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Year 4 Paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

(93 cards)

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1
Q

Define Puberty

A

Well defined sequence of physical and physiological changes during adolescent years that results in attainment of full physical and sexual maturity
Initiated by nocturnal pulsatile release of GnRH

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2
Q

Describe the order of events of Puberty in boys

A

Testicular Growth
Pubic Hair
Growth Spurt
Penis Growth
Deepening of Voice
Increased Sweat
Facial Hair

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3
Q

Describe the order of events of Puberty in girls

A

Breast Buds
Pubic Hair
Growth Spurt
Period
Mature Pubic Hair
Mature Breasts

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4
Q

Describe the Male Tanner Scale for genitalia

A

I - Prepubertal
II - Enlarged testes and scrotum
III - Lengthening of Penis
IV - Increase in length and breadth
V - Adult Size

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5
Q

Describe the Male Tanner scale for Pubic Hair

A

I - Vellus
II - Sparse and long at base of penis
III - Darker and Curlier
IV - Adult hair over smaller area
V - Spread to medial thighs

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6
Q

Describe the Female Tanner scale for Breast Development

A

I - Elevation of papilla only
II - Breast bud stage (elevation of breast and papillae)
III -Further elevation
IV - Areola form second mound
V - Areola recedes and papilla projects

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7
Q

At what Tanner Stage does Menarche start in girls?

A

IV

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8
Q

How do you assess height in Under 2s?

A

Lying horizontally on measuring board

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9
Q

How do you assess height in over 2s?

A

Free standing with moderate upward neck traction

Sitting height vs leg length allows estimate of upper and lower portions

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10
Q

Other than measuring height, how else can height be assessed?

A

Target height range via parents
Bone Age (XRay left wrist)

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11
Q

How do you calculate target height range in children?

A

(Mums Height + Dads Height)/2

+ 6.5 if boy
-6.5 if girl

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12
Q

Define short stature in children

A

Height below and including second centile

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13
Q

Define tall stature in children

A

Height above and including 98th centile

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14
Q

Define Delayed Puberty

A

When puberty hasn’t started at 16y in boys and 14y in girls
Can be normal, and likely a positive family history
Can give sex steroids for 6-8 months to induce changes

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15
Q

Delayed Puberty can be Hypogonadotrophic or Hypergonadotrophic. Give three causes of Hypogonadotrophic

A

Hypopituitarism
CAH
Intracranial Tumours

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16
Q

Delayed Puberty can be Hypogonadotrophic or Hypergonadotrophic. Give three causes of Hypergonadotrophic

A

Turners
Klinefelters
Chemotherapy

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17
Q

Precocious Puberty is onset of puberty before the age of 8 in Girls and 9 in Boys. Give two central and two peripheral causes

A

Central - Intracranial Tumours, Hydrocephalus

Peripheral - Tumours, Exogenous Sex Steroids

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18
Q

Give four investigations for Precocious Puberty

A

Tanner Stage
Neuro Exam
Bone Age
Pelvic and Abdo USS

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19
Q

How is Precocious Puberty managed?

A

GnRH analogues (monthly IV or IM)

Only for central

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20
Q

Describe the clinical features of T1DM

A

25-50% present in DKA

Classic Triad - Polynesia, Polydipsia, Weight Loss

Atypical - Secondary Enuresis, Recurrent Infections

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21
Q

At diagnosis baseline bloods are required to rule out other causes of T1DM. What other diseases should be screened for?

A

Thyroid Disease (TFTs, TPO antibodies)
Coeliac (Anti TTG)

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22
Q

A diagnosis of T1DM requires patient and family education. What should they be told about glucose monitoring?

A

At waking
At each meal
Before bed

Via CBG

Ideally 2h after each meal as well

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23
Q

Describe the typical Insulin management in T1DM

A

Normally initiated on basal bolus (long acting in evening-Lantus, and short acting - Actrapid 30 mins before each meal)

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24
Q

Why should patients vary injection site in T1DM?

