with hx of SGA, problem with alanine mobilization, usu resolve by 8yo

``` hypoglycemia differential in childhood 1-gsd 2- mcad or valproate intox 3- galactosemia 4- insulin or prorpanol 5- ethanol ingestion 6- hyperinsulisnm 7-idiopathic ketotic hypoglycemia 8- addison ```

CRITICAL SAMPLE 3G, 2C, FLIB gas glucose gh cortisol c peptide ffa, lactate, insulin, beta hydroxybutyrate urine; ketones and reducing usbstances tox screen ?acetoacetate

``` normal length growth <12mov- 18-25, 12-24mo 10cm 24-mo-36mo-7.5-10 child 5-6 adolecent 6-9cm ater menarche 7cm total ``` endo . causes - turner (shox gene missing) hypothyroidism, gh approved for turner, chronic renal diseas,e SGA that did not catchup and idipathic short stature

GH influneced by intact thyroid function- resembles insulin non endocrine causes of short stature- russel silver (clyndactyl 5th finger), albright, prader willi, turner, nutrition, ftt gh deficiency - or laron (where no receptor) depressed nasal bridge, frontal bossing, micropenis, hypgylcemia, hyperlipdiemia., central issues at borth like bifid uvula, treatment with growth hormine - inc risk of SCFE AND PSEUDOTUMOR CEREBRI

hypothyroid tsh more then 40 treat plus imagin with radionucleiotide uptake scan and ultrasound, serum thyroglobulin, urine iodine and treat right away with levo 10mcg/kg and off soy formula

sx- macroglossia, hypotonia, umbilical hernia, lethargic, poor feeding, constipation, hypothermia, large post fontanelle, jaundice, dry skim, hoarse cry, acrocyanosis

hypothyroid tsh more then 40 treat plus imagin with radionucleiotide uptake scan and ultrasound, serum thyroglobulin, urine iodine and treat right away with levo 10mcg/kg and off soy formula use ft4 to initiate treatment but tsh to track q6mo, and 6w after any dose adjusment

sx- macroglossia, hypotonia, umbilical hernia, lethargic, poor feeding, constipation, hypothermia, large post fontanelle, jaundice, dry skim, hoarse cry, acrocyanosis vs hyperthyroidsim -polycythemia, irritble, , tachy, heart failure, warm, moist, hsm, hyperphagia, microcephaly, poor sleep, prem

who at risk of hypothyroidism what meds can cause psuedotumor cerebri - levo initiation, growth hormone, minocycline, csa, ocp, isoretinoids, vit A and phenytoin

t1dm, turner, downs, celiac, klinefelter, addison, ms, sjogren aps 1- hypoparathyroid addison, candida aps2- t1dm, addison, autoimm thyroid

pth effects remmeber measure 25 vit d for level as half life 2-3 w 1.25 vit d is the active form and lasts 4 horus

1- reabsorp ca from kidney, inc phsophate excretion 2- mobilize ca from bone 3- increase vit d secretion (which inc ca and phosphpate absorption from the gut)

causes of hypocalcemia low pth- ie, digorge, anatomiical problem x linked hypopth, apeced(autoimmmune) , wilson, albright, vit d defieincy, low magnesium tx vit d, mag, ca carb osteoporosis- caused by marfan, oi, ehlers, hypogonadism like turner or klinfelter, or jdm, sle, ibd, steroids, alcohol, csa, chemo

causes of hypercalcemia ``` hyper pth - men2, tumor hyper vit d subcut fat necrosis, sarcoidosis williams syndrome hyperthryoid ``` tx, hyperhydration, calcitonin, bisphoshphatate

RICKETTS high alp high pth - calcipenic- vit d deficiency (anti sezuire meds can cause this) or hgih dose furoseide tx 1.25 vit d and cal low pth - phosphopenic - aka fgf23 deficiency or fanconi by losing phosphate through the kidney - NORMAL ca and low phospjhate, tx vit d and phosphate

oi - has blue sclera, wormian bones, short stature, scoliosis, dentinogenesis imperrfecta

external male genitalia from dht from testerosterone covnerted via 5 alpha reducatase mis - regresses mullerian duct which prevents uterus tiubes and 1/2 upper vag

dsd workup testosterone, dhea, dht, androstendione, lh fsh and ultrasound if you have gonads ddx XY - ais, partial ais - 5 alpha reductase defieincy - gonad dysgeneisis - hypopit - adrenal hyperplasia no gonads ddx- gonadal XX -dysgensis, androgen excess from cah, aromatase def or matenral androgens

Endo Flashcards

(50 cards)