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Paeds > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

How might a patient with type 1 diabetes present

A

25-50% present with diabetic ketoacidosis

Polyuria

Polydipsia

Weight loss

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2
Q

What investigations are needed for type 1 diabetes

A

Bloods (FBC, U&Es, glucose, TFTs, insulin antibodies)

Blood cultures (if suspect infection)

HbA1c

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3
Q

What is the management for type 1 diabetes

A

Education

SC insulin regime (background long acting, plus short acting before meals)

Monitor dietary carbohydrate intake

Monitor blood sugar levels

Monitor for complications

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4
Q

What are the short term complications of type 1 diabetes

A

Hypoglycaemia:

  • Hunger, tremors, sweating, irritability, dizziness, pallor, reduced consciousness, coma, death
  • Management: rapid acting glucose, slow acting carbohydrates, IV dextrose, IM glucagon

Hyperglycaemia
- Increase insulin dose

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5
Q

What are the long term complications of type 1 diabetes

A

Macrovascular (coronary artery disease, peripheral ischaemia, poor healing, stroke, hypertension)

Microvascular (peripheral neuropathy, retinopathy, glomerulosclerosis)

Infection-related (UTIs, pneumonia, skin infections)

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6
Q

What is diabetic ketoacidosis

A

Life threatening emergency

Liver converts fatty acids to ketones

Acetone smell on breath

Get metabolic acidosis

Severe dehydration

Get potassium imbalance (normally driven into cells by insulin)

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7
Q

What are children with DKA at high risk of developing, how is this risk managed

A

High risk of developing cerebral oedema (if dehydrated brain cells corrected too fast)

Need neuro observations

Signs: headaches, altered behaviour, bradycardia, altered consciousness

Management: slow IV fluids, IV mannitol, IV hypertonic saline

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8
Q

How might a child with diabetic ketoacidosis present

A

Polyuria

Polydipsia

Nausea and vomiting

Weight loss

Acetone smell on breath

Dehydration

Hypotension

Altered consciousness

Symptoms of underlying trigger (sepsis)

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9
Q

What investigations are needed for diabetic ketoacidosis

A

Blood glucose > 11

Blood ketones > 3

pH < 7.3

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10
Q

What is the management for diabetic ketoacidosis

A

Correct dehydration evenly over 48 hours

Fixed rate insulin infusion

Avoid fluid boluses

Treat underlying trigger

Prevent hypoglycaemia (IV dextrose)

Add potassium to IV fluids

Monitor for signs of cerebral oedema

Monitor glucose, ketones, and pH

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11
Q

What are the adrenal hormones affected in adrenal insufficiency

A

Cortisol

Aldosterone

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12
Q

What is primary adrenal insufficiency

A

Aka Addison’s disease

Adrenal glands damaged

Mostly autoimmune

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13
Q

What is secondary adrenal insufficiency

A

Due to low ACTH stimulating adrenal glands

Damage to pituitary (congenital hypoplasia, surgery, infection, radiotherapy)

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14
Q

What is tertiary adrenal insufficiency

A

Inadequate CRH release from hypothalamus

Due to long term steroid use (over 3 weeks, hypothalamus suppressed)

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15
Q

How might babies with adrenal insufficiency present

A

Lethargy

Vomiting

Poor feeding

Hypoglycaemia

Jaundice

Failure to thrive

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16
Q

How might older children with adrenal insufficiency present

A

Nausea and vomiting

Poor weight gain

Reduced appetite

Abdominal pain

Muscle weakness

Cramps

Developmental delay

Bronze hyperpigmentation of skin

17
Q

What investigations are needed for adrenal insufficiency

A

Bloods (U&Es, cortisol, ACTH, aldosterone, renin)

Addison’s: low cortisol, high ACTH, low aldosterone, high renin

Secondary: low cortisol, low ACTH, normal aldosterone, normal renin

Short synacthen test (ACTH stimulation test, measure at 0, 30, and 60 mins, should double)

18
Q

What is the management for adrenal insufficiency

A

Replace steroid hormones (hydrocortisone for cortisol, fludrocortisone for aldosterone)

Give patients steroid card

Increase dose during acute illness

Regular monitoring (growth and development, bloods)

19
Q

What is an Addisonian crisis, how is it managed

A

Adrenal crisis

Presentation: reduced consciousness, hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia

Management: intensive monitoring, IV hydrocortisone, IV fluids, correct hypoglycaemia, monitor U&Es

20
Q

What is congenital adrenal hyperplasia

A

Congenital deficiency of 21-hydroxylase enzyme

Underproduction of cortisol and aldosterone

Overproduction of androgens

Autosomal recessive

21
Q

How does mild congenital adrenal hyperplasia present

A

During childhood or after puberty

Females: tall for age, facial hair, absent periods, deep voice, early puberty

Males: tall for age, deep voice, large penis, small testicles, early puberty

22
Q

How does severe congenital adrenal hyperplasia present

A

Hyponatraemia, hyperkalaemia, hypoglycaemia

Poor feeding

Vomiting

Dehydration

Arrhythmias

Females: ambiguous genitalia, enlarged clitoris

23
Q

What is the management for congenital adrenal hyperplasia

A

Cortisol replacement (hydrocortisone)

Aldosterone replacement (fludrocortisone)

Corrective surgery for ambiguous genitalia

24
Q

Where is growth hormone produced

A

Anterior pituitary

25
Q

What are the congenital causes of growth hormone deficiency

A

Disruption of growth hormone axis

Genetic mutation

Underdevelopment of anterior pituitary

26
Q

What are the acquired causes of growth hormone deficiency

A

Infection

Trauma

Surgery

27
Q

How might a patient with growth hormone deficiency present

A

At birth: micropenis, hypoglycaemia, severe jaundice

Poor growth (severely slowed from age 2-3)

Short stature

Slow development of movement and strength

Delayed puberty

28
Q

What are the investigations for growth hormone deficiency

A

Growth hormone stimulation test (measure response to glucagon or insulin)

Test for associated hormonal deficiencies

MRI brain (structure of pituitary)

Genetic testing

X-ray wrist (bone age)

DEXA scan

29
Q

What is the management for growth hormone deficiency

A

Daily SC growth hormone injections (somatropin)

Treat associated hormone deficiencies

Closely monitor height and development

30
Q

How might a child with congenital hypothyroidism present

A

At newborn heel prick test

Prolonged neonatal jaundice

Poor feeding

Constipation

Increased sleeping

Reduced activity

Slow growth and development

31
Q

How might a child with acquired hypothyroidism present

A

Usually autoimmune

Associated with type 1 diabetes and coeliac disease

Fatigue

Poor growth

Weight gain

Poor school performance

Constipation

Dry skin

Hair loss

32
Q

What is the management for hypothyroidism

A

Levothyroxine

Paeds (17 decks)

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