Endo

Question 1

What is the difference between hypocalcemic and hypophosphatemic rickets?

Answer 1

In Vitamin D deficiency (hypocalcemic) you have decreased calcium, normal (or mildly low) phosphate, increased ALP, PTH and decreased Vitamin D.

Hypophosphatemic: decreased phosph, normal caclium, normal vitamin D, increased ALP

Question 2

What are 5 risk factors for cerebral edema in DKA?

Answer 2

Too much Bolus 
Insulin Bolus
First time presentation 
Young Age <5 years 
High BUN and Low CO2

Question 3

What are the components of the critical sample? (11)

Answer 3

Serum:
Glucose, IGF-1, Cortisol, insulin
Fatty Acids: Free Fatty acids, Carnitine, beta hydroxy buturate
Gluconeogenesis: Pyruvate, Lactate

Urine: Ketones, Urine Amino Acids and Organic acids

Question 4

5 Causes of Primary Amenorrhea

Answer 4

Turner Syndrome
Premature Ovarian Failure
Hypothalmic-Pituitary dysfunction 
Pan hypopit
Malnutrition

Question 5

6 Causes of Secondary amenorrhea

Answer 5

Pregnancy
Premature Ovarian Failure 
Eating Disorder 
CNS Tumor 
Chronic Disease 
Thyroid

Question 6

Rickets Monitoring

Answer 6

Monitoring is via ALP

You can test 25 Vitamin D initially

Question 7

Signs of Rickets?

Answer 7

Ricketic Rosary 
Craniotabes 
Cupping, fraying and splaying
Widened growth plates 
Thickened risks
Bowed Legs

Question 8

Canadian Guidelines for Screening for Type 2 Diabetes

Answer 8

Pre Pubertal = 3 or more
Post Pubertal = 2 or more

Obese
Signs of insulin resistance - Acanthosis nigricans
Family history
High risk ethnicity

Being on atypical antipsychotics will put you at increased risk.

Question 9

Missing Insulin - what is the counselling

Answer 9

Check for Ketones - DKA?
Still need to give long acting Insulin
Will need to bolus for elevated glucose with rapid insulin 
ISF = 100/TDD
Aim for 6-10 - maybe around 8 
Check sugar again in 3 hours

Question 10

What are the screening recommendations for Type 1 dm - Comorbidities and associated risks

Answer 10

Comorbidities:
Retinopathy - 15 years of age and diabetes for more than 5 years
Nephropathy - 12 years of age and diabetes for more than 5 years
Neuropathy - Only if symptomatic and poor control; diabetes for >5 years
Dyslipidemia - 12 and 17 years of age; if less than 12 if they have other risk factors
HTN: twice a year

thyroid - every 2 years; Celiac and Addisons - if symptomatic.

Question 11

Sick day guidelines for Type 1 DM

Answer 11

Children may need extra insulin if they are sick. Use the 5-10-15-20 Rule.
Use this rule if their bg is greater than 15 or if there is ketones in urine or blood.
If the child is vomiting - may need a mini glucagon dose.

Urine Ketones/BG 15-20/BG>20
Negative - none or 5%
Small-5% or 10%
Medium-10% or 15%
Large-15% or 20%

The percentage of insulin is always a percentage of the total daily dose.

Question 12

What are the cut offs for lipds?

Answer 12

No risk factors: 4.9 mmol
Risk factors: 4.1
Diabetes: 3.4

Question 13

What is growth hormone approved for?

Answer 13

Turners, Prader Willi, Have not caught up after 2 years with IUGR/SGA, GH Deficiency, noonan, renal insufficiency, idiopathic short stature.

Question 14

What are the antibodies in:
Graves
Hashimotos

Answer 14

Graves: Anti thyroid receptor, Thyroid stimulating hormone
Thyroglobulin

Hashimotos: Anti TPO (microsomal) - the thyroid is infiltrated by T lymphocytes.

Question 15

What are the treatment for Graves and what are the side effects

Answer 15

Medications: PTU and Methimazole (1st line)
White, Yellow, Red, teratogen and hypothyroid
Agranulocytosis, liver toxx and rash/serum sickness
Radio iodine

Thyroidectomy

Question 16

Explain premature thelarche and adrenarche

Answer 16

Thelarche: is common at 6 months and 24 months. The patient has a normal height velocity and bone age. Not common after 4 years of age.

Adrenarche: normal or mildly increased bone age
Increased DHEA and androsteine; normal testosterone

Question 17

How do you treat adrenal insufficiency/

Answer 17

Normal is 6-8 mg/m2 of Hydrocortisone
Mild Illness 20-30
Moderate 50
Severe 100

All children need to wear a medic alert bracelet.

Question 18

What are 5 side effects of steroid use?

Answer 18

Adrenal insufficiency
Weight Gain
Hyperglycaemia/hypertension 
Infection 
Cataracts

Question 19

What are the clinical signs of osteogenesis imperfecta and how many types are there?

Answer 19

It is an AUTOSOMAL DOMINANT condition with a genetic mutation in collagen.
Clinically: blue sclera, wormian bones, dentogenesis imperfecta, joint laxity, changes in face
4 types: type 2 is the worst. Type 1 multiple fractures but usually in adolescent. Type 3 and 4 are inbetween.

Question 20

Mcune Albright

Answer 20

Poly osteotic disease; cutaneaus manifestations that do not cross midline and precocious puberty

Question 21

Albright Hereditary Osteodystrophy

Answer 21

Like nephrogenic DI but for Vitamin D

Vitamin D dependent rickts - does not respond to parathyroid hormone (increased phosphate and decreased calcium)

Round faces, short stature, short 4th metacarpal and developmental delay, subcutaneous calcifications.

Question 22

What are the clinically significant fractures

Answer 22

2 or more long bone fractures by 10 years
3 or more long bone fractures by 19 years
1 or more vertebral compression fracture (loss of 20%)