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Year 4 Paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Define Puberty

A

Well defined sequence of physical and physiological changes during adolescent years that results in attainment of full physical and sexual maturity
Initiated by nocturnal pulsatile release of GnRH

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2
Q

Describe the order of events of Puberty in boys

A

Testicular Growth
Pubic Hair
Growth Spurt
Penis Growth
Deepening of Voice
Increased Sweat
Facial Hair

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3
Q

Describe the order of events of Puberty in girls

A

Breast Buds
Pubic Hair
Growth Spurt
Period
Mature Pubic Hair
Mature Breasts

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4
Q

Describe the Male Tanner Scale for genitalia

A

I - Prepubertal
II - Enlarged testes and scrotum
III - Lengthening of Penis
IV - Increase in length and breadth
V - Adult Size

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5
Q

Describe the Male Tanner scale for Pubic Hair

A

I - Vellus
II - Sparse and long at base of penis
III - Darker and Curlier
IV - Adult hair over smaller area
V - Spread to medial thighs

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6
Q

Describe the Female Tanner scale for Breast Development

A

I - Elevation of papilla only
II - Breast bud stage (elevation of breast and papillae)
III -Further elevation
IV - Areola form second mound
V - Areola recedes and papilla projects

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7
Q

At what Tanner Stage does Menarche start in girls?

A

IV

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8
Q

How do you assess height in Under 2s?

A

Lying horizontally on measuring board

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9
Q

How do you assess height in over 2s?

A

Free standing with moderate upward neck traction

Sitting height vs leg length allows estimate of upper and lower portions

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10
Q

Other than measuring height, how else can height be assessed?

A

Target height range via parents
Bone Age (XRay left wrist)

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11
Q

How do you calculate target height range in children?

A

(Mums Height + Dads Height)/2

+ 6.5 if boy
-6.5 if girl

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12
Q

Define short stature in children

A

Height below and including second centile

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13
Q

Define tall stature in children

A

Height above and including 98th centile

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14
Q

Define Delayed Puberty

A

When puberty hasn’t started at 16y in boys and 14y in girls
Can be normal, and likely a positive family history
Can give sex steroids for 6-8 months to induce changes

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15
Q

Delayed Puberty can be Hypogonadotrophic or Hypergonadotrophic. Give three causes of Hypogonadotrophic

A

Hypopituitarism
CAH
Intracranial Tumours

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16
Q

Delayed Puberty can be Hypogonadotrophic or Hypergonadotrophic. Give three causes of Hypergonadotrophic

A

Turners
Klinefelters
Chemotherapy

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17
Q

Precocious Puberty is onset of puberty before the age of 8 in Girls and 9 in Boys. Give two central and two peripheral causes

A

Central - Intracranial Tumours, Hydrocephalus

Peripheral - Tumours, Exogenous Sex Steroids

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18
Q

Give four investigations for Precocious Puberty

A

Tanner Stage
Neuro Exam
Bone Age
Pelvic and Abdo USS

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19
Q

How is Precocious Puberty managed?

A

GnRH analogues (monthly IV or IM)

Only for central

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20
Q

Describe the clinical features of T1DM

A

25-50% present in DKA

Classic Triad - Polynesia, Polydipsia, Weight Loss

Atypical - Secondary Enuresis, Recurrent Infections

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21
Q

At diagnosis baseline bloods are required to rule out other causes of T1DM. What other diseases should be screened for?

A

Thyroid Disease (TFTs, TPO antibodies)
Coeliac (Anti TTG)

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22
Q

A diagnosis of T1DM requires patient and family education. What should they be told about glucose monitoring?

A

At waking
At each meal
Before bed

Via CBG

Ideally 2h after each meal as well

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23
Q

Describe the typical Insulin management in T1DM

A

Normally initiated on basal bolus (long acting in evening-Lantus, and short acting - Actrapid 30 mins before each meal)

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24
Q

Why should patients vary injection site in T1DM?