A

To prevent lipodystrophy

Subcutaneous fat hardens preventing further insulin absorption in that area

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25
Who qualifies for an Insulin Pump and how does it work?
If over 12 and difficulty controlling HbA1c Continuous infusion of insulin at different levels through cannula tunnelled under skin. Cannula replaced everything 2-3 days and injection site varied.
26
State the two types of Insulin Pump
Tethered - Attached to patients belt, control on pump Patch - sits directly on skin without visible tubes, have to replace whole patch, controlled remotely
27
Give two advantages and two disadvantages of Insulin pumps
Better Control, More Flexibiity Blockages, infection risk
28
Hypoglycaemia is a short term complication of T1DM. How would it present?
Hunger Tremor Sweating Dizziness Pallor Commonly Nocturnal
29
How is Hypoglycaemia managed?
Rapid acting glucose (Lucozade) and long acting (Bread) Severe - IV 10%Dextrose / IM Glucagon
30
Hyperglycaemia is another short term complication of T1DM. How would you manage using ‘Sick Day Rules’?
If CBG>14, then check serum ketones No Ketones - have next meal as normal with insulin Mild to Mod Ketones - Insulin Bolus of 10% TDD Mod to Severe Ketones - Insulin Bolus of 20% TDD
31
State three broad categories of long term complications from T1DM
Macro vascular (CAD, Cerebrovasc Disease) Micro vascular (Retinopathy, Neuropathy, Renal) Infection related
32
What is Flash Glucose Monitoring?
Sensor measuring level of interstitial fluid in subcutaneous tissue Requires a reader to swipe over sensor
33
Define DKA
Metabolic emergency characterised by Acidosis (pH<7.3 or Bicarbonate <15), Ketonaemia (>3 or ++) and BGC >11
34
How would a child in DKA present?
Preceding symptoms of triad for around 15 days Lethargic, Nausea, Abdominal Pain, Vomiting
35
Describe the pathophysiology of DKA
Glucose cannot be used due to insulin deficiency Causes rise on counter regulatory hormones (eg Cortisol) which worsens BGC Hyperglycaemia causes Osmotic Diuresis and dehydration
36
State two characteristic features which may be seen on examination of a child in DKA
Kussmaul Breathing Pear Drop Breath
37
What investigations would you want to do on a child in DKA?
Bedside Glucose Blood Gas Blood Glucose and Ketones 12 lead ECG
38
Describe the severity scoring in DKA
Mild - pH 7.2 to 7.29 (5% dehydration) Mod - pH 7.1 to 7.19 (5% dehydration) Severe - pH<7.1 (10% dehydration)
39
How should you treat children in DKA shock?
Initially 10ml/kg 0.9% Saline over 15 mins Can repeat once before considering inotropes
40
How should you initially manage fluids of a child in DKA (no shock)?
Initially 10ml/kg over 30 mins
41
How do you calculate fluid deficit?
% x Weight x 10ml
42
Describe the use of insulin in DKA
If alert and well - Subcut Insulin IV Insulin - delayed after at least an hour of fluids to reduce risk of cerebral oedema (0.05-0.1units/kg/h of Actrapid) When pH normal/Ketones<1 start subcut insulin again and stop IV one hour later | See UHL guideline document - also has examples of fluid calculations
43
Give three complications of DKA in children
Cerebral Oedema (leading cause of death) Hypokalaemia Aspiration Pneumonia
44
Describe the criteria for overweight and obese in terms of Paediatric BMI
Overweight >91st Centile BMI Obese >98th Centile BMI
45
State two endocrine causes of Obesity in childhood
Hypothyroidism Cushing
46
State two genetic causes of Obesity in childhood
Prader Willi Syndrome Bardet Biedl Syndrome
47
What would you want to know in a Paediatric Obesity history?
Birth weight Feeding behaviours Growth Pattern Physical activity Neurodevelopment FH
48
What bloods might be done in childhood obesity?
TFTs Cortisol Lipid Profile OGTT
49
How is childhood obesity managed?
Normally a while family approach to nutrition/lifestyle/exercise
50
What is Hypothyroidism?
Reduced thyroid hormones which are essential for development and functioning of brain and body If undiagnosed can cause issues with intellect and neurodevelopment
51
What is Congenital Hypothyroidism?
Occurs in 1/3000 new borns Can be due to dysgenesis (underdeveloped gland) or dyshormonogenesis Screened on Guthrie
52
What can happen if Congenital Hypothyroidism is missed?
Prolonged neonatal jaundice Poor feeding Increased sleeping Slow growth and development
53
The most common cause of acquired hypothyroidism is Hashimotos. How does this present?
Fatigue Low Energy Poor Growth Poor School Performance Constipation
54
Give three causes of Hyperthyroidism
Graves Neonatal/Transient McCune Albright Syndrome
55
Give two causes of Hyperthyroidism that are not due to excess hormone from the gland itself
Thyroiditis (may be drug induced) Exogenous Thyroid Hormone
56
What is Graves?
Autoimmune disease with antibody against TSH receptor
57
What is Neonatal Hyperthyroidism?
Passive transfer of maternal thyroid antibodies from thyrotoxic mothers
58
How does Neonatal Hyperthyroidism present?
