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Flashcards in Endo Deck (53):
1

management for hyperthyroidism/graves disease (3 components)

- refer to pediatric endocrinologist
- PTU to block thyroid hormone synthesis
- surgery (partial or complete)

2

pts with diabetes should have their hemoglobin a1c checked how often?

Q3 months

3

NPH insulin onset, peak, duration

onset: 1-2 hr
peak: 4-12 hr
duration: 18-24 hr

4

If baby presents with:
prolonged neonatal jaundice, poor appetite and suck due to large tongue, dyspnea with feeding, constipation, sluggishness, hypothermia, bradycardia, and parents say "they're the best baby ever...hardly ever cries"
think:

congenital hypothyroidism

5

An A1C goal of ___ is recommended across all pediatric age groups for type 1 diabetes

< 7.5% (58 mmol/mol)

6

what is the causative factor for precocious puberty?

none in majority

7

If child presents with dry skin, apathetic affect, sensitivity to cold, decreased appetite, lethargy, constipation, weight gain, difficulty with concentration, poor school performance, delayed puberty...suspect

acquired hypothyroidism/hashimoto's

8

rapid insulin onset, peak, duration

onset: 10-30 min
peak: 30-90 min
duration: 3-5 hr

9

lantus insulin onset, peak, duration

onset: 1-1.5 hr
peak: none
duration: 20-24 hr

10

if a patient presents with increased appetite but weight loss, fatigue, muscle weakness, emotional lability, poor concentration, poor sleep, and on physical exam shows thyroid bruit, tachycardia, wide pulse pressure, underweight, exopthalmos, warm/moist skin, tremor, or hyperreflexia and may have a goiter, what would this be?

hyperthyroidism/Graves disease

11

normal variants of short stature (2)

familial short stature (most common)
constitutional growth delay

12

which of the following is NOT found in children with growth hormone excess?

- tall stature
- prominent mandible and supraorbital ridge
- high or normal plasma growth hormone
- short stature

- short stature

13

if a child present with normal length/weight at birth, slowed linear growth at 1-3 years, height at or just below 3rd percentile, delayed puberty, history of similar pattern in familiar but on exam, shows normal near exam, delayed bone age/normal growth velocity for bone age

constitutional growth delay

14

peak incidence of hyperthyroidism is ___ years of age

11-15

15

most common cause of hyperthyroidism in childhood is

graves disease

16

BG monitoring for type 1 diabetes patients is how many times a day?

4

17

definitive diagnosis for growth hormone deficiency

radioimmunoassay of plasma GH levels
hand x-rays to evaluate growth potential vs ossification

18

2 main causes of disproportional short stature

skeletal dysplasia (dwarfism)
rickets

19

most children in ketosis are ___% dehydrated

10

20

is constitutional growth delay a disease?

no -common variation

21

all infants require screening for congenital hypothyroidism when

before discharge and before 7th DOL

22

more than ___% of children diagnosed with type 1 diabetes are in DKA

50

23

if a type 1 diabetic child presents with slow labored breathing, flushed cheeks/face, fruity-smelling breath, this would be

ketotic

24

GH replacement successful in ___% of children affected by growth hormone deficiency

80

25

as a result of peak hours with insulin administration, snacks are needed at what 3 times of day for type 1 diabetes kids?

mid-morning
mid-afternoon
bedtime

26

many children with type 1 diabetes are placed on what 2 kinds of insulin? what does each do?

1. fast acting (Novolog, Humalog, Apidra) - multiple daily injections to cover meals and snakcs
2. long acting insulin (Lantus/Levemir) for basal coverage

27

how do insulin pumps work?

use in conjunction with supplemental rapid acting insulin

patients set a basal rate and then boluses at meals according to carbohydrate intake

28

which of the following is NOT characteristic of constitutional growth delay?