A

To prevent lipodystrophy

Subcutaneous fat hardens preventing further insulin absorption in that area

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25
Q

Who qualifies for an Insulin Pump and how does it work?

A

If over 12 and difficulty controlling HbA1c

Continuous infusion of insulin at different levels through cannula tunnelled under skin. Cannula replaced everything 2-3 days and injection site varied.

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26
Q

State the two types of Insulin Pump

A

Tethered - Attached to patients belt, control on pump

Patch - sits directly on skin without visible tubes, have to replace whole patch, controlled remotely

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27
Q

Give two advantages and two disadvantages of Insulin pumps

A

Better Control, More Flexibiity

Blockages, infection risk

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28
Q

Hypoglycaemia is a short term complication of T1DM. How would it present?

A

Hunger
Tremor
Sweating
Dizziness
Pallor

Commonly Nocturnal

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29
Q

How is Hypoglycaemia managed?

A

Rapid acting glucose (Lucozade) and long acting (Bread)
Severe - IV 10%Dextrose / IM Glucagon

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30
Q

Hyperglycaemia is another short term complication of T1DM. How would you manage using ‘Sick Day Rules’?

A

If CBG>14, then check serum ketones

No Ketones - have next meal as normal with insulin

Mild to Mod Ketones - Insulin Bolus of 10% TDD

Mod to Severe Ketones - Insulin Bolus of 20% TDD

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31
Q

State three broad categories of long term complications from T1DM

A

Macro vascular (CAD, Cerebrovasc Disease)
Micro vascular (Retinopathy, Neuropathy, Renal)
Infection related

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32
Q

What is Flash Glucose Monitoring?

A

Sensor measuring level of interstitial fluid in subcutaneous tissue
Requires a reader to swipe over sensor

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33
Q

Define DKA

A

Metabolic emergency characterised by Acidosis (pH<7.3 or Bicarbonate <15), Ketonaemia (>3 or ++) and BGC >11

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34
Q

How would a child in DKA present?

A

Preceding symptoms of triad for around 15 days

Lethargic, Nausea, Abdominal Pain, Vomiting

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35
Q

Describe the pathophysiology of DKA

A

Glucose cannot be used due to insulin deficiency
Causes rise on counter regulatory hormones (eg Cortisol) which worsens BGC

Hyperglycaemia causes Osmotic Diuresis and dehydration

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36
Q

State two characteristic features which may be seen on examination of a child in DKA

A

Kussmaul Breathing
Pear Drop Breath

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37
Q

What investigations would you want to do on a child in DKA?

A

Bedside Glucose
Blood Gas
Blood Glucose and Ketones
12 lead ECG

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38
Q

Describe the severity scoring in DKA

A

Mild - pH 7.2 to 7.29 (5% dehydration)
Mod - pH 7.1 to 7.19 (5% dehydration)
Severe - pH<7.1 (10% dehydration)

39
Q

How should you treat children in DKA shock?

A

Initially 10ml/kg 0.9% Saline over 15 mins

Can repeat once before considering inotropes

40
Q

How should you initially manage fluids of a child in DKA (no shock)?

A

Initially 10ml/kg over 30 mins

41
Q

How do you calculate fluid deficit?

A

% x Weight x 10ml

42
Q

Describe the use of insulin in DKA

A

If alert and well - Subcut Insulin

IV Insulin - delayed after at least an hour of fluids to reduce risk of cerebral oedema (0.05-0.1units/kg/h of Actrapid)

When pH normal/Ketones<1 start subcut insulin again and stop IV one hour later

See UHL guideline document - also has examples of fluid calculations

43
Q

Give three complications of DKA in children

A

Cerebral Oedema (leading cause of death)
Hypokalaemia
Aspiration Pneumonia

44
Q

Describe the criteria for overweight and obese in terms of Paediatric BMI

A

Overweight >91st Centile BMI

Obese >98th Centile BMI

45
Q

State two endocrine causes of Obesity in childhood

A

Hypothyroidism
Cushing

46
Q

State two genetic causes of Obesity in childhood

A

Prader Willi Syndrome
Bardet Biedl Syndrome

47
Q

What would you want to know in a Paediatric Obesity history?

