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*Review TD 2020 > Endo > Flashcards

Endo Flashcards

1
Q

Order of loss of pituitary hormones?

A

Go Look For the Adenoma Please

GH
LH/FSH
TSH
ASTH
Prolactin
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2
Q

GH Stim test stimulation

A

Arginine and Clonidine

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3
Q

Indications for GH therapy

A 
GH deficiency
Turner Syndrome
SGA (no catchup by 3yo)
Idiopathic Short stature (< - 2.25SD)
Prader Willi 
Chronic Renal failure
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4
Q

Delayed puberty?

A

Girls:
No secondary char by 13

Boys:
No secondary char by 14

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5
Q

Precocious puberty

A

Girls: 8
Boys: 9

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6
Q

Primary amenorrhea

A

without sex. char.: 14

with sex char.: 16

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7
Q

Dx for Diabetes

A

FBG > 7 mmol
RBG ≥ 11.1 mmol
2 hr OGT glucose ≥ 11.1 mmol

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8
Q

Dx for DKA

A

– BG > 11 mM
– venous pH <7.3 or Bicarbonate <15 mM
– ketonemia (blood β-hydroxybuyrate ≥ 3 mM or moderate-large urine ketones)

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9
Q

How to Tx T2DM

A

Metformin for all

Insulin if:

  • DKA
  • HbA1C > 9
  • Severe Sx of hyperglycemia
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10
Q

Target HbA1C for T2DM

A

<7

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11
Q

Target HbA1C for T1DM

A

<7.5

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12
Q

T1DM

Associated Conditions and screening

A

Hypothyroidism - TSH + antiTPO

  • at Dx
  • q1y if +TPO
  • q2y if -TPO

Celiac dz - TTG + IA
- if symptomatic

Addisons - AM cortisol, Na, K
- if symptomatic

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13
Q

T1DM

Screening for complications

A 
Diabetic nephropathy (urine alb:cr ratio)
- 12yo &amp; >5y T1DM

Diabetic retinopathy
- 15yo & >5y T1DM

Dyslipidemia
- at 12 yo and 17 yo

Diabetic neuropathy
- ≥15 yo w poor metabolic ctrl ≥5y

Hypertension - everyone 2x/yr

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14
Q

Critical Sample

A 
Glucose
Insulin
Cortisol
BHB
FFA
GH
Cpeptide
Lactate
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15
Q

McCune Albright Syndrome

A

Precocious puberty - PERIPHERAL
Cafe au lait spots
Fibrous dysplasia

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16
Q

Hypocalcemia - signs

A 
Hyporeflexia - Trousseau and Chvostek’s signs
Increased ICP
Muscle Spasm
Candidiasis
Seizures
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17
Q

Bone mineral density

- type of score

A

Z score

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18
Q

Rickets

- signs

A

1) widening of the growth plates

2) softening of the bones
- craniotabes
- genu varum/valgum, wind swept deformity
- fractures

3) painful bones
- delayed motors milestones

19
Q

Williams Syndrome

A

chromosomal deletion 7q11.23
elastin gene

SUPRAVALULAR AORTIC STENOSIS
HYPERCALCEMIA
short stature
elephant facies 
recurrent OM, hearing loss
20
Q

Polyglandular autoimmune syndrome

A

Ach(e) & Act

Type 1:

  • Addison’s
  • Hypoparathyroidism
  • Candidiasis

Type 2:

  • Addison’s
  • T1DM
  • Chronic thyroiditis
21
Q

MEN

A

MEN 1:

  • Parathyroid
  • Pituitary (anterior)
  • Pancreatic islet cells

MEN 2A:

  • medullary thyroid cancer
  • pheochromocytoma
  • primary parathyroid hyperplasia

MEN 2B:

  • medullary thyroid cancer
  • pheochromocytoma
22
Q

PCOS

A

Dx:

1) abnormal uterine bleeding
2) evidence of hyperandrogensism

23
Q

What tanner stage is menses?

