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MK SR INDEX CASES CHILD HEALTH > A child with diabetes mellitus > Flashcards

A child with diabetes mellitus Flashcards

1
Q

Congenital Hypothyroidism - pathophysiology

A
  • After birth, there is a surge in TSH level leading to transiently raised T3, T4, normalises within a week
  • Congenital hypothyroidism • 1:4000
  • Preventable cause of severe learning difficulties
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2
Q

How is Congenital Hypothyroidism detected?

A
  • Guthrie test at D5 of life
  • Screening for raised TSH
  • Pituitary abnormalities will not be picked up (as TSH may be low)
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3
Q

Congenital Hypothyroidism - causes

A

Maldescent of thyroid gland
• Failure of migration of thyroid from base of tongue to below the larynx • Thyroid may fail to develop partially or fully

Dyshormonogenesis
• Inborn error of thyroid hormone synthesis • Commoner in consanguineous marriages

Iodine deficiency – uncommon in UK

TSH deficiency
• Rare
• Pituitary dysfunction
• Other hormonal deficiencies may be associated too

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4
Q

Congenital Hypothyroidism - Clinical features

A
  • Faltering growth
  • Feeding problems
  • Prolonged jaundice
  • Constipation
  • Pale, cold, mottled skin • Coarse facies
  • Large tongue
  • Hoarse cry
  • Umbilical hernia
  • Delayed development
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5
Q

what is the cause of Acquired hypothyroidism?

A
  • Usually caused by autoimmune thyroiditis
  • Uncommon
  • Increased risk in children with Down’s syndrome/Turner syndrome
  • May be associated with other autoimmune disorders e.g. Vitiligo, rheumatoid arthritis, diabetes mellitus
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6
Q

Acquired hypothyroidism - Clinical features

A
  • Females > Males
  • Short stature/ Poor growth
  • Cold intolerance
  • Dry skin
  • Bradycardia, cool peripheries • Thin hair, loss of eyebrows
  • Goitre
  • Slow-relaxing reflexes
  • Constipation
  • Delayed puberty
  • Learning difficulties
  • Obesity
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7
Q

Management of congenital hypothyroidism

A
  • Life long thyroxine

* Titrate to maintain normal growth, TSH and T4 levels

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8
Q

Pathophysiology of childhood Hyperthyroidism

A

• Usually secondary to autoimmune thyroiditis (Grave’s ds) due to antibodies
• Raised T3/T4, Very low TSH
• If Thyroid Peroxisomal antibodies present – may eventually lead
to hypothyroidism
• Neonatal hyperthyroidism may occur due to transplacental transfer of antibodies - transient

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9
Q

Treatment of childhood Hyperthyroidism

A
  • Treatment
  • Carbimazole or Propylthiouracil
  • B-blockers for symptomatic relief of anxiety, tachycardia • Radio-iodine may be considered
  • Surgery
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10
Q

Clinical features of childhood hyperthyroidism

A
  • Anxiety
  • Tremor
  • Tachycardia
  • Increased appetite
  • Weightloss
  • Diarrhoea
  • Advancedbonematurity
  • Warmperipheries
  • Goitre
  • Learningdifficulties
  • Exophthalmos
  • Lid lag
  • Ophthalmoplegia • Lid retraction
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11
Q

What is the function of PTH?

A

• PTH
Parathyroid disorders
• Promotes bone formation via osteoblasts
• When calcium is low:
• PTH promotes bone resorption via osteoclasts • Promotes calcium absorption
• Activates vitamin D

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12
Q

Biochemical features of Parathyroid disorders

A 
Hypoparathyroidism
Serum calcium
Low
Serum phosphate
Raised
PTH
Very low
Pseudohypoparathyr oidism
Serum calcium
Low
Serum phosphate
Raised
PTH
Normal or high

Pseudopseudohypop arathyroidism
Normal
Normal
Normal

Hyperparathyroidism
Serum calcium
High
Serum phosphate
Low
PTH
High
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13
Q

Management of Hypocalcemia

A
  • 10%calciumgluconate

* Oral calcium supplements with vitamin D

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14
Q

Management of Hypercalcemia

A
  • Rehydration
  • Diuretics
  • Bisphosphonates
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15
Q

Congenital Pituitary disorders

A
  • Congenital • Structural
  • Mid-linedefects
  • Septo-optic dysplasia • Pituitary hypoplasia
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16
Q

Acquired Pituitary disorders

A
  • Braintumours
  • Craniopharyngioma • Cranial irrardiation
  • Trauma
  • Infection
  • Infiltration
  • Structural
  • Hydrocephalus
  • Diabetesinsipidus • ADH deficiency
17
Q

Presentation of Congenital Adrenal Hyperplasia

A
  • Insufficient cortisol & mineralocorticoid secretion
  • Autosomalrecessive
  • Presentation
  • Ambiguousgenitalia
  • Salt-losing crisis (low Na, high K)
  • Hypotension
  • Hypoglycaemia
  • Metabolic acidosis
18
Q

