Endo Flashcards
Congenital thyroid what is the T4 and TSH
If the free T4 <6.5 and the TSH is >20
Graves’ disease
If you don’t slow down you’re going to the grave
Hyper thyroidism
Hashimoto’s disease
Hypothyroid = Hashimoto’s
Pathophysiology of type 1 diabetes is which of the following?
Autoimmune destruction of pancreatic beta cells
Primary insulin receptor resistance
Increased hepatic glucose production
Reduce glucose uptake by target tissue
Auto immune destruction of pancreatic beta cells by islet cells
All others are describing pathophysiology of T2DM
Gradual symptoms of fatigue, muscle weakness, nausea, vomiting, or diarrhea, orthostatic hypotension, abdominal discomfort
Adrenocortical insufficiency
Influenza like episode with Periorbital/peripheral Edema, Shortness of breath from pulmonary Edema, dry skin
Nephrotic syndrome
Infant of a mother with gestational diabetes is at risk for what abnormalities
Congenital abnormalities, transient neonatal hypoglycemia, birth trauma (Shoulder dystocia)
Infants with IUGR are prone to hypoglycemia primarily because they__
Have a little glucose stores in the form of glycogen and fats; however infants with iUGR generally have increased metabolic rate, do not become acidotic because of hypoglycemia and thus not more prone to sepsis
During the first well baby visit of Joshua two week old, his mother says she is concerned because his penis looks different from his three-year-old brother’s penis. During the physical exam he noticed the baby scrotum is hyperpigmented.Do you know the most common cause of ambiguous Genitalia is
Congenital adrenal hyperplasia CAH
What signs or symptoms are associated with congenital adrenal hyperplasia
Hyponatremia— excessive sodium loss to the kidneys and inability to maintain some electrolyte balance
weight loss that is progressive
dehydration
hyperkalemia
For families of children with congenital adrenal hyperplasia is critical to educate them about
The need for strict replacement therapy and lifelong medication therapy and follow up
Stress dosing for fevers greater than 101 Fahrenheit, trauma, surgery, persistent vomiting will prevent metabolic decompensation
Glucocorticoid Are necessary to treat CAH, what are the consequences of treatment that should be addressed to prevent long-term health issues
Overweight and bone health
Genetic long-term disease that affects adrenal gland it is non-self-limiting
CAH
Secondary hypothyroidism results from
Disease or disorder of the hypothalamus or pituitary gland compromising thyroid function
Congenital hypothyroidism is a higher incidence in which ethnicity
Hispanics and Native Americans
Symptoms of congenital hypothyroidism
Horse cry, course features, lethargy,Constipation
Which of the following children would you suspect has Hyperthyroidism?
Six-year-old female with tiredness
16-year-old male who complains about restlessness
14-year-old adolescent female who is he intolerant and has amenorrhea
Male preteen with behavior problems
Heat intolerance and amenorrhea are very typical signs of hypothyroidism
Behavior problems and restlessness could be other causes other than hyper thyroidism; The six year old complaint is very non-specific
Nephrogenic, vasopressin resistant Diabetes insipidus is caused by
Reduce Renal responsiveness to antidiuretic hormone ADH
Primary symptoms of growth hormone deficiency in infants
Hypoglycemia, exaggerative jaundice, micropenis in boys
Individuals with chronic adrenal insufficiency often have A craving for. ____.
Salt
Infants of diabetic mothers in a newborn. Are particularly at risk for____
Hypoglycemia; LGA
Growth hormone excess is associated with these signs
Tall stature, prominent mandible in supraorbital Ridge, enlargement of the nose/ears/jaw, headaches, excessive sweating, course facial features, large hands and feet, menstrual irregularities, joint pain
A common skin fighting in children with chronic adrenal insufficiency‘s (Addison disease)
Increase pigmentation in the axilla, growing, areola, hand creases, along surgical scars
What Pharma logical treatment that is approved by the FDA for the treatment of obesity
Orlistat
Works by decreasing fat absorption from the gut approximately 30% fat is excreted in the feces causing side effects of diarrhea abdominal discomfort, farting
Four factors that contribute to type one diabetes
Acute onset
Human leukocyte antigens (HLA) Strongly associated
Distruction of pancreatic beta cells by islet cells
Ketones and blood in urine
Are signs and symptoms of T1DM
Polyuria, polydipsia, polyphagia, nocturnal enuresis, weight loss with increased hunger, fatigue, LOC changes (DKA)
In advanced T1DM opthamalic exam may reveal________ and __________.