A

Stage 4

24
Q

CAH labs

A

Hyponatremia
Hyperkalemia
Metabolic acidosis - from last of aldosterone which normally excretes H+

25
Q

Septo optic dysplasia crisis - how to tx

A

IV hydrocortisone

26
Q

HHS

A

severe hyperglycemia (blood glucose >800 mg/dL; 44 mmol/L
absence of or only slight ketosis
nonketotic acidosis
severe dehydration
depressed sensorium or frank coma
various neurologic signs that may include grand mal seizures, hyperthermia, hemiparesis, and positive Babinski signs

27
Q

6y F has pubic and axillary hair. No other signs of puberty. Where should you look for pathology

A

ADRENALS

28
Q

T2DM renal screening

treatment

A

yearly screening with a random spot urine sample for albumin to creatinine ratio

Abnormal results should be confirmed by 2 additional specimens on separate days

Mgmt: ctrl DM, SBP, ACEi and protein restrict

(1) meticulous control of hyperglycemia
(2) aggressive control of SBP
(3) selective control of arteriolar dilation by use of angiotensin-converting enzyme inhibitors (thus decreasing transglomerular capillary pressure)
(4) dietary protein restriction (because high protein intake increases the renal perfusion rate)

29
Q

TSH newborn screen
false positive screen
false negative screen

A

Positive:

  • In early discharged babies (in the first day or two), because of the cold-induced TSH surge, TSH values are found to be elevated.
  • Intrauterine exposure to antithyroid drugs

Negative:

  • Central (TSH abd FT4 are low)
  • Premature <30 wks
30
Q

Who to screen for T2DM?

A
  1. 8-pubertal with 3 RF
    pubertal with 2 RF
    RF:
    - obesity
    - high risk ethnic group
    - first degree relative w T2DM or exposure in utero to diabetes
    - SnS of insuring resistance (acanthuses nigricans, hypertension, dyslipidemia, NAFLD
  2. PCOS
  3. IFG or IGT
  4. Atypical antipsychotics
31
Q

what is overweight and obese?

A

2-5yo:
Overweight >97 %ile
Obese >99.9 %ile

5-19yo:
Overweight 85-97 %ile
Obese >97 %ile

32
Q

What is the best test to look for vitamin D deficiency?

  1. Serum calcium
  2. Serum 25-OH-Vitamin D
  3. Serum 1-25-OH Vitamin D
  4. PTH
A

Serum 25-OH-Vitamin D

33
Q

Causes of significantly delayed bone age

A

constitutional delay of growth and puberty
nutritional deficiency
inflammatory bowel disease (or other systemic disease)
growth hormone deficiency

34
Q

What is the female athlete triad

A

low energy availability
amenorrhea
low bone density

35
Q

What are risk factors for cerebral edema in DKA?

A 
younger age < 5yo
new onset T1DM
high initial BUN
low pCO2
rapid administration of hypotonic fluids
IV bolus of insulin
early insulin infusion (w/in 1st hour)
failure of serum Na to rise during treatment
use of bicarb
36
Q

Pathological polyuria

A

Urine output >2L/m2/day

37
Q

Ddx Polyuria + Polydipsia

A 
Diabetes Mellitus
Renal 
Psychogenic polydipsia
Nephrogenic Diabetes Insipidus
Central Diabetes Insipidus
38
Q

How to Dx DI

A

u/o >4cc/kg/hr x 2 consecutive hours
Na >145
S.G. <1.005 OR urine osm <300mOsm/kg

Water deprivation test

39
Q

Insensible losses

A 
babies = 400cc/m2/day
adults = 200cc/m2/day
40
Q

BSA - how to calculate

A

BSA √= wt x ht/3600

41
Q

how to diagnose metabolic syndrome

A 
2 of:
Abdominal Obesity
Elevated TG
Low HDL
Hypertension
Glucose abnormalities – T2DM, IFG, IGT
42
Q

Who to screen for dyslipidemia?

When?

A

1) Positive fhx of dyslipidemia or premature cardiovascular disease (1st or 2nd degree relative)

2) If fhx unknown or in presence of other cardiovascular disease factors:
- Overweight (BMI > 85th%) or Obese (BMI > 95th%)
- Hypertension (BP > 95th %)
- Cigarette smoking
- Diabetes Mellitus

Start between the ages of 2-10 years
Retest q 3-5 years- if initial screen normal

43
Q

Mgmt of dyslipidemia

A

Pharmacotherapy (statin) should be considered in children > 8 years if:

  • LDL-C >/= 4.9 mmol/L
  • LDL-C >/= 4.1 mmol/L + family history of early heart disease or >/= 2 risk factors present
  • LDL-C >/= 3.4 mmol/L + Diabetes Mellitus
44
Q

How to screen fr dyslipidemia

A 
Fasting lipid profile
Total Cholesterol
Triglycerides
HDL-C
LDL-C

*Review TD 2020 (16 decks)

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