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Pediatrics > Exam 2 - Growth & Endocrine > Flashcards

Exam 2 - Growth & Endocrine Flashcards

1
Q

Normal growth in childhood is _______

A

5-6.5cm/year

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2
Q

Adult height is _______

A

Genetically pre-determined.

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3
Q

Breasts (thelarche) -> pubic hair (pubarche usually w/in 1 year of thelarche) -> menarche (begins at stage 4 breast but usually when Mom started hers)

A
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4
Q

Genetic conditions with growth alterations have specific growth charts.

A
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5
Q

How to calculate a target or mid-parental height.

A

Boys: (mom’s height + dad’s height + 13)/2 cm
Girls: (mom’s height + dad’s height -13)/2 cm

If the childs’ growth pattern curve at 20 is within 5cm of mid-parental height = appropriate for family.

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6
Q

Evaluate for abnormal growth patient who are below _____ and above______

A

3rd and 97th percentile.

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7
Q

Bone age is abnormal if: _____

A

Advanced or delayed by more than 2 SDs

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8
Q

Basic screening lab test to evaluate abnormal growth in children.

A

CBC w diff (anemia, infection)
BMP (renal disease, electrolyte abnormalities, DI)
LFT (metabolic or infectious disorders with liver dysfxn)
UA and urine pH (renal tubular acidosis)
ESR (chronic inflammation)

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9
Q

Normal reasons for short stature

A

Familial
Constitutional growth delay

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10
Q

Pathologic reasons for short stature

A

Nutritional
Endocrine
Chromosomal
IUGR
Skeletal dysplasia
Chronic illness
Psychosocial

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11
Q

How do you investigate bone age?

A

AP view of LEFT wrist/hand and look at how fused the growth plates are. This calculates the amount of remaining growth the patient has.

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12
Q

If bone age is < chronological age, then they have ________ time to grow. Ex?

A

MORE.
Girl age 9 with bone age 8. She might be short now but she has more time to grow.

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13
Q

Delayed bone age with _____ or _______

A

GH deficiency
Hypothyroidism,
Chronic illness, malnutrition.

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14
Q

Bone age can be advanced with ______

A

Prolonged elevation of sex steroid levels
Percocious puberty
Congenital adrenal hyperplasia
GNRH agonists
Exogenous sex steroids
Significant: sotos syndrome, beckwith-wiedemann syndrome, Marshall-smith syndrome

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15
Q

Genetic (familial) short stature

A

Falls off growth chart around 8-19 months then resumes normal velocity
Normal PE
Growth rate >4cm/yr
Bone age is equal to chronological age.
No pubertal delay
No deceleration of weight

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16
Q

Constitutional delay: bone age is ______ and _______ to height age.

A

Delayed
Approximately equal

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17
Q

Genetic syndromes that can lead to tall stature

A

Kleinfelter
Marfan
Beckwith-wiedemann
Sotos
Weaver

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18
Q

What is length vs stature/height?

A

Length - laying down (<2yo)
Stature/height - standing up (>2yo)

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19
Q

Girls pubertal delay?
Boys?

A

Girls no breast development by 13 years OR no menarche by 3 years after breast development OR no menarche by 16
Boys no testicular enlargement by 14.

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20
Q

Is disconcordant pubertal delay most likely pathologic?

A

Yes. Some things are growing the way they’re supposed to and others are not.

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21
Q

Learn tanner stages

A
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22
Q

TQ What is the correct sequence of events in puberty in boys

A

Growth of testicles
Pubic hair appears
Growth of penis scrotum
Axillary hair
First ejaculations
Growth spurt
Facial hair
Adult height.

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23
Q

TQ What is the correct sequence of events in puberty in girls

A

Breast bud appearance
Pubic hair
Growth spurt
Axillary hair
Pubic hair matures
Breasts mature
Menarche
Adult height

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24
Q

Review slide 49 causes of delayed puberty

A
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25
Q

In precocious puberty, bone age is _______

A

Advanced.

