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Toni's Paeds > Endo > Flashcards

Endo Flashcards

1
Q

What chance does an identical twin of a diabetic have of developing the disease?

A

30-40%

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2
Q

What is the risk of developing T1DM in the general population?

A

1/400

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3
Q

What is the risk of developing T1DM if your mother has it?

A

1/40-80

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4
Q

What is th risk of developing T1DM if your father has it?

A

1/20-40

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5
Q

What might trigger development of T1DM?

A

enteroviral infections

cows milk protein

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6
Q

What causes T1DM

A

AI process
-> pancreatic beta cell destruction
insulin deficiency

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7
Q

What are markers of bet cell destruction?

A

islet cell antibodies

glutamic acid decarboxylase antibodies

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8
Q

When are the two age peaks and two seasonal peaks in T1DM presentation?

A

preschool
teenager
spring
autumn

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9
Q

What is the classical paediatric presentation of T1DM

A

polydipsia
polyuria
weight loss
nocturnal enuresis

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10
Q

What are rarer presenting features of T1DM in paeds?

A

skin sepsis

candida infection

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11
Q

Symptoms and Signs of DKA

A 
abdo pain
vomiting
dehydration (can -> shock)
hyperventilation
drowsiness (can -> coma)
sell of ketones on breath
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12
Q

How to confirm diagnosis of T1DM

A

random blood glucose >11.1
fasting blood glucose >7
glycosuria
ketonuria

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13
Q

When might you suspect T2DM in a child?

A

fhx T2DM
severely obese
acanthosis nigricans
PCOS phenotype

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14
Q

What does diabetes education involve?

A 
Pathophysiology of T1DM
Insulin injection: sites + technique
Diet advice: carb counting
Adjusting for exercise
Sick-day rules
Blood glucose + ketones monitoring
Recognising and treating hypos
Psych impact
Sources of support
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15
Q

Who comprise the diabetes MDT?

A 
Paeds consultant
Paeds diabetic specialist nurse
Paeds dietician
Clinical osychologist
Social worker
Support groups
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16
Q

Rapid-acting human insulin analgues

A

insulin lispro: Humalog
insulin glulisine: Apidra
insulin aspart: Novo Rapid

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17
Q

Long-acting human insulin analogues

A

insulin detemir: Levemir

glargine: :antus

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18
Q

Short-acting soluble human regulator insulin

A 
Actrapid
Humulin 5
30-60 min onset of action 
8 hr duration
given 15-30 min prior to meals
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19
Q

intermediate-acting insulin

A

Insulatard
Humulin I
1-2 hr onset
peak action 4-12 hrs

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20
Q

insulin injection sites

A 
sub cutaneous:
upper arm
buttocks
abdomen
ant + lat thigh
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21
Q

What insulin regimens are there?

A

basal-bolus regimen

continuous pump insulin

22
Q

what are the factors which affect insulin dosage?

A 
age
weight
diet
blood glucose
exercise
infection/illness
hormones e.g. puberty
23
Q

What is HbA1c?

A

glycosylated haemoglobin
indicates control over 6-12 wks
check 3x yearly

24
Q

What are the symptoms of hypoglycaemia?

