Endocrinology (Alice) (3%)

Question 1

mc endocrine dz in peds

Answer 1

T1DM

Question 2

rf for T1DM

Answer 2

fam hx/histocompatability antigens:
DR3
DR4

Question 3

what type of breathing is associated w. DKA

Answer 3

kussmaul respirations

Question 4

dx criteria for DM (4)

Answer 4

-random BG > 200 mg/dL PLUS symptoms
-2 separate 8 hr fasting BG > 126
-2 hr OGTT > 200
-A1C >/= 6.5

Question 5

how does C peptide relate to T1 vs T2 diabetes

Answer 5

T1DM: low vs inappropriately low during fasting
T2DM: high

Question 6

what abs are associated w. T1DM

Answer 6

insulin abs
GAD65
IA-2

if >/= 1 is present, consider T1DM

Question 7

what type of infxn might make you concerned for DM in a kid

Answer 7

prolonged candidal infxn

Question 8

A1C goal for pediatric DM

Answer 8

< 7.5

Question 9

t/f: hypercalcemia is more concerning in kids than adults

Answer 9

t!

Question 10

hypercalcemia is often discovered when a kid is worked up for

Answer 10

FTT

Question 11

4 signs of end organ damage with hyperparathyroidism

Answer 11

nephrocalcinosis
nephrolithiasis
acute pancreatitis
bone pathology

Question 12

t/f: most kids with hyperparthyroidism present w. end organ damage

Answer 12

t!

most are symptomatic at presentation

Question 13

ddx for hypercalcemia in peds (10)

Answer 13

family hypocalciuric hyperCa
NSHPT (neonatal severe primary hyperparathyroidism )
subcutaneous fat necrosis
williams syndrome
primary hyperparathyroidism
humoral malignancy
osteolytic malignancy
granulomatous dz
vit D toxicity
immobilization

Question 14

pharm for pediatric hypercalcemia

Answer 14

increase urinary excretion:
calcitonin
bisphosphonates
zoledronic acid

Question 15

_ is recommended for all peds w. primary hyperparathyroidism

Answer 15

parathyroidectomy

Question 16

mcc of hyperthyroidism in peds

Answer 16

graves dz

others:
thyroid nodule
acute supporative thyroiditis

Question 17

adult sx of hyperthyroidism that is uncommon in peds

Answer 17

exophthalmos

Question 18

3 sx of hyperthyroidism in peds that Smarty PANCE stresses

Answer 18

palpitations
change in behavior
change in school performance

Question 19

what is neonatal graves dz

Answer 19

infant born to mom w. graves dz -> passage of TSH receptor abs cross placenta

Question 20

t/f: neonates will graves dz often have a goiter

Answer 20

t!

Question 21

tx for hyperthyroidism in peds

Answer 21

same as adults:
PTU
methimazole
radioiodine

Question 22

med preferred in pediatric hyperthyroidism

Answer 22

methimazole

fewer s.e

Question 23

t/f: half of kids w. graves dz have spontaneous remission w.in 12-24 mo

Answer 23

t!

Question 24

management of kid who had hyperthyroidism but then went into remission

Answer 24

lifelong TSH monitoring

Question 25

tx for neonatal graves

Answer 25

propranolol +/- methimazole *most self resolve w.in 2-3 mos*

Question 26

3 mo old infant - presents w. intermittent choking, constipation, lethargy, hoarse cry - on PE she is floppy and 25th %ile for weight w. protuberant abdomen, dry skin, brittle hair, and a low hairline

Answer 26

hypothyroidism

Question 27

causes of hypothyroidism in peds (6)

Answer 27

**hashimoto's -> mc** panhypopituitarism ectopic thyroid dysgenesis antithyroid meds surgery for hyperthyroidism congenital hypothyroidism (cretinism)

Question 28

presentation of congenital hypothyroidism (cretinism) (5)

Answer 28

hypotonia lethargy macroglossia large fontanelles dry skin

Question 29

2 rf for congenital hypothyroidism

Answer 29

female fam hx

Question 30

PE findings of congenital hypothyroidism (5)

Answer 30

delayed puberty immature body proportions coarse, puffy facies think hair DTRs w. delayed rxn time

Question 31

tx for hypothyroidism in peds

Answer 31

levothyroxine

Question 32

weight classifications for peds

Answer 32

underweight: BMI < 5th %ile normal weight: BMI 5th - 85th %ile overweight: BMI >/= 85th %ile obese: BMI >/= 95th %ile severe obesity: BMI >/= 120th %ile OR >/= 35

Question 33

what lab value is most effecacious for eval of NAFLD in kids

Answer 33

ALT

Question 34

management of severely obese kids or overweight/obese kids w. comorbidities

Answer 34

referral

Question 35

sugar recs for kids

Answer 35

25g (6 tsp) sugar daily *gah! dumb rec...so much sugar :(*

Question 36

2 non pathologic causes of short stature

Answer 36

familial constitutional

Question 37

definition of familial short stature

Answer 37

-growth curves

Question 38

definition of constitutional delay

Answer 38

-kid develops parallel to growth curve -pubety delayed -> delay in bone age

Question 39

3 pathologic causes of short stature

Answer 39

-disproportionate short stature -proportionate short stature postnatal causes

Question 40

characteristics of disproportionate short stature (2)

Answer 40

short limbs average sized trunk

Question 41

2 causes of disproportionate short stature

Answer 41

rickets achondroplasia (dwarfism)

Question 42

characteristics of proportionate short stature (PSS)

Answer 42

small person normal proportions

Question 43

2 classifications of pss

Answer 43

prenatal postnatal

Question 44

5 prenatal causes of pss

Answer 44

intrauterine growth retardation placental dysfxn intrauterine infxns teratogens chromosomal abnl (trisomy 21, turner's)

Question 45

8 postnatal causes of pss

Answer 45

malnutrition chronic systemic dz psychosocial drugs hypothyroid GH deficiency glucocorticoid excess precocious puberty

Question 46

how do you determine bone age in peds

Answer 46

AP xray of left wrist *differentiates familial short stature from constitutional delay*

Question 47

advanced bone age in peds indicates

Answer 47

precocious puberty

Question 48

short stature + normal bone age

Answer 48

familial short stature

Question 49

short stature + delayed bone age

Answer 49

constitutional delay

Question 50

what labs would you order to rule out GH deficiency in kid w. short stature (2)

Answer 50

IGF-1 IGF-BP3