Endocrinology

Question 1

When to start screening overweight kids with at least 2 risk factors for diabetes?

Answer 1

At age 10 yo and every 3 years after

Question 2

Most common cause of goiter in adolescents. How to dx?

Answer 2

Hashimoto (Chronic lymphocytic thyroiditis); Check anti-thyroglobulin and anti-thyroid peroxidase antibodies

Question 3

Most common presentation of Hashimoto?

Answer 3

Hypothyroidism; can get thyrotoxicosis

Question 4

Antibody in Grave’s disease?

Answer 4

Anti-thyroid-stimulating immunoglobulin (TSH receptor Ab)

Question 5

How to distinguish Grave’s disease from subacute thyroiditis?

Answer 5

Radioactive iodine uptake. High in Graves, Low in subacute

Question 6

Solitary nodule in thyroid of adolescent. Next step?

Answer 6

Ultrasound and Fine needle aspiration. Adolescents have higher risk of malignancy with solitary nodule than adults

Question 7

Abnormally low serum T4 concentrations, but normal free T4, clinically euthyroid, and normal TSH. Tx?

Answer 7

Thyroid binding globulin deficiency. Tx is not necessary as patient is euthyroid.

Question 8

Dx of diabetes

Answer 8

• 2 random glucose >200; OR 1 random >200 WITH sx - Fasting glucose >126 - 2 hour post gluc tolerance test >200

Question 9

When to start monitoring lipid levels in child with DM1? When to start eye exams?

Answer 9

Lipid levels at 12, Eye exam at 10

Question 10

DKA, when to add glucose into IV fluids?

Answer 10

Once glucose drops below 250 can add D5, once below 150 can add D10

Question 11

Child with acanthosis nigricans, obesity. Most likely lab finding?

Answer 11

Low HDL

Question 12

Child with vomiting, mental status changes, glucose 600s, hypernatremia, and elevated serum osmolality

Answer 12

Hyperosmolar diabetic coma

Question 13

Criteria for metabolic syndrome

Answer 13

1. Elevated TGs 2. Low HDL 3. HTN 4. Elevated glucose 5. Truncal obesity

Question 14

pH and HCO3 in mild, moderate, severe DKA

Answer 14

Mild DKA: pH <7.3; HCO3 <15

Moderate: pH<7.2; HCO3 <10

Severe: pH <7.1; HCO3 <5

Question 15

How to calculate corrected Na in diabetes?

Answer 15

Corrected Na= Measured Na + 0.016 (glucose - 100)

Question 16

What to consider if sodium is low in DKA

Answer 16

SIADH secondary to cerebral edema

Question 18

What does this EKG indicate?

Answer 18

Hypokalemia, U wave after T wave. Can eventually overtake T wave

Question 19

At what age can intensive insulin therapy be started in children?

Answer 19

13 yo

Question 20

Child on insulin therapy with pre-breakfast hyperglycemia. 2 am glucose is elevated. What is the issue and what is the treatment?

Answer 20

Dawn phemnomenon= early morning insulin resistance 2/2 nocturnal GH secretion. Tx by increasing the night-time long acting insulin

Question 21

Child on insulin therapy with pre-breakfast hyperglycemia. 2 am glucose is LOW. What is the issue and what is the treatment?

Answer 21

Somogyi phemnomenon= Post-hypOglycemia hyperglycemia during the night, causing prebreakfast hypoglycemia. Tx by lowering the night time long acting insulin

Question 22

What recommendations for a diabetic child on sick days?

Answer 22

1. Check BG frequently and us rapid acting insulins
2. Check urine ketones
3. Stay hydrated

Question 23

Management if diabetic child has consistently elevated blood glucose before lunch?

Answer 23

Increase the AM short acting component

Question 24

Management in diabetic child with consistently elevated glucose before dinner?

Answer 24

Increase the AM long-acting insulin

Question 25

Management in a diabetic child with consistently elevated blood glucose before bedtime?

Answer 25

Increase the night time short acting insulin

Question 26

Formula for BMI Obesity is defined as above what %tile?

Answer 26

BMI = Weight (kg) / Height (m^2) Obesity = \>95%tile

Question 27

A child who is obese at 6 yo has a what % chance of being obese as an adult? A child who is obese at 12 yo has a what % chance of being obese as an adult?

Answer 27

6 yo has 25% chance 12 yo has 75% chance

Question 28

Most common complication of childhood obesity

Answer 28

Psychological factors: Depression and low self esteem

Question 29

Obese child with polydactyly/syndactyly, mental deficiency, eye issues, broad/short feet, abnormal kidneys

Answer 29

Bardet-Biedl Syndrome

Question 30

What does this finding indicate

Answer 30

Brushfield spots; Down Syndrome

Question 31

Moderately obese child with delayed dental eruption, short 4th metacarpals, extraskeletal calcification, hypocalcemia and hypophosphatemia (pseudohypoparathyroidism)

Answer 31

Albright hereditary osteodystrophy

Question 32

Child with growth failure. What test to order?

Answer 32

Think about hypothyroidism. Check TSH, T4 and thyroid antibodies

Question 33

Child with loss of milestones, adrenal insufficiency, multiple males in family affected

Answer 33

Adrenoleukodystrophy

Question 34

Growth failure, HTN, truncal obesity and hirsutism. How to diagnose?

Answer 34

Cushing's disease. Overnight dexamethasone suppression test. If suppression (low cortisol), then +Cushings.

Question 35

Paroxysms of severe headache, HTN and sweating. How to dx? Tx?

Answer 35

Pheochromocytoma Dx with urinary catechols (Metanephrine/HVA) Tx preop alpha adrenergic blockade (phentolamine) Surgical resection

Question 36

What 4 hormones increase glucose?

Answer 36

Growth hormone, cortisol, epinephrine, and glucagon

Question 37

Cut off for hypocalcemia? Cut off for hypercalcemia?

Answer 37

\<8.5 or ionized calcium \<4.5 \>11

Question 38

Symptoms of hypocalcemia

Answer 38

Painful muscle spasms Seizures Vomiting Prolonged QT on EKG

Question 39

Short obese child with developmental delay, moon facies, calcification of basal ganglia. What labs to order?

Answer 39

Pseudohypoparathyroidism Would have HIGH PTH and LOW calcium

Question 40

Children on anticonvulsants are at increased risk for what deficiency?

Answer 40

Hypocalcemia leading to rickets

Question 41

Elevated PTH, low serum calcium and phosphorus indicates what? What do you measure?

Answer 41

Vitamin D deficiency Measure 25OH vitamin D

Question 42

Patient with hypocalcemia, hypophosphatemia, elevated PTH. Does not respond to vitamin D replacement. What is dx?

Answer 42

Vitamin D dependent Rickets Type 1 has low 1,25 OH2 D (active form) Type 2 has high 1,25 OH2 D

Question 43

Answer 43