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Paeds > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Tests in newly diagnosed T1DM?

A

FBC, U&E, glucose
HbA1c
TFTs
coeliac screening
autoantibodies

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2
Q

Presentation of T1DM?

A

25-50% present with DKA
polyuria
polydipsia
weight loss (dehydration)

secondary enuresis
recurrent UTIs

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3
Q

Autoantibodies associated with T1DM?

A

insulin antibodies
anti-GAD antibodies
islet cell antibodies

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4
Q

Mx of T1DM?

A

education (parent and child)
subcutaneous insulin regimes
monitoring dietary carb intake
monitoring blood sugar levels
monitor and manage complications

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5
Q

Short-term complications of T1DM?

A

hypoglycaemia
hyperglycaemia (+DKA)

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6
Q

Long-term complications of T1DM?

A

macrovascular complications:
CAD
PAD
stroke
HTN
microvascular complications:
peripheral neuropathy
retinopathy
nephropathy, particularly glomerulosclerosis
infection-related:
UTIs
pneumonia
skin and soft tissue infections
fungal infections, oral and vaginal candidasis

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7
Q

Presentation of DKA?

A

polyuria
polydipsia
nausea and vomiting
dehydration
weight loss
acetone smell to breath
hypotension
altered consciousness
symptoms of underlying trigger

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8
Q

Diagnosis of DKA?

A

hyperglycaemia (>11mmol/L)
ketosis (>3mmol/L)
acidosis (<7.3)

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9
Q

Pathophysiology of DKA?

A

ketoacidosis
dehydration
potassium imbalance

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10
Q

Mx of DKA?

A

IV fluid resuscitation (10ml/kg/hr)
maintenance fluids + potassium
no insulin for 1st hr
insulin 0.1unit/kg/hr
add 5% dextrose when blood glucose 17mmol/L

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11
Q

What is adrenal insufficiency?

A

condition where the adrenal glands do not produce enough steroid hormones, particularly cortisol and aldosterone

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12
Q

What is Addison’s disease?

A

primary adrenal insufficiency (i.e., damage to the adrenal glands)
autoimmune most common

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13
Q

What is secondary adrenal insufficiency?

A

inadequate secretion of ACTH by the pituitary glands

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14
Q

What is tertiary adrenal insufficiency?

A

inadequate CRH release from the hypothalamus to stimulate the pituitary

usually the result of sudden cessation of long-term steroids

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15
Q

Features of adrenal insufficiency in babies?

A

lethargy
vomiting
poor feeding
hypoglycaemia
jaundice
failure to thrive

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16
Q

Features of adrenal insufficiency in older children?

A

nausea and vomiting
poor weight gain or weight loss
anorexia
abdo pain
muscle cramps
developmental delay or poor academic performance
bronze hyperpigmentation (Addison’s)

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17
Q

Investigations for adrenal insufficiency?

A

U&Es
blood glucose
cortisol, ACTH, aldosterone and renin
Short synacthen test

18
Q

U&Es in adrenal insufficiency?

A

hyponatraemia
hyperkalaemia
hypoglycaemia

19
Q

Primary vs secondary adrenal insufficiency results?

A

primary:
low cortisol
high ACTH
low aldosterone
high renin

secondary:
low cortisol
low ACTH
normal aldosterone
normal renin

20
Q

What is the short synacthen test used for?

A

to confirm the diagnosis of primary adrenal insufficiency

21
Q

Short synacthen test results?

A

performed in morning
administer synacthen (synthetic ACTH)
cortisol levels should at least double - failure to rise indicates primary adrenal insufficiency

22
Q

Mx of adrenal insufficiency?

A

hydrocortisone +/- fludrocortisone
steroid card
DON’T STOP

23
Q

What is an Addisonian crisis?

A

acute presentation of severe Addison’s disease

reduced consciousness
hypotension
hypoglycaemia, hyponatraemia, hyperkalaemia

can be first presentation, triggered by illness or if someone stops taking their steroids abruptly

24
Q

Mx of Addisonian crisis?

A

IV hydrocortisone
IV fluid resuscitation
correct hypoglycaemia
careful monitoring of electrolytes and fluid balance

25
Q

What causes congenital adrenal hyperplasia?

A

deficiency of the 21-hydroxylase enzyme

21-hydroxylase converts progesterone to cortisol and aldosterone
absence of this enzyme -> excess progesterone that gets converted into testosterone

26
Q

What is congenital adrenal hyperplasia?

A

an autosomal recessive genetic condition that causes overproduction of androgens and underproduction of cortisol and aldosterone

27
Q

Presentation of congenital adrenal hyperplasia?

A

severe cases:
ambiguous genitalia
hyponatraemia, hyperkalaemia, hypoglycaemia
poor feeding
vomiting
dehydration
arrhythmias

milder cases:
girls:
tall
hirsutism
primary amenorrhoea
deep voice
early puberty
boys:
tall
deep voice
large penis
small testes
early puberty

hyperpigmentation (due to incr. ACTH because of low cortisol levels)

28
Q

Mx of congenital adrenal hyperplasia?

A

refer to paediatric endocrinologist
hydrocortisone +/- fludrocortisone
corrective sx

29
Q

Causes of GH deficiency?

A

congenital (genetic mutations, empty sella syndrome)
acquired (damage to pituitary)

30
Q

Presentation of GH deficiency?

A

neonates:
micropenis
hypoglycaemia
severe jaundice
older children:
poor growth
short stature
slow development of movement and strength
delayed puberty

31
Q

Investigations for GH deficiency?

A

GH stimulation test
test for other associated hormone deficiency (thyroid, adrenal)
MRI brain
genetic testing (Turner, Prader-Willi)
X-ray of wrist

32
Q

Mx of GH deficiency?

A

daily SC injections of GH
management of other associated conditions
monitoring of height and development

33
Q

Types of hypothyroidism?

A

congenital (usually picked up on heelprick test)
acquired

34
Q

Presentation of congenital hypothyroidism?

A

usually picked up on heelprick test
prolonged neonatal jaundice
poor feeding
constipation
incr. sleeping
red. activity
delayed development and growth

35
Q

Presentation of acquired hypothyroidism?

A

fatigue and low energy
poor growth
weight gain
poor school performance
constipation
dry skin
hair loss

36
Q

Most common cause of acquired hypothyroidism?

A

Hashimoto’s thyroiditis

37
Q

Antibodies in Hashimoto’s thryoiditis?

A

anti-TPO antibodies
anti-Tg antibodies

38
Q

Associated diseases with Hashimoto’s thyroiditis?

A

T1DM
coeliac disease

39
Q

Investigations for hypothyroidism?

A

referral paediatric endocrinologist
TFTs
thyroid antibodies
screen for other autoimmune diseases

40
Q

Mx of hypothyroidism?

A

levothyroxine

Paeds (16 decks)

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