- no history of similar growth pattern in other family members
- child usually remains constitutionally small as an adult
- final adult stature tends to be normal
- weight and height at birth are generally in the lower percentiles

- child usually remains constitutionally small as an adult

29

TSH, FT4 and T3 levels in congenital hypothyroidism

TSH: elevated
Free T4: low
T3: low

30

precocious puberty definition

sexual development before age 9 in boys, 8 in girls

31

most cases of hyperthyroidism are the result of ___ disease

Graves

32

deep and fast respirations associated with type II diabetes are known as

kussmaul

33

delayed puberty criteria

if a male 14 years or older
or female 13 years or older
has NO clinical features of puberty

34

short stature criteria: any child over __ years who is ___ SD below the mean on the standard growth charts or who has decreased growth velocity (falls off growth curve)

2, 2

35

if child presents with dehydration, weight loss/muscle wasting, tachycardia, vaginal yeast thrush or other infection, and potentially ketotic think

type 1 diabetes

36

diagnostic testing for diabetes:
- symptoms of diabetes plus an elevated random plasma glucose of ___?
- fasting blood glucose of ____ on how many occasions?
- urine for ___ and ___

how many of these criteria must be met for diagnosis of diabetes?

elevated random plasma glucose of > 200mg/dl

fasting blood glucose of >126mg/dl on 2 occasions

urine for ketones and glucose

only 1 of 3 must be met for dx

37

type 2 diabetes management includes what 6 points

- BG monitoring
- diet plan
- weight reduction
- exercise
- oral hypoglycemia agents as necessary
- referral to endocrine

38

treatment for precocious puberty (3 components)

- refer to peds endo
- leuprolide (lupron) slows pre-pubertal growth to normal rates, and then discontinued at age for normal pubertal changes to resume
- psychological support

39

if hyperthyroidism were suspected, lab results of what TSH and what Free T3 and T4 results would confirm?

low TSH
high free T3 and T4

40

if you see an infant in clinic and he has a low T4 and elevated TSH for the second time the PNP should provide what information to the parents?
1. this is uncommon but it occurs more often in males than in female newborns
2. this condition needs to be treated with proplythiorucaiil
3. these test results occur sometimes but are not to worry about
4. it is important for your child to be referred to peds endo and begin treatment with levothyroxine to prevent cognitive delay

4. it is important for your child to be referred to peds endo and begin treatment with levothyroxine to prevent cognitive delay

41

common diagnostic tests for delayed puberty (5)

- screening for acute and chronic illness
- bone age x-ray
- Free T4 and TSH
- growth hormones
- LH and FSH

42

Abdominal pain and vomiting are particularly critical to monitor in children with diabetes because these findings may represent the onset of:

- ketoacidosis
- GI infection
- hyperglycemia
- autoimmune response to the pancreas

- ketoacidosis

43

The main symptoms associated with Graves Disease are: 1) exopthalamos, 2) tremors, 3) being female, 4) anxiety or agitation

ALL

44

alcohol and exercise ___ BG while sickness and stress ___ BG

decrease, increase

45

hyperthyroidism/graves disease is believed to be caused by

serum thyroid-stimulating immunoglobulin

46

regular insulin onset, peak, duration

onset: 30-60 min
peak: 1-3 hr
duration: 6-8 hr

47

delayed bone age with normal growth rate for bone age

constitutional growth delay

48

3 Ps for type II diabetes

polydipsia
polyuria
polyphasia
(and bedwetting)

49

if untreated, congenital hypothyroidism can lead to ____

cognitive delay

50

most common cause of acquired hypothyroidism in children and adolescents

hashimoto's

51

if child present with dysmorphic features, midline defects, increased ICP, thyroid issues, delayed puberty -?

growth hormone deficiency

52

management for congenital hypothyroidism

- oral thyroid hormone replacement
- prompt treatment needed for brain growth in infants
- compliance with med regime crucial

53

pharmacologic treatment for acquired hypothyroidism

daily life-long levothyroxine (Synthroid)