ENDOCRINOLOGY

Question 1

Primary mound of breast. SMR stage

Answer 1

SMR 2

Question 2

Secondary mound of breast. SMR Stage?

Answer 2

SMR 4

Question 3

SMR Landmarks

Answer 3

Question 4

thelarche age

Answer 4

10-11 years

Question 5

menarche age

Answer 5

average age 12.5 years old, 9-15 years

*Menstruation start 2-2.5 years after thelarche

Question 6

gonadarche

Answer 6

growth of testes ≥4mL volume or 2.5cm longest diameter, 11-12yo

Question 7

Girls’ peak height velocity (PHV) coincides with _____ while boys’ PHV

coincides with _____

Answer 7

SMR 2-3

SMR 3-4

Question 8

SEXUAL DEVELOPMENT

Answer 8

• GIRLS: thelarche (10-11 years) → pubarche → growth spurt → menarche (average age 12.5 years old, 9-15 years)
• BOYS: gonadarche (growth of testes ≥4mL volume or 2.5cm longest diameter, 11-12yo) → pubarche → adrenarche → growth spurt

Question 9

GIRLS:

Precocious puberty → ______

Delayed puberty → ______

Answer 9

8 years

13 years

Question 10

BOYS:

Precocious puberty → _____

Delayed puberty → ______

Answer 10

9 years

14 years

Question 11

breast development in the first 2 yrs of life, regress after 2 yrs & rarely progressive

Answer 11

Premature thelarche

Question 12

pubic hair; early maturational event of adrenal androgen production

Answer 12

Premature adrenarche

Question 13

WHEN TO SUSPECT AN ABNORMALITY in sexual development

Answer 13

• If 13: No thelarche
• If 14: no menses, hematocolpos, no vagina
• If 16: with menses but other secondary sex characteristics not present (gonadal failure or pituitary)
• Precocious puberty

Question 14

defined as 2 or more standard deviations below the mean height for children of that gender and chronological age.

Answer 14

Short stature

Question 15

Short Stature With

o Normal linear growth velocity for age

o Bone age consistent with chronological age

o Normal age for onset of puberty

o Absence of physical or psychological disease

Answer 15

FAMILIAL SHORT STATURE

Question 16

• Delayed growth in one parent but average final stature
• Normal birth history and growth for first few months

• Chronologic age is greater than bone age (CA>BA)

Answer 16

CONSTITUTIONAL SHORT STATURE

Question 17

• Persistent weight less than 5 th percentile for age
• Growth curve: crossing 2 major percentile lines on growth chart

Answer 17

FAILURE TO THRIVE

Question 18

SIADH Bartter-Schwartz criteria:

Answer 18

• Continued renal excretion of Na
• Hyponatremia with hypo-osmolality
• Urine less than maximally dilute
• Absence of clinical evidence of volume depletion
• Absence of other causes of hyponatremia
• Correction of hyponatremia by fluid restriction

Question 19

DIAGNOSIS OF DI

Answer 19

DI is established if the serum osmolality is >300 mOsm/kg and the urine osmolality is <300 mOsm/kg

Question 20

• If the serum osmolality value is 290 mOsm/kg or higher with a simultaneous urine osmolality value of <290 mOsm/kg, a formal water deprivation test is not necessary.
• inability to respond to ADH (and thus the presence of NDI) should then be confirmed by the administration of vasopressin (10-20 μg intranasally) followed by serial urine and serum osmolality measurements hourly for 4 hr.

Answer 20

NEPHROGENIC DIABETES INSIPIDUS

Question 21

CLNICAL PARAMETERS of SIADH, CSW, CENTRAL DI

Answer 21

Question 22

Definitive Tx for GRAVES DISEASE

Answer 22

radioactive iodine ablation or thyroidectomy

Question 23

Pathophy of DM

Answer 23

EFFECTS OF INSULIN DEFICIENCY:

• With progressive deficiency → excessive glucose production & impairment of its utilization → hyperglycemia with glucosuria → resultant osmotic diuresis produces polyuria, urinary losses of electrolytes, dehydration, polydipsia → hypersecretion of epinephrine, glucagon, cortisol, & GH which amplifies & perpetuates metabolic derangements & accelerates metabolic decompensation
• Combination of insulin deficiency & ↑ counterregulatory hormones is responsible for accelerated lipolysis & impaired lipid synthesis → ↑ plasma total lipids, cholesterol, TG, FFA à ketone body formation which exceeds the capacity for peripheral utilization & renal excretion → metabolic acidosis & rapid deep breathing

Question 25

Management of DM in children

Answer 25

• Ketoacidosis: expansion of intravascular volume, correction of deficits in fluid, electrolyte & acid-base status; initiation of insulin therapy
• Initial hydrating fluid is isotonic saline (hypotonic relative to the patient’s serum osmolality)
• Administration of glucose (5% solution in 0.2 N saline) is initiated when blood glucose approaches 300 mg/dL to limit the decline of serum osmolality & reduce cerebral edema
• Give potassium added after the initial 20 ml/kg if UO is adequate.
• Bicarbonate only if pH <7.2 given slowly
• Anticipate cerebral edema – limit rate of fluid to 4 L/m2/day or less
• Insulin 0.1 U/kg of regular insulin followed by constant infusion of 0.1 U/kg/hr

Question 26

• Most common cause of thyroid disease in children & adolescents
• HLA-DR4, HLA-DR5 associated with an increased risk of goiter & thyroiditis
• Thyroid is diffusely enlarged, firm & nontender in most patients

Answer 26

Lymphocytic / Hashimoto / Autoimmune THYROIDITIS

Question 27

MC enzyme deficient in CONGENITAL ADRENAL HYPERPLASIA

Answer 27

• 21-hydroxylase deficiency: increased serum 17-OHP