A

Birth weight
Feeding behaviours
Growth Pattern
Physical activity
Neurodevelopment
FH

48
Q

What bloods might be done in childhood obesity?

A

TFTs
Cortisol
Lipid Profile
OGTT

49
Q

How is childhood obesity managed?

A

Normally a while family approach to nutrition/lifestyle/exercise

50
Q

What is Hypothyroidism?

A

Reduced thyroid hormones which are essential for development and functioning of brain and body
If undiagnosed can cause issues with intellect and neurodevelopment

51
Q

What is Congenital Hypothyroidism?

A

Occurs in 1/3000 new borns

Can be due to dysgenesis (underdeveloped gland) or dyshormonogenesis

Screened on Guthrie

52
Q

What can happen if Congenital Hypothyroidism is missed?

A

Prolonged neonatal jaundice
Poor feeding
Increased sleeping
Slow growth and development

53
Q

The most common cause of acquired hypothyroidism is Hashimotos. How does this present?

A

Fatigue
Low Energy
Poor Growth
Poor School Performance
Constipation

54
Q

Give three causes of Hyperthyroidism

A

Graves
Neonatal/Transient
McCune Albright Syndrome

55
Q

Give two causes of Hyperthyroidism that are not due to excess hormone from the gland itself

A

Thyroiditis (may be drug induced)
Exogenous Thyroid Hormone

56
Q

What is Graves?

A

Autoimmune disease with antibody against TSH receptor

57
Q

What is Neonatal Hyperthyroidism?

A

Passive transfer of maternal thyroid antibodies from thyrotoxic mothers

58
Q

How does Neonatal Hyperthyroidism present?

A

Irritable
Flushed
Tachycardia
Poor weight gain

59
Q

How is Neonatal Hyperthyroidism managed?

A

Supportive therapy with beta blockers

60
Q

What extra features are seen in Graves compared to other causes of Hyperthyroidism?

A

Diffuse Goitre

Opthalmology (Proptosis, Lid Lag, Opthalmoplegia)

Pretibial Myxoedema

61
Q

How would you investigate hyperthyroidism?

A

TFTs
Thyroid Antibody Screen
Radionucleotide scan
ECG

62
Q

Describe two different types of regimens in Hyperthyroidism treatment

A

Dose Titration

Block and Replace (at lowest dose necessary to stop thyroid and then replace with levothyroxine)

Normally requires 12-24 months of treatment before weaning

63
Q

What is the most common cause of Cushings Syndrome in children?

A

Long Term Steroids (eg for Asthma or Nephrotic Syndrome)

Other causes such as Pituitary Adenoma and Adrenocortical tumours are rare

64
Q

Name five clinical features of Cushing’s Syndrome

A

Growth Failure
Facial and Truncal Obesity
Hirsutism
Striae
HTN

65
Q

State four investigations for Cushing’s Syndrome

A

Serum Cortisol (Loss of Diurnal Variation)

Increased 24h free cortisol

Plasma ACTH

Dexamethasone Suppression

66
Q

Cushing’s Disease is managed by treating the underlying cause. What medication can you give if the underlying cause was a tumour?

A

Metyrapone

67
Q

Define Congenital Adrenal Hyperplasia

A

Congenital deficiency in 21 Hydroxylase enzyme, causing under production of cortisol and aldosterone, and over production of androgens from birth

68
Q

Describe the pathophysiology of CAH

A

The enzyme converts progesterone into aldosterone and cortisol
Excess progesterone will get converted to testosterone instead

69
Q

Describe the features of mild CAH in a female

A

Tall for age
Facial hair
Absent periods
Deep voice
Early puberty

70
Q

Describe the features of mild CAH in a male

A

Tall
Deep voice
Large Penis with Small Testes
Early puberty

71
Q

How does severe CAH present in females?

