module 2 - endo

Question 1

when to refer to endo for growth hormone therapy

Answer 1

• hypothyroid
• low IGF-1 or IGFBP - 3
  other hormone deficiency is confirmed
• unexplained persistent slow growth

Question 2

What other conditions to screen for in DM1

Answer 2

• hypothyroid

- Celiac disease

Question 3

Target A1c for DM1

Answer 3

<7.5%

Question 4

Medication for children with DM2

Answer 4

• 1st try lifestyle modification

- metformin and insulin

Question 5

Rapid acting Insulin

Answer 5

novolog, humalog, and Apidra

duration 3-5 hrs

Question 6

short acting insulin

Answer 6

regular

duration 5-8 hrs

Question 7

Intermediate insulin

Answer 7

NPH

duration 12-24hrs

Question 8

Long acting insulin

Answer 8

levemir, lantus, tresiba

duration up to 24 hrs

Question 9

When would pancreatic antibodies be useful

Answer 9

to confirm DM1, especially when uncertainty of type

Question 10

clinical manifestations of Adrenal insufficiency

Answer 10

hyperpigmentation, salt craving, postural hypotension, hyperkalemia, and elevated plasma renin activity

Question 11

Dx for adrenal insufficiency

Answer 11

serum glucose
blood gasses and bicarb show meta acidosis
electrolytes (hyponatremia, hyperkalemia)
serum cortisol (>20)
ACTH (elevated)
serum 17-OHP
Serum renin (elevated)
aldosterone

Question 12

Hyperthyroid labs

Answer 12

free T4 and total T4 - elevated

TSH - suppressed below sensitivity

Question 13

central hypothyroid labs

Answer 13

TSH - normal

free T4 - low

Question 14

congenital hypothyroid labs

Answer 14

NBS
TSH - elevated
free T4 normal or low

Question 15

Thyroid Binding Globulin Deficiency labs

Answer 15

total T4 - low

free T4 and TSH - normal

Question 16

PCOS - presenting symptoms

Answer 16

irregular menstrual cycle
hirsutism
Acne
thinning hair/hair loss
obesity
darkening of skin
skin tags

Question 17

normal progression of puberty in girls

Answer 17

Live virus vaccines should be delayed until 6 months after cardiopulmonary bypass and exposure to red blood cells and plasma.

Question 18

normal progression of puberty in boys

Answer 18

Boys should reach sexual maturity rating stage 5 within 4.5 years of initiation of puberty.

Question 19

Delayed puberty definition and most common cause

Answer 19

Delayed puberty is when a boy 14 years or older or a girl 13 years or older has no clinical features of puberty on physical exam or puberty has not progressed within a timely manner. The most common cause of delayed puberty is CGD (constitutional growth delay).

Question 20

Premature Adrenarche

Answer 20

Presenting Symptoms: early onset of pubic/axilla hair in boys before 10Y and girls before 8Y without other features of true puberty; mostly idiopathic
-may be caused by congenital adrenal hyperplasia (CAH), topical testosterone exposure; rarely adrenal tumor
-bone and height may be slightly advanced for age
-DHEA may be slightly elevated but correlate with Tanner staging
Diagnostic Studies: Serum 17-OPH to exclude CAH, 24-hour urine collection for 17-ketosteroids OR imaging of adrenal glands to exclude tumor
Prognosis: increased risk for PCOS and metabolic syndrome

Question 21

Obesity definitions

Answer 21

BMI greater than or equal to 95th percentile for age and gender
-extreme obesity: BMI greater than or equal to 120th percentile for age and gender