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05 Endo > Obesity and DM > Flashcards

Obesity and DM Flashcards

(75 cards)

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1
Q

childhood obesity is more prevalent in

A

males
student in private schools
children in urban areas

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2
Q

how to measure obesity

A 
body weight for height
bmi
cdc bmi chart
who growth chart
waist and hip circumference
skinfold thickness
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3
Q

bmi chart results

A

bmi > 85th percentile: overweight

bmi > 95th percentile: obese

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4
Q

who growth chart 0-5 yo

A

above +2 sd: overweight

above +3 sd: obese

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5
Q

who growth chart 5-19 yo

A

above +1 sd: overweight
above +2 sd: obese
above +3 sd: morbidly obese

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6
Q

adult interpretation for skinfold thickness

A

lean: 6-12 mm
obese: 40-50 mm

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7
Q

cut offs for weight

A 
underweight bmi < 5th percentile
normal =5th to < 85th percentile
overweight >/= 84th to 95th percentile
obese >/= 95th percentile
severe obesity
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8
Q

causes of simple obesity

A

high caloric intake
low energy expenditure

with no demonstrable disease that accounts for excess adiposity

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9
Q

t/f pathologic (endogenous) obesity accounts for a great majority of obesity in children

A

false, simple (exogenous) obesity is more common

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10
Q

causes of pathologic obesity

A 
gh deficiency
congenital and acquired hypothyroidism
cushing syndrome
prader-willi syndrome
adrenal insufficiency due to medications
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11
Q

features of gh deficiency

A

morning headaches, vomiting, visual disturbances, excessive urination and drinking
cherubic facies
short stature
craniopharyngioma*

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12
Q

features of acquired hypothyroidism

A

dry skin, constipation, intolerance to cold, easy fatigability
manifests later

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13
Q

features of congenital hypothyroidism

A

macroglossia, periorbital puffiness, flat nasal bridge, dry skin, frontal bossing, distended abdomen, constipation

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14
Q

features of cushing syndrome

A

selective accumulation of fat in the neck and trunk, purple/violaceous striae
hypertrichosis, truncal obesity, prominent cheeks, acne, stunted growth

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15
Q

features of prader willi syndrome

A

hypotonia, hyperphagia, short stature, mental retardation, hypogonadism, likes to pick their skin

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16
Q

t/f pediatric obesity may signal to underlying pathology

A

true

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17
Q

t/f one of the most common consults is due to skin infections

A

false, due to high bp (headaches, loss of consciousness)

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18
Q

pathogenesis of nalfd from obesity

A

obesity > insulin resistance or hyperinsulinemia > steatosis > steatohepatitis > liver cirrhosis > HCC

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19
Q

signs of osa

A

patient prefers to sleep sitting down or needs cpap to sleep

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20
Q

orthopedic complications of childhood obesity

A

blout’s disease (bowing of legs)

slipped capital femoral epiphysis (fermoral head slips from epiphyseal plate)

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21
Q

causes of orthopedic complications in childhood obesity

A

compressive pressure on the proximal medial metaphyseal area of tibia

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22
Q

t/f medical consequences of childhood obesity is more prevalent

A

false, phsycosocial consequences are more prevalent

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23
Q

this is the most long-term complication of obesity

A

metabolic syndrome

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24
Q

components of successful weight loss plan

A

education, dietary management, exercise or physical activity, lifestyle and behavior modification, family involvement!!