Treatment of Congenital Adrenal Hyperplasia

A
  • Treatment

* Lifelonggluco-corticoids+/- mineralocorticoids

19
Q

Addison’s disease Causes

A
  • Autoimmune
  • Haemorrhage/ Infarction
  • X- linked adrenoleukosytrophy • TB
  • Pituitary dysfunction
  • Disease process
  • Hypothalamus-pituitary-adrenal suppression due to long term steroid therapy
20
Q

Addison’s disease - Presentation

A 
Acute
• LowNa
• HighK
• Hypoglycaemia
• Dehydration
• Hypotension
• Growth failure
• Circulatory collapse

Chronic
• Vomiting
• Lethargy
• Brown pigmentation (gums, scars, skin creases)

21
Q

Diagnosis of Addison’s disease

A
  • Lab parameters
  • Metabolic acidosis
  • Plasma cortisol is low • ACTH is high
  • Synacthen test – plasma cortisol remains low
  • In primary adrenal dysfunction
  • In long-standing pituitary/hypothalamic dysfunction • Normal response excludes adrenal insufficiency
22
Q

Management of Addison’s disease

A
  • Life long glucocorticoids • Hydrocortisone
  • Mineralocorticoids • Fludrocortisone
  • Monitoring of growth
  • 17 α-hydroxyprogesterone levels
  • Sick day rules
  • Adrenal crisis
  • Emergency treatment with fluids and steroids
23
Q

Cushing syndrome Clinical features

A
  • Usually due to long-term glucocorticoid treatment
  • Clinical features
  • Growth failure
  • Face and trunk obesity • Flushed cheeks
  • Hirsutism
  • Striae
  • Hypertension
  • Muscle wasting
  • Psychological issues
24
Q

causes of Delayed puberty

A
  • Girls – 14yr Boys – 15yr
  • Causes
  • Familial (commonest)
  • Low gonadotrophin secretion
  • Systemic disease
  • Hypothalamo-pituitary disorders
  • High gonadotrophin secretion
  • Chromosomal abnormalities (Klinefelter’s, Turner’s) • Steroid hormone enzyme deficiencies
  • Acquired gonadal damage
25
Q

Antibody marker for Type I DM

A

Glutamic Acid Decarboxylase (GAD)

26
Q

Name 3 autoimmune conditions associated with T1DM

A 
Celiac Disease
Thyroid Disease
Addison’s Ds
Rheumatological 
Pernicious anaemia
27
Q

early symptoms of Type I diabetes

A

The earliest symptom is nocturia. Polyuria, polydipsia, weight loss, bed wetting, fungal infections, tiredness

Late: DKA presentation - Vomiting, dehydration, abdominal pain, kussmaul breathing, drowsiness, and shock are features of DKAKetotic breath

28
Q

What features in the history and examination would make you suspect a child is in DKA?

A

Vomiting, dehydration, abdominal pain, kussmaul breathing, drowsiness, and shock are features of DKA

29
Q

What checks/ tests are done in the out patient clinic for children with Type I DM?

A
  • Children have their height and weight measured and plotted in clinic
  • HbA1c is done at every clinic visit
  • Smart meter, pump/ handset, CGM is downloaded to review data
  • Injection sites are checked
  • Children and their parents meet the different members of the team who then explore their knowledge and understanding
  • Trouble shooting: psychosocial aspects, exercise, hypos

At annual review: Routine annual blood screen other auto-immune conditions, eye exam, if more than 12 years old check feet

30
Q

What checks/ tests are done at annual review for children with Type I DM?

A 
At annual review the following are done
•Blood tests: TFT, coeliac screen, lipid profile
•Urine for microalbuminuria if > 12 years
•Retinopathy screen if > 12 years
•BP if > 12 years
•Feet are examined
•Flu vaccine reminder
•Reflexes and vibration sense
31
Q

Erin has Type I DM. She currently has vomiting and diarrhoea
Her BMs are between 3mmol/l to 8 mmol/l
Her mother rings the diabetes team for advice.

A

Long acting should not be stopped

Check ketones particularly important when ill

Monitor ketones and glucose closely, likely need extra insulin, seen by hospital if concerned

if hypoglycaemic, have a source of glucose
may need glucagon if not tolerating oral

Hospital IF Not tolerating anything orally, very unwell, not improving, blood sugar regulation struggling, any features of DKA, family struggling to manage

32
Q

When should children with T1DM be advised to come to hospital for further management?

A

Not tolerating anything orally, very unwell, not improving, blood sugar regulation struggling, any features of DKA, family struggling to manage

33
Q

Symptoms of hypoglycaemia

A

Irritable, tremor, aggression, drowsy, N/V

In children, hypo is defined as anything less than 4 mmol/L

MK SR INDEX CASES CHILD HEALTH (24 decks)

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