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Royal College Studying > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

What is protective against T2DM

A

breastfeeding, weight loss, healthy behavior interventions, bariatric surgery, orlistat/metformin

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2
Q

Risk factors for T2DM development

A

first or second degree relative with T2DM
being a member of a high risk group (Asian, indigenous, african, arab, hispanic)
obesity
impaired glucose tolerance
PCOS
exposure to diabetes in utero
acanthosis nigricans
HTN, dyslipidemia
NAFLD
atypical antipsychotic medications

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3
Q

what is recommended screening test for T2DM

A

fasting blood glucose

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4
Q

What is target AIC for most children with T2DM

A

< 7.0%

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5
Q

When do you need to start insulin immediately in T2Dm

A

present in DKA
A1C > 9
severe symptoms of hyperglycemia

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6
Q

Who is higher risk for developing CV and microvascular complications T1 or T2

A

T2DM children

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7
Q

RF for complications in T2Dm

A

older age at diagnosis
poorer metbaolic control

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8
Q

Screening for complications schedule in T2Dm

A

Neuropathy- yearly at diagnosis (asking about symptoms , vibration sense, light touch and ankle reflexes)
retinopathy- yearly screening at diagnosis
nephropathy- yearly screening at diagnosis with first morning ACR
dyslipidemia- at diagnosis and yearly afterwards
HTN- at diagnosis and every diabetes related encounter after (at least twice per year)
NAFLD0 yearly screening at diagnosis
PCOS yearly screening at diagnosis
OSA- yearly
depression- yearly
binge eating- yearly

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9
Q

Who to screen for T2DM and when

A

Every 2 years using a combination of A1C and HPG in children with > 3 risk factors nonpubertal (starting age 8) or >2 risk factors pubertal
RF:
- obesity (BMI >95)
- high risk ethnic group
- first degree relative with T2DM or exposure to DM in utero
- signs of insulin resistnace (acanthosis, HTN, dyslipidemia, NAFLD)

Also screen: PCOS, IFG, use of atpical antipsyhotic medicationsq

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10
Q

A1C target T1DM

A

< 7.5%

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11
Q

increased DKA risk

A

children with poor control or previous episodes of DKA
peripubertal and adolescent girls
children with pumps
ethnic minorities
children with psych disorders
difficult family cirucmstances

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12
Q

RF for cerebral edema

A

bolus of insulin before infusion
early insulin (within 1 hour of fluid)
young children (<5)
First presentation DM
greater severity of acidosis
high initial urea
low CO2
rapid administation of hypotonic fluids
failure of serum sodium to rise during treatment
use of bicarbonate

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13
Q

Screening in T1DM

A

Thyroid disease- TSH and TPO, at diagnosis and every 2 years after (every 6-12mo if TPO Ab +)
AI- as clinically indicated
celiac disease- as clinically indicated

nephropathy- yearly starting at age 12 if DM >5 years with first morning ACR
retinopathy- yearly screening starting at age 15 with DM > 5 years
Neuropathy - children over 15 with poor control should be screened after 5y of DM

Dyslipidemia- delay screening until control stable, screen at 12 and 17 years f age, < 12 only screen if BMI > 97th, family history
HTN- all children with T1DM at least twice per year

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14
Q

How much glucagon to give >5 and < 5

A

1mg over 5 and 0.5mg under 5

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15
Q

when to start giving dextrose in DKA

A

BG < 17

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16
Q

definition of albuminuria

A

> 2.5mg/mmol AER >20mcg/min

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17
Q

when should you do genetic testing for neonatal DM

A

Before 6mo

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18
Q

how to diagnose DM

A

FAsting BG > 7
Random BG or 2hr OGT BG >11
antibodies- GAD, insulin, islet cell

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19
Q

How is MODY inherited

A

autosomal dominant

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20
Q

Enzyme deficiency for MODy

A

glucokinase, HNF1a, HNF4a

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21
Q

How to treat MODY

A

sulfonylureas

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22
Q

critical sample for hypoglycemia

A

blood glucose, insulin, c-peptide, growth hormon, cortisol, ketones, lactate
total and free carnitine and acylcarnitine, plasma amino acids, ammonia

