Endocrine

Question 1

What is congenital hypothyroidism

Answer 1

When hypothyroidism presents at birth

Question 2

Types of congenital hypothyroidism

Answer 2

Athyreosis
Thyroid dysgenesis
Dyshormonogenesis

Question 3

Ix for congenital hypothyroidism

Answer 3

All babies screened at birth
Heel prick blood test

The Guthrie Card

Question 4

Rx for congenital hypothyroidism

Answer 4

Paediatric endocrinologist

Levothyroxine

Question 5

Causes of acquired hypothyroidism

Answer 5

Autoimmune (Hashimoto’s Thyroiditis)
Hypopituitarism
Trisomy 21

Question 6

Define acquired hypothyroidism

Answer 6

Hypothyroidism acquired after birth

Question 7

Clinical features of hypothyroidism

Answer 7

Stunted growth (short limbs)
Delayed dentition 
Inactivity
Lack of energy 
Constipation 
Dry skin 
Slow mental development 
Poor school performance
Delayed puberty 
Slow speech 
Hair loss 
Weight gain

Question 8

Rx for acquired hypothyroidism

Answer 8

Levothyroxine

Question 9

Which type of DM is mainly seen in children

Answer 9

Type I

Question 10

Pathology of Type I DM

Answer 10

Autoimmune condition
T cell mediated destruction of pancreatic beta cells
Insulin deficiency
Therefore, glc in the blood cannot be taken up by tissues
Blood glc increases

Question 11

THINK symptoms DM

Answer 11

Thirsty
Thinner
Tired
Toilet

Question 12

Ix for DM

Answer 12

Test immediately:
Random blood glc >11mmol/l

Fating blood glucose >7mmol/l

Question 13

Rx for DM

Answer 13

MDT team
Insulin
(may benefit from sub. cut insulin infusion)

Question 14

What is the most concerning complications of DKA in children

Answer 14

Cerebral oedema

Question 15

Pathology of DKA

Answer 15

Insulin deficiency
Rise in counter-regulatory hormones (e.g glucagon, cortisol, growth hormone)
Inappropriate gluconeogenesis
Accelerate catabolism from lipolysis of adipose tissues
Increased fatty acid circulation

Question 16

Clinical features of DKA

Answer 16

Confusion 
Dehydration (severe)
Vomiting 
Polyuria 
Polydipsia 
W.t loss 
Abdominal pain 
Sweet smelling breath ‘pear drops’
Rapid, deep ‘sighing’ respiration (Kussmaul’s Respiration)

Question 17

Children <5yrs DM signs

Answer 17

Heavier than usual nappies 
Blurred vision 
Candidiasis (oral, vulval)
Constipation 
Recurring skin infections 
Irritability 
Behavioural changes

Question 18

Ix for DKA

Answer 18

Hyperglycaemia:
>11mmol/l

Acidosis:
Venous pH <7.3

Ketones present:
Urine (dipstick)
Blood

Question 19

Emergency Rx of DKA

Answer 19

Fluid resuscitation (0.9% IV saline no K+)

IV fluids maintenance (+ correction of K+)

Start IV insulin (after 1hr of fluid)

Avoid bicarbonate

Question 20

What should you avoid RX in DM

Answer 20

Bicarbonate

Question 21

Most common cause of obesity in children

Answer 21

Simple obesity

Question 22

Common causes obesity

Answer 22

Poor diet
Decreased exercise
Genetics FH

Question 23

Which medications can cause weight gain children

Answer 23

Sodium valproate
Carbamezepine
Steroids

Question 24

Medical causes obesity in children

Answer 24

Hypothyroidism
Cushing’s Syndrome
GH deficiency
Prader-Willi Syndrome

Question 25

What is abnormal relating to obesity

Answer 25

Short and obese

Question 26

For <4yrs which charts should be used to measure child obesity

Answer 26

WHO charts

Question 27

For >4yrs which measurement should be used to measure child obesity

Answer 27

BMI

Question 28

Is Ix commonly needed for obesity

Answer 28

No rarely needed

Question 29

Rx for obesity

Answer 29

Diet modification Exercise If underlying condition treat

Question 30

Medium term consequences child obesity

Answer 30

``` Insulin resistance Type II DM Sleep apnoea Orthopaedic problems Non-alcoholic fatty liver disease ```

Question 31

Long term consequences child obesity

Answer 31

``` Atherosclerosis Early onset CVD Some cancers (part. breast and bowel) Subfertility Hypertension ```

Question 32

Is diet alone Rx recommended

Answer 32

No

Question 33

which gender go through puberty earlier?

Answer 33

Females

Question 34

Common causes short stature

Answer 34

short parents | Late growth spurt

Question 35

Pathological causes short stature

Answer 35

``` Undernutrition Hypothyroidism Turner Noonan Deprivation Iatrogenic - steroids Chronic illness (JIA, coeliac) ```

Question 36

Which staging system is used to measure puberty

Answer 36

Tanner

Question 37

Causes delayed puberty

Answer 37

``` Gonadal dysgenesis (Turner, Klinfelter) Chronic disease (asthma, Crohn's) Impaired HCG axis ```

Question 38

What does Tanner Staging take into account

Answer 38

Breasts Pubic hair Genitals Axillary hair