Endocrinology

Question 1

Which endocrine disorder is most strongly associated with trisomy 21?

Answer 1

Hypothyroidism

Question 2

What glucose bolus is given to children who are hypoglycaemic?

Answer 2

10% glucose solution

2mL/kg

Question 3

What ketones may be present in DKA?

Answer 3

1. Acetone
2. Acetoacetate
3. Beta-hydroxybutyrate

Question 4

Which ketone is most sensitive for detecting early DKA?

Answer 4

Betahydroxybutyrate

Question 5

Throughout management of DKA, betahydroxybutyrate levels decrease while acetacetate levels increase. What does this suggest?

Answer 5

Normal

Betahydroxybutyrate is converted to acetoacetate

Question 6

What is the biochemical criteria for DKA?

Answer 6

Hyperglycaemia, defined by a BGL > 11mmol/L

Venous pH <7.3 or bicarbonate < 15mmol/L

Presence of blood or urinary ketones

Question 7

What happens to K+ during DKA?

Answer 7

Moves extracellularly → lost in urine

Moves intracellularly with insulin administration

Question 8

What is the most significant cause of mortality in children with DKA?

Answer 8

Cerebral oedema

Question 9

Which biochemical marker is elevated in rickets?

Answer 9

ALP

Question 10

Which antibodies are measured to support a diagnosis of T1DM?

Answer 10

Anti-glutamic acid decarboxylase (anti-GAD)

Question 11

What is the target BSL range for children with diabetes?

Answer 11

4-8 mmol/L

Question 12

What is the target HbA1c for children with diabetes?

Answer 12

7%

Question 13

What is the approximate daily insulin requirement for a T1DM child?

Answer 13

1 unit/kg/day

Question 14

Why might patients with DKA have abdominal distension/succussion splash/acute gastric dilatation?

Answer 14

Gastroparesis from metabolic acidosis

Question 15

What can cause SIADH?

Answer 15

Any CNS disorder e.g., stroke, haemorrhage, trauma, meningitis

Pulmonary disease e.g., pneumonia, asthma, bronchiolitis, pneumothorax

Tumour e.g., small cell carcinoma (lung)

Medications e.g., carbamazepine, chlorpropamine, SSRIs

Question 16

How is fluid balance in children with SIADH managed?

Answer 16

2/3 total daily requirement

Question 17

What is the definition of a base excess?

Answer 17

The amount of acid required to restore a litre of blood it its normal pH

Increases in alkalosis and decreases in acidosis

Question 18

What are the macrovascular complications of diabetes?

Answer 18

1. Peripheral vascular disease (atherosclerosis)
2. Ischaemic heart disease
3. Stroke

Question 19

Which GLUT receptor is present in the brain?

Answer 19

GLUT 1

Question 20

Which GLUT receptor is present in the pancreas and liver?

Answer 20

GLUT 2

Question 21

Which antibodies are most strongly associated with Graves’ disease?

Answer 21

TSH receptor antibodies (TRAb)

Have a stimulating effect

Question 22

Which antibodies are most strongly associated with Hashimoto’s thyroiditis?

Answer 22

Thyroid peroxidase antibodies (TPOAb)

Thyroglobulin antibodies (TgAb)

• → Hashimoto’s → release of thyroglobulin → antibody formation*
• Not implicated in disease process per se*

Question 23

What are the causes of short stature?

Answer 23

A - alone (neglect)

B - bone dysplasia (rickets, scoliosis, mucopolysaccharidoses)

C - chromosomal (Down, Turner)

D - delayed growth (constitutional)

E - endocrine (low GH, Cushing, hypothyroid)

F - familial

G - GI malabsorption (coeliac, Crohn’s)

Question 24

Why is corrected sodium used in DKA management?

Answer 24

There is a dilutional effect of hyperglycaemia and hyperlipidaemia

Question 25

How is corrected sodium calculated in DKA?

Answer 25

Sodium + glucose/3

Question 26

What fluid bolus is given in DKA?

Answer 26

If red zone (shocked) - 20mL/kg

If yellow zone - 10mL/kg

Question 27

If potassium replacement is indicated in DKA therapy, what dose is given?

Answer 27

40 mmol/L in 0.9% NaCl

Question 28

During DKA treatment, how do the fluids change once BGL is 14 mmol/L or less?

Answer 28

Change to 0.45% NaCl + 5% glucose

Question 29

How do you dose insulin therapy in DKA?

Answer 29

Add 1 unit/kg body weight into 50mL of 0.9% NaCl

Run at 5mL/kg

Equates to 0.1 unit/kg/hour