A

Asymptomatic
Jittery, convulsions, hypotonia, apnoea
Blood glucose

25
What are the causes of congenital hypothyroidism?
maldescent of the thyroid/athyrosis dyshormonogenesis iodine deficiency TSH deficiency
26
What is maldescent / athyosis?
commonest cause of sporadic congenital hypothyroidism failure of thyroid to migrate from base of tongue to subpharyngeal position partial/complete failure of thyroid development
27
What is dyshormogenesis?
inborn error of thyroid hormone synthesis | more likely with consanguinous parents
28
What is iodine deficiency congenital hypothyroidism?
commonest cause worldwide | prevented by iodination of salt in the diet
29
What is TSH deficiency congenital hypothyroidism?
rare
30
What are the clinical features of congenital hypothyroidism?
failure to thrive, feeding issues, prolonged jaundice, constipation, pale mottled dry skin, large tongue, hoarse cry, coarse facies, goitre, umbilical hernia, delayed development
31
What are the clinical features of acquired hypothyroidism?
female>male, short stature, cold intolerance, dry skin, bradycardia, goitre, slow relaxing reflexes, contipation, delayed puberty, slipped upper femoral epiphysis, learning difficulties Usually AI: Hashimoto's Autoantibodies to thyroid peroxidase found
32
What is juvenile hypothyroidism?
due to AI thyroiditis incr risk in Downs or Turners incr risk of other AI diseases goitre often present
33
What is hyperthyroidism
oft due to Graves AI thyroiditis secondary to thyroid stimulating immunoglobulins teenage girls 1st line: carbimazole
34
What is the treatment for hyperthyroidism?
Carbimazole | + beta blockers for symptomatic relief
35
Side effects of steroids
``` Htn Glucose intolerance - hyperglycaemia Weight gain: tray all obesity, intra scapular fat pad Short stature Osteoporosis Striae, thin skin + incr bruising Prox myopathy Incr susceptibility to infection Adrenal suppression Cataracts ```
36
Precocious puberty
Onset of puberty: girls boys, 80-90% idiopathic, other = intracranial pathology False= inappropriate sequence = gonadotrophin independent, extracranial: CAH, Cushing's, malignancy, McCuneAlbright: + cafe au lait spots + fibrous dysplasia
37
Treating an addisonian crisis
Hydrocortisone | IV dextrose
38
McCune Albright syndrome
Sporadic genetic condition Precocious puberty: primary ovarian cysts secreting oestradiol Cafe au last spots Polyostotic fibrous dysplasia: normal bone replaced by cystic bone
39
Delayed puberty
``` Absence of pubertal development Girls 13 yrs Boys 14 yrs Or failure of progression over 2 yrs 1st line investigation: gonadotrophins ```
40
Measures to take when changing insulin regime
Adjust only one dose at a time Increase or decrease dose by 10% Allow a few days to assess outcome Check blood sugar more regularly
41
Growth hormone deficiency
Drop in growth velocity Assoc with neonatal hypoglycaemia, jaundice, doll-like face Acquired causes: head injury, irradiation + tumours Congenital: inherited, idiopathic, assoc with midline defects e.g. cleft palate Treatment: GH supplementation
42
Causes of delayed puberty
``` Low gonadotrophins: Constitutional delay, chronic illness(CF, asthma, crohns, anorexia), disorders of the hypothalamic-pituitary axis, intracranial lesions. Raised gonadotrophins + defective gonads Turners, Klinefelter's Chemo/radiotherapy Torsion ```
43
Causes of cranial diabetes insipidus
Head injury Surgery Sarcoidosis DIDMOAD: diabetes insipidus, diabetes mellitus, optic atrophy, deafness
44
Causes of nephrogenic diabetes insipidus
Metabolic abnormalities: hypokalaemia, hypercalcaemia Drugs: lithium, demeclocycline Genetic defects Heavy metal poisoning
45
Which infants are at greater risk of hypoglycaemia?
Babies
46
What are the risks of untreated hypoglycaemia?
Permanent neurological disability | Management: feed or IV glucose if not possible
47
What is Cushing's syndrome?
Clinical features due to adrenal steroid excess Most commonly caused by iatrogenic steroids Moon-like facies, plethora, acne Interscapular fat pad, truncal obesity, growth arrest Easy bruising, htn, hypogonadism, cataracts, glucose intolerance Raised 24 hr free urinary cortisol Or dexamethasone suppression test
48
What is Cushing's disease?
Excess corticosteroid secretion secondary to a pituitary tumour May present with features of Cushing's syndrome
49
What is Addison's disease?
Primary AI mediated adrenocortical failure: Decr glucocorticoids= hypoglycaemia, weight loss Decr mineralocorticoids= hypotension, hyperK, hypoNa Decr adrenal androgens= decr body hair + libido ACTH excess= incr pigmentation
50
How is Addison's disease diagnosed?
Short synthACTHen test: no rise in cortisol Management: replace glucocorticoids + mineralocorticoids With hydrocortisone + fludrocortisone

Toni's Paeds (16 decks)

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