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25
recommended physical activity
30-60 minutes of moderate to vigorous play or physical activity daily
26
recommended time watching tv/playing games
max 2 hours per day
27
t/f medical treatment is not a first line treatment for childhood obesity
true
28
types of surgeries for childhood obesity
jejunoileal bypass gastric bypass gastric plication or gastroplasty by stapling jaw wiring
29
a loss of ___ of total body weight can reduce many of the health risks associated with obesity
5-20%
30
5210 care approach to prevent CO
5 fruits and vegetables cut screen time to 2 hours 1 hour physical activity 0 soda or sweetened drinks
31
t/f t1dm presents with acanthosis nigricans
false (2022 table 4)
32
incidence of t1dm
minor peak at 4-6 years (infection) | major peak 10-14 years (puberty)
33
usually a __ reduction in beta cell volume is required to induce symptomatic t1dm
80%
34
main problem in t2dm
peripheral insulin resistance, relative insulin deficiency NOT ABSOLUTE INSULIN DEFICIENCY!
35
expected bmi in t2dm obesity
85th percentile for age and sex | mean bmi 27-38 kgm2
36
mean age of diagnosis for t2dm puberty
12-16 yo peak age of diagnosis of t2dm
37
sign that presents in 90% of children and adolescents with t2dm
t2dm acanthosis nigricans | also associated with insulin resistance, hyperinsulinemia, and obesity
38
perinatal factors in t2dm
high maternal bs during pregnancy maternal or fetal undernutri large or small for gestational aage
39
t/f breast feeding has a protective effect against obesity and t2dm
true, encouraged until 2 yo
40
who to screen for t2dm in children or adolescents
bmi 85th percentile wfh > 85th percentile weight > 120% of ideal for height + any 2 risk factors: family history, ethnicity, signs of insulin resistance, maternal history of diabetes or gdm
41
age of initiation of monitoring and frequency for t2dm
initiate: at risk age 10 or younger screen: every 2 years
42
preferred screening study for t2dm
fasting plasma glucose
43
signs and symptoms for dm
polyuria, nocturia, polydipsia, polyphagia, mood changes and tiredness, blurring of vision, numbness of hands and feet (not necessarily diabetic retinopathy), candidiasis, non-healing wound
44
t/f you can diagnose a child with diabetes if he has an rbs of 200
true
45
t/f adults and pedia have different cut offs
false, they have the same
46
when to request for ogtt
when patient's fbg is not high but patient has signs and symptoms, family history, and high index of suspicion
47
additional work up for dm
serum insulin (low in t1dm) c-peptide (low in t1dm, high in t2dm) ica and anti-gad (+ for t1dm, + or - in t2dm)
48
preferred treatment for t2dm in children
ohas are not used, use insulin sensitizers
49
daily sc injections for t1dm
rapid acting insulin + long acting insulin intermediate insulin + short acting insulin 2-4 injections a day regimens
50
__ injections a day mimics the normal physiologic insulin production of the body
4 injections a day
51
mainstay treatment for t2dm
diet, exercise, healthy lifestyle
52
the only drug fda approved for use in children
metformin
53
progression of treatment for t2dm in children
lifestyle -> metformin for asymptomatic -> oha -> insulin
54
indications to immediately start insulin therapy in t2dm
symptomatic increased blood glucose levels hba1c >8% (+ dka or hhs)
55
glucose management for toddlers and preschool (0-6 yo)
a1c 7.5-8.5 fasting before a meal goal 100-180 bedtime or overnight goal 110-200
56
glucose management in school age (6-12 yo)
a1c <8 fasting before a meal goal 90-180 bedtime or overnight goal 100-180
57
adolescents/ya (13-19 yo)
a1c <7.5 fasting before a meal goal 90-130 bedtime or overnight goal 90-150
58
why are values for toddlers' glucose management higher
to avoid hypogly, seizures, or loss of consciousness because they don't always report what they're feeling
59
main cause of morbidity/mortality in children with t1dm
dka
60
pathophysiology of dka
low insulin, high counter-regulatory hormones -> inc glucose from liver/kidney, dec peripheral glucose use -> hypergly, proteolysis, lipolysis -> ketosis and met acid
61
clinical manifestation of dka
glucosuria leading to dehydration catabolic state leading to body weakness ketonemia and met acid
62
common misdiagnoses of dka
penumonia, bronchitis, asthma, uti, gastritis if PE and tachypnea don't match, do a cbg or rbs
63
biochemical defintion of dka
hypergly (>200 mg/dl) venous ph <7.3 serum hco3 <15 mmol/l
64
severity of dka
mild ph <7.3 shco3 <15 moderate ph <7.2 shco3 <10 severe ph <7.1 shco3 <5
65
risk factors for dka
``` poor metabolic control peri-pubertal girls difficult family circumstances psych disorders insulin omission or treatment error* inadequate insulin therapy during intercurrent illness ```
66
dka management
hypergly + milk ketosis, no vomiting or severe dehydration: wards moderately to severely dehydrated: icu admission (risk of cerebral edema)
67
dka management: restoration of vascular volume
if in shock with poor peripheral perfusion or come give 10 cc/kg of plain 0.9 nss x 10-30 min until pulses are good fluid requirements should include maintenance, deficit, and continuing losses
68
other aspects of volume restoration
potassium supplementation at 3rd hour or as patient is voiding shift to glucose containing soln when blood glucose is down to 200 mg/dl
69
dka management: inhibition of lipolysis and correction of hyperglycemia
insulin therapy after reversal of shock and 1-2 hrs after fluid replacement
70
t/f do not stop insulin infusion or decrease below 0.05 u/kg/hr
true, glucose and insulin are both needed to promote anabolism and reduce ketosis
71
dka management: correction of acidosis
fluids to stop lactic acidosis | insulin to stop ketoacidosis
72
holiday segar method
first 10 kg = 100 ml/kg/d , 4 ml/kg/h second 10 kg = 50 mg/kd/d , 2 mg/kg/h every kg after 20 ml/kg/d , 1 ml/kg/h
73
complications of dka
cerebral edema before, during, or 4-12 hrs after treatment started warning signs: headache, deterioration of consciousness, seizure, papilledema, slow pulse, inc bp
74
associated conditions in t1dm
autoimmune (thyroiditis, celiac, adrenal insufficiency) | skin diseases and infections
75
lab test frequencies
``` bsm daily hba1c every 3 mos urinalysis and microalbuminuria every 12 mos crea and liver function at diagnosis lipid at diagnosis and every 12 mos ```

05 Endo (16 decks)

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