A

Ambiguous genitalia and enlarged Clitoris

72
Q

How is CAH managed?

A

Cortisol replacement (Hydrocortisone)
Aldosterone replacement (Fludrocortisone)
Corrective surgery for females of virilised

73
Q

When do you investigate small height in children?

A

Height<0.4th Centile
1 SD below mid parental height

74
Q

What are the respective fluid deficits for mild, moderate and severe DKA?

A

5%
7%
10%

75
Q

How will you calculate child’s total fluid rate in DKA?

A

1) Calculate deficit (weight * dehydration*10)
2) Subtract initial bolus and divide by 48
3) Work out maintenance per day and divide by 24 to find hourly
4) Add 2 and 3 together

76
Q

How does Gonadotrophin dependent precocious puberty present in boys?

A

High FSH and LH

Large Testes

77
Q

How does Gonadotrophin independent precocious puberty present in boys?

A

Low FSH and LH

Small/Normal Testes

78
Q

Give three normal variants of Paediatric Short Stature

A

Familial
Constitutionally Small
IUGR and catch up growth

79
Q

Give four non endocrinology causes of Short Stature

A

Malnutrition
Medication (Steroids, Methylphenidate)
CKD
Coeliac

80
Q

Give three endocrine causes of Short Stature

A

Cushing’s Disease
Hypothyroidism
GH shortage

81
Q

Give three genetic causes of Short Stature

A

Turner
Prader Willi
Achondroplasia

82
Q

Give two causes of Tall Stature in infancy

A

Maternal Diabetes
Beckwith Wiedemann

83
Q

Give three endocrine causes of Tall Stature

A

GH excess
Hyperthyroidism
Androgen Insensitivity

84
Q

Give three non endocrine causes of Tall Stature

A

Obesity
Klinefelters
Marfans

85
Q

What Testicular Volume implies Puberty

A

> 4ml

86
Q

Name two changes in puberty that may seem pathological but are in fact physiological

A

Thyroid Gland Enlargement

Gynaecomastia

87
Q

What blood glucose levels are required to diagnose Diabetes?

A

Fasted >= 7

2 hours Post Prandial/OGTT >=11.1

HbA1c >= 48mmol or 6.5%

88
Q

If a patient has been admitted and diagnosed with T1DM, what are the requirements for discharge?

A
  • Check insulin administration
  • Check BGC monitoring
  • Advise on dietary choices
  • Advise on symptoms and management of Hypoglycaemia
  • Advise on sick day rules
89
Q

When could you prescribe Orlistat for a child?

A

If they were over 12 and had SEVERE physical or psychiatric comorbidities

90
Q

Describe 5 aspects of motivational interviewing an overweight child/parent

A
  • Assess their view of the weight and reasons behind it
  • Explore eating patterns and physical activity
  • Explore any unhelpful beliefs
  • Explore what they’ve tried/How it went/What they learnt
  • Assess readiness and confidence to change
91
Q

How can Delayed Puberty be investigated?

A
  • Variety of bloods (inc Gonadotrophins, Prolactin, TFTs)
  • Karyotyping
  • GnRH stimulation
  • Pelvis USS
  • Bone scan
92
Q

When do you minus rescucitation boluses used from replacement volume?

A

Only if child NOT in shock

Replacement = 10 x %dehyd + weight (-10ml/kg if not shocked)

Total daily req = maintenance + replacement/24

93
Q

How should paediatric fluids be replaced in DKA

A

Over 24-48h as per local guidance

Divide replacement by either 24/48 and add to maintenance

If over 48h will require 2*maintenance

Year 4 Paediatrics (15 decks)

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