ENDOCRINE DISORDERS PART 2 2.1(AB)

Question 1

When is the critical window for maternal and child undernutrition?

Answer 1

Between pregnancy and the child’s second birthday. Also called the first 1.000 days.

Question 2

Why is nutrition important during the first 1,000 days?

Answer 2

Supports rapid growth and development. Reduces risk of malnutrition and infection.

Question 3

What are consequences of prolonged inadequate nutrition during the critical window?

Answer 3

Leads to stunting. Affects physical and cognitive development.

Question 4

What are benefits of proper nutrition during the first 1,000 days?

Answer 4

10x better survival. 4.6x better academics. 21 percent more adult wages.

Question 5

What criteria are used to identify children with severe acute malnutrition?

Answer 5

MUAC <11.5 cm. WFL or WFH below -3 z-score. Any degree of bipedal edema.

Question 6

What is the next step after identifying a child with severe acute malnutrition?

Answer 6

Refer for full assessment and admit to treatment program.

Question 7

Name the 10 steps to recovery from severe acute malnutrition.

Answer 7

Treat hypoglycemia. Treat hypothermia. Treat dehydration. Correct electrolytes. Treat infection. Correct micronutrients. Start cautious feeding. Catch-up growth. Provide stimulation. Plan follow-up.

Question 8

What are PPS-proven interventions for adolescents and pregnancy to prevent malnutrition?

Answer 8

Use local foods. Salt iodization. Micronutrient supplements. Deworming. Food supplements. Antenatal care including HIV testing.

Question 9

What are PPS interventions at birth to prevent malnutrition?

Answer 9

Delayed cord clamping. Neonatal Vitamin K. Breastfeeding initiation. Infant practices. Immunization. Newborn screening.

Question 10

What are PPS interventions for 0-5 months to prevent malnutrition?

Answer 10

Exclusive breastfeeding. Proper feeding. Immunization. Vitamin A. Multi-micronutrients. Use local and fortified foods.

Question 11

What are PPS interventions for 6-23 months to prevent malnutrition?

Answer 11

Complementary feeding. Breastfeeding. Vitamin A. Zinc. Deworming. Food fortification. Handwashing. Sanitation. Immunization.

Question 12

What conditions can accompany GH deficiency?

Answer 12

Hypoadrenalism. Hypothyroidism. Gonadotropin deficiency.

Question 13

What is the most common cause of GH deficiency?

Answer 13

Idiopathic GH deficiency.

Question 14

What are causes of acquired GH deficiency?

Answer 14

Tumors. Radiotherapy. Meningitis. Histiocytosis. Trauma.

Question 15

What are infant signs of GH deficiency?

Answer 15

Apnea. Cyanosis. Severe hypoglycemia. Prolonged jaundice. Nystagmus.

Question 16

What is classic GH deficiency appearance?

Answer 16

Cherubian facies. High pitched voice. Normal intellect.

Question 17

What are signs of GH resistance like Laron syndrome?

Answer 17

Abnormal GH receptors.

Question 18

What is the hallmark of congenital GH deficiency in early life?

Answer 18

Normal birth weight. Growth slows after birth. Becomes short with high weight to height ratio.

Question 19

What genital finding suggests GH deficiency in males?

Answer 19

Micropenis with stretched length <2 cm.

Question 20

What are typical facial features in GH deficiency?

Answer 20

Round head. Broad face. Depressed nasal bridge. Underdeveloped chin.

Question 21

What other physical signs are present in GH deficiency?

Answer 21

Small larynx. High pitched voice. Delayed sexual maturation. Pudgy body.

Question 22

What tests screen for GH deficiency?

Answer 22

CBC. Metabolic panel. Celiac panel. Carotene and folic acid levels.

Question 23

What hormones are measured in GH testing?

Answer 23

IGF-1. IGFBP3.

Question 24

What drugs are used in provocative GH tests?

Answer 24

Arginine. Levodopa. Insulin. Clonidine. Glucagon.

Question 25

Why assess thyroid hormone before GH testing?

Answer 25

Thyroid hormone is needed for GH synthesis.

Question 26

What brain MRI findings support GH deficiency?

Answer 26

Small pituitary. Missing stalk. Ectopic posterior pituitary.

Question 27

What bone imaging is done in GH deficiency?

Answer 27

Hand x-ray for bone age.

Question 28

What is the dosage of rhGH for GH deficiency?

Answer 28

0.16-0.24 mg/kg/wk or 22-25 micrograms/kg/day.

Question 29

What are indications for rhGH?

Answer 29

GH deficiency. Turner syndrome. CRF. ISS. SGA. PWS. SHOX defect. Noonan syndrome.

Question 30

When should GH therapy stop?

