Exam 2 Clin

Question 1

Diagnosis?

Polyuria
Thirst
Altered mental state
Profound hyperglycemia
T2DM hx

Answer 1

NKHS

*contrast with DKA: which has smaller fluid deficit, and N/V, kussmaul

Question 2

State the normal growth velocity for school age children

Answer 2

5cm/year (2 inches/year)

Question 3

Identify the growth parameter most commonly first affected in children with endocrine growth disorders.

Answer 3

Length or height

Question 4

Define what is meant by “delayed bone age.”

Answer 4

A bone age that is 2 standard deviations or more below the chronologic age of the patient is considered delayed.

Question 5

Identify abnormal or concerning growth patterns as plotted on a growth chart:

Height

Answer 5

Endocrine disorder (ie GH deficiency)

Question 6

Identify abnormal or concerning growth patterns as plotted on a growth chart:

Weight

Answer 6

Caloric/nutrition related (low = underfed)

Question 7

Identify abnormal or concerning growth patterns as plotted on a growth chart:

Head circumference

Answer 7

Brain/ skull/ hydrocephalus (expansion think hydrocephalus)

Question 8

Benign causes of short stature: Familial

Answer 8

Bone age is consistent with chronological age,

just have tiny parents

Question 9

Benign causes of short stature: Constitutional

Answer 9

delayed bone age***

Question 10

Benign causes of short stature: idiopathic

Answer 10

Bone age is consistent with chronological age,

no fam hx or disorders found

Question 11

Decreased levels of IGF-1 and IGFBP-3 levels are consistent with

Answer 11

growth hormone deficiency

Question 12

Describe the basic work-up for suspected precocious puberty.

Answer 12

H&P
Labs: LH, FSH, Estrodiol and/or Testosterone
Imaging: Bone age (will be advanced in prec puberty)

Question 13

Describe the difference between short-term and long-term stress response in terms of the HPA axis and the adrenal cortex

Answer 13

Short term = catecholamine release from adrenal medulla

Long term = CRH stimulation in pit, leading to mineralcorticoid and glucocorticoid release

Question 14

Recognize the mainstays of treatment in an infant in crisis due to congenital adrenal hyperplasia.

Answer 14

Hydrocortisone (IV or IM)

same tx for acute adrenal crisis

Question 15

Recognize the mainstays of treatment in an infant in crisis due to congenital adrenal hyperplasia.

Answer 15

Hydrocortisone (IV or IM)…this is essential and lifesaving

Question 16

Discuss the laboratory findings seen in patients with primary adrenal insufficiency

Answer 16

Low 8 AM plasma cortisol accompanied by simultaneous significant elevation of plasma ACTH

Question 17

Elevated midnight cortisol levels are indicative of

Answer 17

Cushing syndrome

Question 18

Diagnosis?

1. low renin hypertension
2. hypokalemia
3. metabolic alkalosis

Answer 18

Primary hyperaldosteronism

Conn syndrome is used interchangeably with primary hyperaldosteronism