EXAM #2: DM & THYROID DISEASE IN PEDS

Question 1

What race shows a predominance of IDDM?

Answer 1

Caucasian

Question 2

In what age group is NIDDM most common in?

Answer 2

Adults

*Note that it is becoming more common in obese children

Question 3

What are the three P’s of IDDM?

Answer 3

• Polyuria
• Polydipsia
• Polyphagia

Question 4

What glucose levels “sinch” the diagnosis of DM?

Answer 4

Random= 300 mg/dL or higher 
Fasting= 200 mg/dL or higher

Question 5

What HLA antigens are associated with DM-I?

Answer 5

HLA-DR3 and 4

Question 6

Generally, how is insulin dosed for the DM-I patient?

Answer 6

• 2/3 of the daily dose before breakfast
• 1/3 of the daily dose before dinner

*Typically, 2/3 of this insulin dose is long-acting, and 2/3 is short-acting

Question 7

What foods are DM-I patients told to specifically avoid?

Answer 7

Pure sugar foods

Question 8

How often should DM-I peds check their blood sugar?

Answer 8

Twice daily, more if ill or having difficulty maintaining glucose control

Question 9

What is the goal blood glucose level for the newborn- 4 y/o?

Answer 9

100-200 mg/dL

Question 10

What is the goal blood glucose level for the 5-12 y/o?

Answer 10

80-180 mg/dL

Question 11

What is the goal blood glucose level for the 13+ y/o?

Answer 11

70-150 mg/dL

Question 12

When should you perform urine ketone monitoring?

Answer 12

• Any time there is significant illness
• Single episode of vomiting (or more)
• Blood sugar is 240 mg/dL

Question 13

What is HbA1c?

Answer 13

Measure of non-enzymatic glycation that occurs on the beta chain of the hemoglobin molecule upon exposure to glucose in the plasma

Question 14

What HbA1c is part of the diagnostic criteria for DM?

Answer 14

Greater than 6.5%

Question 15

What is the mnemonic to remember the symptoms of hypoglycemia?

Answer 15

The symptoms of hypoglycemia can remembered with the mnemonic STAB AT diabetes:

• Sweating
• Tremor
• Anxiety or agitation
• Blurry vision
• Altered mental status
• Tachycardia

*This is treated with oral sugar (OJ) first

Question 16

What are the diagnostic criteria for DKA?

Answer 16

• Blood glucose greater than 200 mg/dL

- Venous blood gas with pH less than 7.3 OR bicarbonate less than 15 mEq/L

Question 17

How is DKA treated?

Answer 17

1) Restore intravascular fluid volume
2) Insulin
3) Replacement of body salts (Na+, K+, and PO4)

*At a blood sugar of roughly 300, glucose is added to fluid to prevent “bottoming-out”

Question 18

What is a major complication of DKA?

Answer 18

Cerebral edema

Question 19

What can be done to avoid cerebral HTN and brainstem herniation in DKA?

Answer 19

1) Avoid over-zealous fluid resuscitation

2) Slowly decrease blood sugar

Question 20

What happens to K+ in the setting of acidosis?

Answer 20

Shift of K+ extracellularly–correction will shift K+ back into the cells

Question 21

What should be avoided in the correction of acidosis in DKA?

Answer 21

Sodium bicarbonate

Question 22

What are the long-term complications of DM?

Answer 22

1) Retinopathy
2) Neuropathy (stocking-glove)
3) Renal damage

Question 23

Describe the fetal and maternal pituitary-thyroid axes?

Answer 23

Independent

Question 24

What do you need to remember about anti-thyroid drugs in pregnant mothers?

Answer 24

These drugs cross the placenta and can affect fetal thyroid homeostasis

Question 25

When clinically evaluating the thyroid of a newborn, what should you do if TSH is normal?

Answer 25

Nothing

Question 26

When clinically evaluating the thyroid of a newborn, what should you do if TSH is high?

Answer 26

Add T4 to determine the degree of hypothyroidism

Question 27

When clinically evaluating the thyroid of a newborn, what should you do if TSH is low?

Answer 27

Add T4 and T3 to determine degree of hyperthyroidism

Question 28

What causes most cases of hypothyroid in peds? What clinical sign are you likely to see in this presentation?

Answer 28

Hashimoto’s Thyroiditis w/ goiter

Question 29

What kind of anemia is associated with hypothyroidism?

Answer 29

Normocytic

Question 30

A pediatric patient has an exquisitely tender thyroid and a toxic appearance, what is the most likely diagnosis?

Answer 30

Acute suppurative thyroiditis

Question 31

How does bone maturation differ between hypothyroidism and hyperthyroidism?

Answer 31

Hypo= delayed w/ epiphyseal stippling

Hyper= advanced bone age