Irritable Flushed Tachycardia Poor weight gain
59
How is Neonatal Hyperthyroidism managed?
Supportive therapy with beta blockers
60
What extra features are seen in Graves compared to other causes of Hyperthyroidism?
Diffuse Goitre Opthalmology (Proptosis, Lid Lag, Opthalmoplegia) Pretibial Myxoedema
61
How would you investigate hyperthyroidism?
TFTs Thyroid Antibody Screen Radionucleotide scan ECG
62
Describe two different types of regimens in Hyperthyroidism treatment
Dose Titration Block and Replace (at lowest dose necessary to stop thyroid and then replace with levothyroxine) Normally requires 12-24 months of treatment before weaning
63
What is the most common cause of Cushings Syndrome in children?
Long Term Steroids (eg for Asthma or Nephrotic Syndrome) Other causes such as Pituitary Adenoma and Adrenocortical tumours are rare
64
Name five clinical features of Cushing’s Syndrome
Growth Failure Facial and Truncal Obesity Hirsutism Striae HTN
65
State four investigations for Cushing’s Syndrome
Serum Cortisol (Loss of Diurnal Variation) Increased 24h free cortisol Plasma ACTH Dexamethasone Suppression
66
Cushing’s Disease is managed by treating the underlying cause. What medication can you give if the underlying cause was a tumour?
Metyrapone
67
Define Congenital Adrenal Hyperplasia
Congenital deficiency in 21 Hydroxylase enzyme, causing under production of cortisol and aldosterone, and over production of androgens from birth
68
Describe the pathophysiology of CAH
The enzyme converts progesterone into aldosterone and cortisol Excess progesterone will get converted to testosterone instead
69
Describe the features of mild CAH in a female
Tall for age Facial hair Absent periods Deep voice Early puberty
70
Describe the features of mild CAH in a male
Tall Deep voice Large Penis with Small Testes Early puberty
71
How does severe CAH present in females?
Ambiguous genitalia and enlarged Clitoris
72
How is CAH managed?
Cortisol replacement (Hydrocortisone) Aldosterone replacement (Fludrocortisone) Corrective surgery for females of virilised
73
When do you investigate small height in children?
Height<0.4th Centile 1 SD below mid parental height
74
What are the respective fluid deficits for mild, moderate and severe DKA?
5% 7% 10%
75
How will you calculate child’s total fluid rate in DKA?
1) Calculate deficit (weight * dehydration*10) 2) Subtract initial bolus and divide by 48 3) Work out maintenance per day and divide by 24 to find hourly 4) Add 2 and 3 together
76
How does Gonadotrophin dependent precocious puberty present in boys?
High FSH and LH Large Testes
77
How does Gonadotrophin independent precocious puberty present in boys?
Low FSH and LH Small/Normal Testes
78
Give three normal variants of Paediatric Short Stature
Familial Constitutionally Small IUGR and catch up growth
79
Give four non endocrinology causes of Short Stature
Malnutrition Medication (Steroids, Methylphenidate) CKD Coeliac
80
Give three endocrine causes of Short Stature
Cushing’s Disease Hypothyroidism GH shortage
81
Give three genetic causes of Short Stature
Turner Prader Willi Achondroplasia
82
Give two causes of Tall Stature in infancy
Maternal Diabetes Beckwith Wiedemann
83
Give three endocrine causes of Tall Stature
GH excess Hyperthyroidism Androgen Insensitivity
84
Give three non endocrine causes of Tall Stature
Obesity Klinefelters Marfans
85
What Testicular Volume implies Puberty
>4ml
86
Name two changes in puberty that may seem pathological but are in fact physiological
Thyroid Gland Enlargement Gynaecomastia
87
What blood glucose levels are required to diagnose Diabetes?
Fasted >= 7 2 hours Post Prandial/OGTT >=11.1 HbA1c >= 48mmol or 6.5%
88
If a patient has been admitted and diagnosed with T1DM, what are the requirements for discharge?
- Check insulin administration - Check BGC monitoring - Advise on dietary choices - Advise on symptoms and management of Hypoglycaemia - Advise on sick day rules
89
When could you prescribe Orlistat for a child?
If they were over 12 and had SEVERE physical or psychiatric comorbidities
90
Describe 5 aspects of motivational interviewing an overweight child/parent
- Assess their view of the weight and reasons behind it - Explore eating patterns and physical activity - Explore any unhelpful beliefs - Explore what they’ve tried/How it went/What they learnt - Assess readiness and confidence to change
91
How can Delayed Puberty be investigated?
- Variety of bloods (inc Gonadotrophins, Prolactin, TFTs) - Karyotyping - GnRH stimulation - Pelvis USS - Bone scan
92
When do you minus rescucitation boluses used from replacement volume?
Only if child NOT in shock Replacement = 10 x %dehyd + weight (-10ml/kg if not shocked) Total daily req = maintenance + replacement/24
93
How should paediatric fluids be replaced in DKA
Over 24-48h as per local guidance Divide replacement by either 24/48 and add to maintenance If over 48h will require 2*maintenance

Year 4 Paediatrics (15 decks)

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