Micro aneurysms or cotton wool spots
DTRs in T1DM maybe diminished or hyper responsive?
Diminished
Serum fasting blood glucose of ____on two separate occasions can be a diagnostic tool for T1DM
> 126
Random blood sugar___ with polydipsia, polyuria and weight loss
> 200 ; T1DM
And type 1 diabetes The patient may have impaired glucose tolerance, plasma key tones, ISLET sell antibodies present, Serum BUN and creatinine will be ____ ,
Hgb A1c will be ____, And urine may show____and _____.
Elevated; >6.5%; Glucosuria and ketonuria
Blood sugar can drop in 30 to 60 minutes of physical activity the nurse practitioner should recommend what to prevent post exercise hypoglycemia
15 to 20 g carbs snack without insulin
Normal recommended dose of insulin
0.5 U/KG/day
Value of hypoglycemia neonates
<45 mg/dL
Value of hypoglycemia and children and teens
<60 to 70 MG/DL
Type 2 diabetes characteristics
Not linked to human leukocyte antigen, no islet cell antibodies, presence of obesity or family history increases risk
Insidious onset of hyperglycemia, generalized itching, we are current vaginitis, chronic skin infections, acantholysis Nigricans
T 2 DM
Weight management for type 2 diabetes
Weight loss of 5 to 7% can help glycemic goals
What medication is used in T 2 DM
MetForman (Glucophage) FDA approved in children, reduces gluconeogenesis, significant gastrointestinal upset
Hypothyroid what is T3/T4 and TSH?
T3/T4 decreased; TSH increased
Hyperthyroid what is T3/T4 and TSH?
T3/T4 increased; TSH decreased
Symptoms of hyper thyroidism
Nervousness, restlessness, increased sweating, muscle cramps, frequent BM, palpitations, weight loss, menstrual irregularities, fine hair, tachycardia without underline heart disease, atrial fibrelation, Bugeyes, goiter, increased DTRs
Treatment for hypothyroidism
Propranolol for symptomatic relief (beta blocker)—-anxiety
Radio active iodine—-permanently suppress his thyroid function can induce hypothyroid
Thyroid surgery not really indicated
Lugols solution to reduce the vascularity of the gland
symptoms of hypothyroidism and an infant
May have no symptoms in the first month
Decreased growth, bradycardia, hypotonia, intolerance to cold, constipation, DD, prolong jaundice, respiratory distress, lethargy, prolongs feeding,
prolonged BiliRubin >10 @ 3 days of life
Symptoms of hypothyroidism and older children
Weakness, muscle fatigue, arthralgias, cramps, cold intolerance, constipation, weight gain, low energy, increased weight for height, dry hair, brittle nails, poor muscle tone, decreased concentration/memory, delayed puberty
Congenital hypothyroidism can cause
Severe mental retardation; early treatment can help
What medication is used in the treatment of hypo thyroid
Hormone replacement therapy with Synthroid (levothyroxine)
When she direct the parent to give Synthroid
30 to 60 minutes before food for the best absorption
Synthroid should not be given with
Iron interferes with absorption
Do not mix and formula or breast milk
Inflamed thyroid gland caused by auto immune response
Thyroiditis
Causes of thyroiditis
Chronic Hashimoto’s, infection, group a strep, staff aureus, pneumococci, viral, exposure to radiation/trauma, or idiopathic
Height fall in less than two standard deviation’s below the main or marked deviation of gross or failure to grow more than 4 cm per year
Short stature
Familiar genetic variants a short stature
Normal linear growth and a short target height
Constitutional delay —- short stature
Bone age consistent with high age; slow growth rate for the first 2-3 years of life then a low normal growth velocity, family history/delayed puberty often present
Short stature can be caused by these genetic disorders
Turner syndrome, noonan syndrom, Prader Willi