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23
Q

micropenis size

A

< 2.5cm in term infant

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24
Q

clitoromegaly defn

A

> 9mm in term infant

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25
Q

what is the msot common DSD in 46XX

A

CAH

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26
Q

what is responsible for testes determination/formation

A

SRY gene on Y chromosome

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27
Q

what do Leydig and sertoli cells secrete

A

Leydig- testosterone
Sertoli- AMH

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28
Q

What is Swyer syndrome

A

XY individuals but defect in SRY gene so can’t develop testes, can’t develop AMH
Phenotypically female and have mullerian structures but gonads are streak gonads, they do not go through breast development or menarche at puberty
Can have some virilization

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29
Q

Denys Drash

A

partial gonadal dysgenesis with undervirilized or ambiguous genitalia and absent mullerian structures
they also have renal dsiease and will develop ESRD
WT1 gene mutation
increased risk for wilms tumor

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30
Q

when to suspect Complete androgen insensitivity

A

prepubertal girl with male goands during evaluation of inguinal hernias or evaluation for primary amenorrhea

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31
Q

How to diagnose adrenal insufficiency

A

ACTH stimulation test- low dose for central AI and high dose for eripheral AI
cortisol drawn at 0, 30 and 60 minutes
Cortisol peak > 350 is normal at ACH

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32
Q

What is normal growth velocity

A

> 4.5cm per year pre pubertal

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33
Q

Ddx poor growth velocity

A

GH deficiency
hypothyroidism
AI
Cushings
chronic disease states

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34
Q

how to calculate mid parental height

A

mothers height + fathers height (+/-13cm) /2

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35
Q

Ddx short statrue with normal bone age

A

familial short stature
turner, russel sliver, prader willi

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36
Q

Features of GH deficiency

A

poor growth velocity
crossing percentiles
hypogylcemia
micropenis

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37
Q

how to diagnose GH deficiency

A

May have low IGF-1
Gold standard = growth hormone stim test by giving arginine, clonidine, L-dopa, propanolol or glucagon (insulin not used in peds)
normal peak of >5 on ether test rules out GHD

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38
Q

Side effects of GH

A

SCFE, IIH, hyergylcemia, growth of nevi, carpal tunnel, injection site reactions, sudden death in pt with OSA

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39
Q

INdications for GH therapy

A

turner, chronic renal failure, SGA with inadequate catch up growth, ISS, SHOX mutation, prader willi, noonan, GH deficiency

40
Q

Tall stature ddx

A

klinefeleter, familal, late onset CAH, recocious puberty, growth hormone exesss obesity
overgrowth syndromes in infants

41
Q

timing of puberty boys and girls

A

8-13 in girls
9-14 in boys

42
Q

normal pubertal progression in girls

A

thelarche
pubarche within 6mo
peak growth spurt tanner 2-3
menarche 2y after thelarche

43
Q

normal pubertal progression in boys

A

increased testicular volume, scrotal thinning
pubarche
secondary sexual characterisitics
peak growtwh velocity tanner 5

44
Q

Benign premature thelarche

A

usually within first 2 years of life
no advancement of bone age
no other pubertal changes

45
Q

benign premature adrenarche

A

virilizing changes between 6-8 years
no bone age advancement
no other pubertal changes

46
Q

Red flags for precocious puberty

A

rapid progression of puberty
bone age advancement > 2 years
CNS signs and symptoms

47
Q

Investigations for precocious puebrty

A

Boys ALWAYS need head imaging, girls if young age
peripheral- labs/imaging to determine source

48
Q

How to treat precocious puberty

A

GnRH analog (lupron)

