Endocrine

Question 1

What are the three phases of normal growth?

Answer 1

Infantile
Childhood
Pubertal

Question 2

What are the measurements for assessing child growth?

Answer 2

Length/Height
Sitting height
Head circumference

Question 3

What is the current chart for plotting child growth?

Answer 3

RCPCH UK2-18 growth chart

Question 4

What chart would you use to plot against parents height?

Answer 4

Target height and mid parental heigh (MPH)

Question 5

What other test can be used to plot growth/growth potential?

Answer 5

Bone age: TW 20

Question 6

What are the complete assessment tools for child growth?

Answer 6

Height/length/weight
Growth charts and plotting
MPH and target centiles
Growth velocity
Bone age
Pubertal assessment

Question 7

What would you ask in a Hx about growth?

Answer 7

Birth weight and gestation
PMx
Fx/Sx/schooling
Systematic enquiry
Dysmorphic features
Systemic examination including pubertal assessment

Question 8

What are indictions for referral on suspicion of a growth disorder?

Answer 8

Extreme short/tall stature
Height below target height
Abnormal height velocity
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty

Question 9

What are some common causes of short stature?

Answer 9

Familial
Constitutional
SGA/IUGR

Question 10

What are some pathological causes of short stature?

Answer 10

Undernutrition
Chronic illness (JCA, IBD, coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal (GHD, hypothyroidism)
Syndromes (Turner, P-W)

Question 11

What are investigations for looking at small stature?

Answer 11

FBC and ferritin
U&E, LFT, Ca, CRP
Coeliac serology and IgA
IGF-1, TFT, prolactin, cortisol
Karyotype

Question 12

What does FBC and ferritin investigate re: short stature?

Answer 12

General health, coeliac, Crohn’s, JCA

Question 13

What does Ca investigate re: short stature?

Answer 13

Disorders of Ca metabolism

Question 14

What do IGF-1, TFT, prolactin and cortisol investigate re: short stature?

Answer 14

Hormonal disorders

Question 15

What does doing a karyotype investigate re: short stature?

Answer 15

Turner’s syndrome

Question 16

What can be given to activate a GH stimulation test?

Answer 16

Arginine test

Insulin tolerance test

Question 17

If someone fails the GH stimulation test what does this mean?

Answer 17

GH deficiency

Question 18

What are two malformations of the pituitary gland which can result in GH deficiency?

Answer 18

Ectopic pituitary gland

Small pituitary gland

Question 19

What is the typical presentation of thyroid deficiency?

Answer 19

Lost height

Gained weight

Question 20

What are the signs of Turner syndrome?

Answer 20

L

Question 21

What is the staging system of puberty called?

Answer 21

Tanner method

Question 22

What are the signs of Prader-Willi syndrome?

Answer 22

D

Question 23

What are the signs of Noonan’s syndrome?

Answer 23

D

Question 24

What is the Tanner method of staging puberty?

Answer 24

B - breast
G - genital
PH - pubic hair
AH - axillary hair
T - testes

Question 25

How is the Tanner method assessed?

Answer 25

Clinical examination

Question 26

What is the device used to measure testicular maturation?

Answer 26

Prader orchidometer

Question 27

Which Tanner stage is pubertal?

Answer 27

Stage 2

Question 28

Which Tanner stage is pre-pubertal?

Answer 28

Stage 1

Question 29

What is the first sign of puberty in females?

Answer 29

Breast budding

Question 30

What happens at the end of puberty in females?

Answer 30

Menarche

Question 31

What happens at the end of puberty in males?

Answer 31

Facial hair

Question 32

What is the first sign of puberty in males?

Answer 32

Testicular growth

Question 33

When is early puberty in males?

Answer 33

>9yrs

Question 34

When is delayed puberty in males?

Answer 34

>14yrs

Question 35

When is delayed puberty in females?

Answer 35

>13yrs

Question 36

When is early puberty in females?

Answer 36

<8yrs

Question 37

What is CDGP?

Answer 37

Constitutional delay of growth and puberty (CDGP)

Question 38

Who does CDGP mainly affect?

Answer 38

Boys FH Bone age delay

Question 39

What are some causes of delayed puberty?

Answer 39

Gonadal dysgenesis (Turner, Klinefelter) Chronic disease Impaired HPG axis Peripheral (cryptorchidim)

Question 40

What happens if adrenal glands sex hormones are activated earlier?

Answer 40

Adrenarche

Question 41

What is adrenarche?

Answer 41

Development of pubic hair/axillary hair

Question 42

Where does true precocious puberty begin?

Answer 42

Pituitary gland

Question 43

What would you need to exclude if premature secondary sexual characteristics?

Answer 43

Congenital adrenal hyperplasia

Question 44

What is precocious pseudopuberty?

Answer 44

Abnormal sex steroid hormone secretion

Question 45

What is the clinical picture of precocious pseudopuberty?

Answer 45

Secondary sexual characteristics

Question 46

What is the management approach towards ambiguous genitalia?

Answer 46

``` Do not guess sex MDT Examination Karyotype Exclude congenital adrenal hyperplasia ```

Question 47

Why should you exclude congenital adrenal hyperplasia in ambiguous genitalia?

Answer 47

Risk of adrenal crisis and death

Question 48

Which Tanner stage is breast budding in girls?

Answer 48

Tanner Stage B2

Question 49

What Tanner stage is testicular enlargement?

Answer 49

Tanner Stage G2 | T3-4ml

Question 50

What can cause congenital hypothyroidism?

Answer 50

Athyreosis/hypoplastic/ectopic | Dyshormongenic

Question 51

How is congenital hypothyroidism managed?

Answer 51

Newborn screening | Treatment within first two weeks

Question 52

What is the most common cause of acquired hypothyroidism?

Answer 52

Autoimmune (Hashimoto’s) thyroiditis

Question 53

What are the childhood problems that present with acquired hypothyroidism?

Answer 53

Lack of height gain Pubertal delay Poor school performance Obesity

Question 54

When should you worry about an obese child?

Answer 54

Obese + short = abnormal

Question 55

What are the causes of obesity in children?

Answer 55

``` Simple obesity Drugs Syndromes Endocrine Hypothalamic damage ```

Question 56

What are the THINK type I diabetes symptoms?

Answer 56

Thirsty Thinner Tired Toilet - more

Question 57

What are the steps to making an early diagnosis of type I diabetes?

Answer 57

THINK symptoms TEST TELEPHONE

Question 58

What is the immediate test for type I diabetes in children?

Answer 58

Finger prick capillary glucose test | >11mmol/l -> refer

Question 59

What is a red flag symptom of type I diabetes?

Answer 59

Return to bed-wetting | Day-wetting

Question 60

What signs should you look for in >5s with possible type I diabetes?

Answer 60

``` Heavier than usual nappies Blurred vision Candidiasis Constipation Recurring skin infections Irritability/behaviour change ```

Question 61

What are symptoms of DKA?

Answer 61

``` Nausea & vomiting Abdominal pain Sweet smelling ‘ketotic’ breath Drowsiness Rapid, deep ‘sighing’ respiration Coma ```

Question 62

What result of the finger prick capillary blood glucose test indicates type I diabetes in children?

Answer 62

>11mmol/l