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26
Q

Weed and weight lifting supplements can cause Gynecomastia.

A
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27
Q

In GH deficiency, growth plates _____

A

Don’t close or take longer to close. Bone age will be younger so they have much more growth potential

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28
Q

Hypothyroid and bone age - they have more time.

A
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29
Q

Hyperthyroidism - bone age - they grow tall and skinny but their plates close sooner so they stop growing faster.

A
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30
Q

Hypothyroidism is diagnosed with ______ TSH and ______ T4

A

Increased
Low

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31
Q

Look in Harriet lane for synthroid dosing in pediatrics!

A
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32
Q

Most common manifestation in peds hypothyroid is ::

A

Growth failure.

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33
Q

Most common phenotypic characteristic associated with Turner’s syndrome?

A

Short stature.

34
Q

PTH, VitD, calcium and Mg all go together….

A
35
Q

80% of kids with hypercalcemia have ____ or ____

A

Hyperparathyroidism or malignant tumor.

36
Q

Review endo slides 106-121

A
37
Q

Steroid taper not usually needed for courses less than ______. If longer than that, then taper by ______% every _____

A

10-14 days
25-50%
2-7days

38
Q

PKU - no aspartame!

A
39
Q

Endocrine disorders typically manifest in 1 of 4 ways?

A

Excess hormone
Deficient hormone
Abnormal response from end organ
Gland enlargement

40
Q

______ is most closely associated with postnatal growth in addition to GH

A

Insulin-like growth factor 1 (IGF-1).

41
Q

What is the most important factor affecting growth on a world-wide basis?

A

Nutrition

42
Q

Pubarche results from. _________ and results in ________

A

Adrenal maturation
Pubic hair, oiliness of hair, axillary hair, acne, body odor, gonadal sex steroid.

43
Q

Laurence-Moon-Bardet-Biedl, Prader-Willi and Kallmann syndromes can result in

A

Hypopituitarism and hypogonadotropic Hypogonadism

44
Q

What is an organic/environmental cause of gonadotropin fxn?

A

Intentional caloric restriction or malnutrition resulting in body weight less than 80% ideal weight.

45
Q

Turner syndrome = ________ failure
Kleinfelter syndrome = ________ failure

A

Ovarian
Testicular

46
Q

Most common cause of GnRH-independent precocious puberty (more common in _____) is ________
Some associated features?

A

Females
McCabe-Albright syndrome.
Precocious gonadarche, bone disorder with polyostotic fibrous dysplasia and cafe-au-lait spots

47
Q

Short stature not associated with weight gain could be attributed to ———-

A

Hypothyroid

48
Q

Congenital adrenal mineralocorticoid deficiency manifests as _______ and _______

A

Hyponatremia and hyperkalemia by 5-7 DOL

49
Q

Diagnostic criteria for T1DM

A
  • S/s of diabetes AND a random plasma glucose >200mg/dl
  • OR fasting plasma glucose >= 126mg/dl
  • OR 2-hr plasma glucose greater than or = to 200mg/dl during an OGTT
  • OR hemA1c >= 6.5
    In the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing on a different day.
50
Q

Wt loss in DM T1 is attributed to:

A

Fluid loss from osmotic diuresis
Glucose unable to be stored in cells so start burning fat and muscle.

51
Q

T1DM prevalence 1:300
Peak age at dx: 4-6; 10-14

A
52
Q

AGBI - Autoimmune in T1DM destroys. Which cells?

A

Alpha cells glucagon, Beta cells insulin
Beta cells.

53
Q

Tzield - what is this?

A

A medication that could potentially pause the autoimmune destruction of pancreatic beta cells.

54
Q

Check siblings of patients with T1DM for pancreatic antibodies - potential to give Tzield?

A
55
Q

What are some environmental triggers that can provide the “second hit” for development of T1DM?

A

Viruses: rubella, COVID, others.
Early exposure to cow’s milk and vit D deficiency.

56
Q

What is the diagnostic criteria for DKA?