Answer 30

Parental decision. Growth rate <1 inch/year. Bone age >14 (girls). Bone age >16 (boys).

Question 31

What are complications of GH therapy?

Answer 31

Hypothyroidism. Adrenal insufficiency. Type 2 diabetes risk.

Question 32

How is failure to thrive defined?

Answer 32

Weight <3rd percentile. Drop across 2 major percentiles. Height <80 percent of expected.

Question 33

What are signs of malnutrition in FTT?

Answer 33

Wasting. Stunting. Poor weight gain. Low BMI.

Question 34

What causes rickets?

Answer 34

Vitamin D deficiency. Phosphorus deficiency. Calcium deficiency.

Question 35

What are signs of rickets in older infants?

Answer 35

Bowing legs. Wrist thickening. Rachitic rosary.

Question 36

What are common radiographic signs of rickets?

Answer 36

Fraying. Cupping of metaphyses.

Question 37

What labs help diagnose rickets?

Answer 37

Ca2+. PO4-. PTH. 1.25-diOH Vit D.

Question 38

What is the treatment for nutritional rickets?

Answer 38

Vitamin D and calcium supplementation.

Question 39

How is hypophosphatemic rickets treated?

Answer 39

Phosphate and vitamin D therapy.

Question 40

What defines obesity?

Answer 40

Imbalance of caloric intake and expenditure. Environmental factors include food. physical activity. changes in health behavior and sleep. and genetics.

Question 41

When are the sensitive periods for obesity risk?

Answer 41

Infancy. adiposity rebound when body fat is lowest around 5.5 years old. and adolescence.

Question 42

What are neuroendocrine feedback loops in obesity?

Answer 42

They are appetite and weight negative feedback systems that link adipose tissue. GI tract. and CNS.

Question 43

Which GI hormones regulate appetite and satiety?

Answer 43

CCK. glucagon like peptide 1. peptide YY which reduces food intake via the vagal-brainstem-hypothalamic pathway. vagal neuronal feedback. and ghrelin which stimulates appetite.

Question 44

How does peptide YY affect food intake?

Answer 44

It reduces food intake via the vagal-brainstem-hypothalamic pathway. its levels are lower in obese children.

Question 45

What is the role of ghrelin?

Answer 45

Ghrelin stimulates appetite.

Question 46

How does adipose tissue influence energy regulation?

Answer 46

Adipose tissue regulates energy levels to the brain through the release of leptin and adiponectin.

Question 47

How do leptin levels affect hunger?

Answer 47

Low leptin levels stimulate food intake. high leptin levels inhibit hunger.

Question 48

What do adiponectin levels indicate?

Answer 48

Low adiponectin levels are associated with obesity. high levels occur in fasting.

Question 49

What endocrine cause is linked with obesity?

Answer 49

Slow linear growth is an endocrine feature seen in obesity.

Question 50

What genetic features contribute to obesity?

Answer 50

Extreme hyperphagia. coexisting dysmorphic features. cognitive impairment. vision and hearing abnormalities. and short stature are genetic causes.

Question 51

How is obesity diagnosed by BMI?

Answer 51

Overweight is defined as a BMI between the 85th and 95th percentile. obesity is defined as a BMI at or above the 95th percentile.

Question 52

What comorbidities are often seen in obesity?

Answer 52

Developmental delay. hearing impairment. difficulty snoring. sleep disturbances such as sleep apnea and daytime sleepiness may be present.

Question 53

How does family history play a role in obesity risk?

Answer 53

Parental obesity increases the risk for obesity in children.

Question 54

Which lab tests are recommended in an obesity evaluation?

Answer 54

Fasting blood sugar. triglycerides. LDL. HDL. liver function tests. and a 24 hour food recall are used.

Question 55

What morbidity risks are increased with obesity?

Answer 55

There is an increased risk for cardiovascular disease. type 2 diabetes mellitus. hypertension. hyperlipidemia. and nonalcoholic fatty liver disease including cirrhosis.

Question 56

What mechanical complications may result from obesity?

Answer 56

Obstructive sleep apnea. orthopedic complications. and low self-esteem leading to depression and eating disorders may occur.

Question 57

What lifestyle interventions are recommended for obesity?

Answer 57

Nutrition modifications. exercise. and cognitive behavioral approaches such as controlling caloric intake. modifying eating patterns via the traffic light diet. and limiting screen time.

Question 58

What additional treatments are available for adolescents with obesity?

Answer 58

Medications such as sibutramine which is a NE or serotonin reuptake inhibitor. and orlistat an intestinal lipase inhibitor are options.

Question 59

When is bariatric surgery considered in pediatric obesity?

Answer 59

It is reserved for children with near complete skeletal maturity. a BMI above 40. and those with medical complications after 6 months of a multidisciplinary weight management program.