Paediatric endocrinology Flashcards Preview

Year 2 > Paediatric endocrinology > Flashcards

Flashcards in Paediatric endocrinology Deck (38):
1

Diabetes is one of the most common chronic diseases to be seen in children. T/F

True

2

What are the stages of development of type 1 diabetes?

Genetic predisposition
Beta cell pathology
Pre-diabetes (large number of beta cells still functioning)
Diabetes

3

What is the typical presentation of type 1 diabetes in children?

Polyuria
Polydipsia
Weight loss
Enuresis
Malaise
Constipation
Oral or vulvulal candida
Blurred vision

4

What is the typical presentation of DKA?

Vomiting
Nausea
Abdominal pain
Kussmaul respiration
Pear drop breath
Decreased consciousness
Coma
Death

5

What are the clinical signs of type 1 diabetes?

Fasting blood glucose >7
Random blood glucose >11

6

What are the clinical signs of DKA?

Ketonuria
Dehydration
Blood pH

7

What two questions are important to ask directly in a child with suspected diabetes?

Polyuria
Polydipsia

8

Should a child with suspected type 1 diabetes be immediately referred to secondary care?

Yes

9

How should suspected type 1 diabetes be investigated?

Random blood glucose
Urinalysis

10

How is DKA management in children different than management in adults?

Weight based
Careful fluid resuscitation
Insulin started one hour after IV fluids given

11

What is the risk with overenthusiastic fluid resuscitation in children with DKA?

Cerebral oedema

12

What are diabetic children routinely screened for?

Retinopathy (fundoscopy)
Microvascular (BP)
Nephropathy (albumin;creatinine ratio)

13

What is the effect of poor diabetes control in children?

Poor growth
Microvascular changes
Social and emotional

14

What are the early changes of microvascular disease in children with type 1 diabetes?

Microalbuminuria
Cardiovascular autonomic neuropathy (postural hypotension)
Retinopathy
Sensory nerve damage
Skin vascular changes
Endothelial pathology
Cheiroarthropathy

15

Which factors indicate high risk paediatric patients?

Not seen for over 6 months
High HbA1c
DKA admissions
Social work involvement

16

What are the primary causes of congenital thyroid disease?

Gland dysplasia +/- abnormal location
Inborn errors of metabolism

17

What are the secondary causes of congenital thyroid disease?

Congenital pituitary disease (hypopituitarism)

18

How does congenial thyroid disease present?

Delayed jaundice
Weight gain despite poor feeding
Hypotonia
Umbilical hernia
Constipation
Skin & hair changes

19

How does congenial thyroid disease present?

Delayed jaundice
Weight gain despite poor feeding
Hypotonia
Umbilical hernia
Constipation
Skin & hair changes

20

How is congenital thyroid disease screened for? How is this done?

Gunthrie test - blood spot on day 5 of life to measure TSH and T4

21

When should therapy of congenital thyroid disease be initiated?

Ideally within 2 weeks
2-3 months before cretinism

22

What is cretinism?

Permanent developmental delay

23

Why is there a window of opportunity for treatment?

Baby is protected by placental hormones

24

In what scenarios might acquired thyroid disease present in the young?

Delayed congenital
Associated with type one diabetes
Autoimmune
Post-infection
Iodine deficiency

25

How might hypothyroidism present in the young?

Delayed puberty
Growth failure
Educational difficulties
Goitre

26

How might hypothyroidism be investigated?

Thyroid function tests (TSH high and T3/4 low)
Thyroid antibody tests (high)

27

How is hypothyroidism treated?

Thyroxine for life

28

How is the dose of thyroxine determined?

By the child's weight

29

Is hyperthyroidism common in the young?

No

30

How can hyperthyroidism present?

Eating and behavioural difficulties
Sleep disturbance
Goitre
High pulse
Precocious puberty

31

How might hyperthyroidism be investigated?

Thyroid function tests (low TSH and high T3/4)
Thyroid antibody tests (high)

32

How is hyperthyroidism treated?

Beta-blockers
For the first two years carbimazole +/- thyroxine
Surgery
Radio-iodine

33

What are the causes of primary underactive adrenal disease in the young?

Hypoplasia
Inborn error of metabolism
Congenital bilateral hyperplasia

34

What are the causes of secondary underactive adrenal disease in the young?

Pituitary
Suppression secondary to high dose/prolonged steroids

35

What are the causes of overactive adrenal disease in the young?

Cortisol therapy
Adrenal or pituitary cushing's

36

How does an addison's crisis present?

Low sodium, high potassium, hypovolaemia

37

How is an addison's crisis treated?

Salt & cortisol

38

What are the common causes of ambiguous genitalia?

Adrenal hyperplasia
Steroid abnormalities
Gene/chromosome abnormalities
Congenital defects

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