A

BG >200 (D)
+ Ketonemia/ketonuria (K)
PH <7.3 (A)

Bicarb <20 or anion gap >12 are used for severity rating

57
Q

T/F: all patients with DKA come in with some cerebral edema

A

True. Treatment is so important because it can exacerbate and worsen, but they come in with cerebral edema already there.

58
Q

Lipolysis and proteolysis - how do these contribute to patho of DKA?

A

Lipolysis - ketone bodies
Proteolysis - converts amino acids into sugars which worsens hyperglycemias.

59
Q

3 pronged approach to successfully navigating DKA?

A

Fluids
Insulin
Electrolytes

60
Q

What is the fluid resuscitation considerations for DKA?

A

Large fluid shifts can be a concerning risk factor for cerebral edema BUT
Treat shock - 20cc/kg bolus over first 1-2 hours is still okay! You can do 10cc, however 20-30 is standard.

61
Q

Start insulin drip at:

A

0.05 - 0.1 u/kg/hr

62
Q

What is a goal for dropping blood glucose?

A

Drop by 50-100mg/dl/hr
Target range of 200-300 while correcting acidosis

63
Q

T/F: in DKA, once blood sugar reaches goal, you can stop the insulin.

A

FALSE: continue the dextrose and IV insulin until ACIDOSIS is corrected, then wean off insulin drip.

64
Q

Electrolytes - which ones are usually deficient in DKA and need to be replaced?

A

Na, K. Usually just add to IVF, don’t’ usually need bolusing.

65
Q

How to recognize cerebral edema

A

Sudden, persistent drop in HR, change in LOC, HA, emesis, incontinence, unexplained tachypnea

66
Q

Insulin total daily requirement is 0.5-1u/kg/day up to 1.5u/kg/day during ______

A

Puberty - raises requirements.

67
Q

Partial coverage can be an issue in teenage years - they know that if they don’t cover their carbs all the way, then they’ll pee it out and they won’t gain the weight. It’s an eating disorder.

A
68
Q

What is an ESSENTIAL accompanying referral for new T1DM dx

A

MENTAL HEALTH!

69
Q

Basal rate is _______% of TDD which is _____
T/F: the bolus amount makes up the other 50%

A

50%
0.5-1u/kg/day
FALSE! The bolus is related to meal/snack/carb consumption

70
Q

I:C ratio
450/TDD
What is this?

A

Amount of carbs 1 unit of insulin will cover.
Ex: 30kg kid has a 30u/day TDD
450/30 = 15. 1u of insulin will cover 15 carbs.

71
Q

Correction factor rule
1800/TDD - the amount of mg/dl we estimate 1 unit of insulin will lower blood glucose.

A

1800/30 = 60mg/dl 1 unit will lower BG
If BG is 220, then 1u will lower to 160.

72
Q

Target blood glucose for bolus calculations?

A

150mg/dl

73
Q

When can hypoglycemia occur after exercise?

A

During, immediately after or 8-24hrs later. BS usually decreases during exercise but MAY initially increase.

74
Q

Do not exercise if _______ are present.

A

Ketones.

75
Q

Usually need ____ g carbs for every _____ mins of vigorous exercise.

A

15
30

76
Q

Hypoglycemia is _____ in kids
Rule of 15s. Give 15g carbs and recheck in 15 mins.

A

<70mg/dl

77
Q

Test blood sugar every _______ on sick days and check ______

A

2-4hrs
Urine ketones.

78
Q

What is the “honeymoon” T1DM?

A

May last for weeks - 1 year or longer.
Once glucotoxicity is resolved, the pancreas starts functioning (partially) again. They may need less insulin, maybe even off of bolus insulin all together! BUT it is NOT a cure. It is just temporary. Once beta cells are fully destroyed, their insulin requirement will increase again.

79
Q

T1DM associated autoimmune disease?

A

HyPOthyroid is most common but hyper is common too

80
Q

HgA1c goal for children?

A

<7%

Pediatrics (11 decks)

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