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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?

24
Q

CAH labs

A

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

25
Septo optic dysplasia crisis - how to tx
IV hydrocortisone
26
HHS
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
6y F has pubic and axillary hair. No other signs of puberty. Where should you look for pathology
ADRENALS
28
T2DM renal screening | treatment
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
TSH newborn screen false positive screen false negative screen
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
Who to screen for T2DM?
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
what is overweight and obese?
2-5yo: Overweight >97 %ile Obese >99.9 %ile 5-19yo: Overweight 85-97 %ile Obese >97 %ile
32
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
Serum 25-OH-Vitamin D
33
Causes of significantly delayed bone age
constitutional delay of growth and puberty nutritional deficiency inflammatory bowel disease (or other systemic disease) growth hormone deficiency
34
What is the female athlete triad
low energy availability amenorrhea low bone density
35
What are risk factors for cerebral edema in DKA?
``` 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
Pathological polyuria
Urine output >2L/m2/day
37
Ddx Polyuria + Polydipsia
``` Diabetes Mellitus Renal Psychogenic polydipsia Nephrogenic Diabetes Insipidus Central Diabetes Insipidus ```
38
How to Dx DI
u/o >4cc/kg/hr x 2 consecutive hours Na >145 S.G. <1.005 OR urine osm <300mOsm/kg Water deprivation test
39
Insensible losses
``` babies = 400cc/m2/day adults = 200cc/m2/day ```
40
BSA - how to calculate
BSA √= wt x ht/3600
41
how to diagnose metabolic syndrome
``` 2 of: Abdominal Obesity Elevated TG Low HDL Hypertension Glucose abnormalities – T2DM, IFG, IGT ```
42
Who to screen for dyslipidemia? | When?
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
Mgmt of dyslipidemia
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
How to screen fr dyslipidemia
``` Fasting lipid profile Total Cholesterol Triglycerides HDL-C LDL-C ```

*Review TD 2020 (16 decks)

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