49
Q

define delayed puberty

A

absence of secondary sexual characteriitics by age 13 in girls, 14 in boys

50
Q

what do sertoli cells produces

A

AMH

51
Q

what do leydig cells produce

A

testosterone

52
Q

definition of clitiromegaly

A

wider than 6mm longer than 9mm

53
Q

micropenis

A

<2.5cm in term infant

54
Q

inheritance CAH

A

AR

55
Q

what % of CAH is 21OH def

A

95%

56
Q

when does salt wasting present

A

DOL 7-14

57
Q

how does classic non salt wasting CAH present

A

virilization age 2-4

58
Q

what first AM cortisol suggests insuff

A

< 100
> 350 is normal

59
Q

causes of primary AI

A

autoimmune (addisons)
CAH
Adrenoleukodystrophy, Smith lemli opitz
infection, drugs, infiltration

60
Q

stress doings doses

A

HC
moderate 30-50mg/m2
severe 100mg/m2

61
Q

triad for septo optic dysplasia

A

optic nerve hypoplasia
midline brain abnormalities
pituitary hypoplasia

62
Q

what is septo optic dysplasia associated with

A

lower maternal age and primiparity

63
Q

growth velocity first year, 1-4 and over 5

A

0-1 25cm/year
1-4 10cm/year
5< 5cm/year

64
Q

what are you look for on water deprivation test

A

as serum osm increases over 300, urine concentration should > 1000

65
Q

how is nephrogenic DI inherited

A

X linked

66
Q

how is central DI inherited

A

AD, AR, x-inked

67
Q

what medications/interventions can cause nephrogenic DI

A

osmotic diuresis (hypertonic saline bolus), lithium, hypercalcemia, hypoklamiea, CKD

68
Q

fluid status in SIADH

A

normovolemia

69
Q

fluid status in cerebral salt wasting

A

hypovolemia

70
Q

MEN 1

A

pituitary, parathyroid, pancreas tumors (insulinoma)

71
Q

Autoimmune polyglandular syndrome

A

Type 1 DM, esp AI or hypoparathyroidism, candidiasis, ectodermal dystrophy

72
Q

APS 2

A

AI, thyroid, DM

73
Q

Albrights osteodystrophy

A

pseudohypoPTH, dont respond to this so you get low Ca and high PO4
Also get short stature, brachydactylyl of digits 3/4/5, round face with low nasal bridge,

74
Q

Whats the most important way to get vit D

A

cutaenous synthesis

75
Q

vitamin D dependent ricketts

A

dont have 1, alpha hydroxylase to make 1,25 vit D

76
Q

x-linked hypophosphatemia

A

dont respond to FGFR23 so low phophate, normal calcium

77
Q

Lab findings in PCOS

A

High LH/FSH ratio (and high androgens)

78
Q

What is the bone age in GH deficiency

A

Delayed

79
Q

Cause of proximal RTA

A

cystinosis (most common)
tyrosinemia
galactosemia
heredtiary fructose deficiency
wilsons

80
Q

DEnt disease

A

x-linked nephrolithiasis

81
Q

What to consider in phenotypic female with bilateral inguinal hernias

A

androgen insensitivity

82
Q

Most common cause of ectopic ACTH secretion in a baby

A

adrenalcortico tumor

83
Q

Most common cause of ACTH secretion in a older child

A

pituitary adenoma

84
Q

What lyte disturbances can cause nephrogenic DI

A

hypoK and hyperca

85
Q

What is target HbA1C in DM

A

< 7.5

86
Q

Growth velocity in first year of life

A

18-25cm/yr

87
Q

Laron syndrome

A

GH resistance

88
Q

LAurence moon biedel

A

short stature, retinitis pigmentosa

89
Q

GH for

A

Turner, Gh def, noonan, CKD, SHOX def, prader willi, SGA without catch yp and idiopathic shrot < 2.25 SD

90
Q

GH SE

A

edema, joint pan, PTC, local bruising , wrosening scoliosis, insulin resistance, SCFE, gynecomastia

91
Q

When to screen for T2DM

A

BMI over 85th and 2 of fam hx, ethnicity, mat DM/GDM, PCOS/acanthosis, screen at age 10 or puberty, whichever is earlier

92
Q

insulin to carb ratio

A

500/TDDD

93
Q

when to start screening for nephrotpathy in DM

A

age 10 or after 5 years

94
Q

Target HbA1C in T2DM

A

< 7

95
Q

easy way to figure out correction factor for insulin

A

10-20% TDD

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