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Peds II > Exam 3 - Endocrine > Flashcards

Exam 3 - Endocrine Flashcards

1
Q

When do the two peaks of Type 1 DM occur in childhood?

A

Ages 4-6 and 10-14

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2
Q

What population is at the highest risk of Type 1 DM?

A

Non-hispanic white population

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3
Q

What genes show an increased risk of developing Type 1 DM in whites?

A

HLA-DR3, HLA-DR4

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4
Q

What is the classic and most common presentation associated with Type 1 DM?

A

The 3 “P”s:

  • Polyuria
  • Polydipsia
  • Polyphagia

+ weight loss/fatigue

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5
Q

What are the three presentations in which Type 1 DM can present?

A
  1. “Classic”
  2. DKA
  3. Silent (incidental) Discovery
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6
Q

What is the diagnostic criteria for Type 1 DM?

A

One of the following 4 signs of abnormal glucose metabolism:

  1. Fasting plasma glucose of 126 or higher
  2. Random plasma glucose of 200 or higher
  3. Plasma glucose > 200 two hours after oral glucose tolerance test
  4. Hemoglobin A1C > 6.5%
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7
Q

What will be found in Type 1 DM that will be not found in Type 2 DM?

A

Pancreatic Auto-Antibodies

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8
Q

What is important to note regarding the ideal fasting blood glucose in the different age ranges related to Type 1 DM?

A

As age increases, the ideal fasting blood glucose can be lowered due to the decreased risk of hypoglycemia

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9
Q

What are the different types of insulin?

A
  • Rapid acting (lispro, aspart, glulisine)
  • Short-acting (regular insulin)
  • Intermediate-acting (NPH insulin)
  • Long-acting (glargine, detemir)
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10
Q

When is short-acting insulin administered?

A

Administered as a pre-meal bolus 5-30 minutes before meal

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11
Q

When is intermediate-acting insulin administered?

A

Administered in a targeted manner in combo with long-acting insulins

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12
Q

When is long-acting insulin administered?

A

1-2 times per day

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13
Q

Which type of insulin administration method is most prone to hypoglycemia?

A

Syringe

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14
Q

What BMI percentiles defines overweight and obese?

A

Overweight: 85th-95th percentile

Obese: 95th percentile or greater

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15
Q

In what populations is childhood obesity the highest?

A
  • American Indian
  • African American
  • Mexican American
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16
Q

What is the exercise recommendation for pediatrics?

What is the recommendation regarding screen time?

A

Recommended 30-60 minutes of physical activity per day

Restrict non-academic screen time to 2 hours per day

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17
Q

What is the most common presentation of Type 2 DM in pediatrics?

A

Asymptomatic

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18
Q

While Type 2 pediatric patients are typically asymptomatic upon presentation, what are some signs/symptoms that could occur?

A
  • Fatigue
  • Irritability
  • Overweight/obese
  • Acanthosis nigricans
  • Polydipsia
  • Polyuria
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19
Q

When should we screen for Type 2 DM in children?

A

Children who are 10 years or older if they are overweight/obese AND have 2 or more of the following:

  • Type 2 DM in first/second-degree relative
  • High-risk ethnic group
  • Signs of insulin resistance or conditions associated with insulin resistance
  • Maternal history of DM or gestational DM when child was in utero

Repeat screening every 3 years

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20
Q

How is Type 2 DM diagnosed?

A
  1. Fasting plasma glucose of 126 or higher
  2. Random plasma glucose of 200 or higher
  3. Plasma glucose > 200 two hours after oral glucose tolerance test
  4. Hemoglobin A1C > 6.5%
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21
Q

Which two DM tests are most commonly used to diagnose Type 1 DM?

A
  1. Fasting plasma glucose of 126 or higher

2. Random plasma glucose of 200 or higher

22
Q

What is the first line medication treatment for Type 2 DM?

23
Q

When is insulin therapy recommended in Type 2 DM?

A

When random glucose is 250 or higher or hemoglobin A1C is > 9%

24
Q

How often should A1C be measured in Type 2 DM?

A

Every 3 months

25
What is the first line treatment for HTN in Type 2 DM patients that are 13 years or older?
ACE-I or ARBs
26
What is the second line treatment for HTN in Type 2 DM patients that are 13 years or older?
Thiazide diuretics, CCB, beta blockers ***Note: beta blockers can mask symptoms of hypoglycemia, so not preferred therapy
27
What are the goals for lipid levels in adolescents with diabetes (LDL, HDL, triglycerides)?
- LDL < 100 - HDL > 35 - Triglycerides < 150
28
What are the recommendations for treatment of hyperlipidemia in adolescents with diabetes?
- 6 months of nonpharmacologic therapy first - Drug therapy with HMG-CoA reductase inhibitors if LDL > 130, older than 10 years of age and obesity/other CV risk factors
29
What is the definition of short stature?
Child whose height is 2 standard deviations or more below the mean for children of that sex and chronological age (height is < 2.3 percentile)
30
Describe Familial Short Stature?
Bone age is normal, but child is short. Check mean parental height. One or both parents are short.
31
What is the most common cause of short stature?
Constitutional delay of growth; "Late-Bloomers" Bone age and puberty are delayed, but adult height will be normal.
32
What is the most common cause of pathologic short stature?
GH Deficiency
33
What should you rule out when assessing for pathologic short stature?
Rule out hypothyroidism, Turner Syndrome, and skeletal disorders
34
What will be seen on diagnostic tests in pathologic short stature due to GH deficiency?
- Low IGF-1 - Low IGFBP-3 - Delayed bone age (left hand/wrist xray)
35
What is the first line treatment for GH deficiency?
Recombinant Human Growth Hormone Therapy (rhGH) ***must treat prior to closure of epiphyseal plate
36
What is the general treatment for GH deficiency?
- rhGH - Monitor IGF-1 levels - Monitor bone age annually
37
What are some possible side effects of rhGH?
- Pseudotumor cerebri - Hyperglycemia/insulin resistance - Gynecomastia - Increase conversion of T4 to T3 without hypothyroidism
38
What are some syndromes that cause pathological short stature?
- Turner Syndrome - Noonan Syndrome - Prader-Willi Syndrome - Achondroplasia
39
What gene is mutated in Achondroplasia?
FGFR3 gene
40
What are some diagnostic studies that can be used to evaluate for Gigantism?
- Serum IGF-1 will be elevated - GH fails to fall below 1 ng/mL in GH Suppression Test - MRI to evaluate pituitary and hypothalamus
41
What is the treatment for Gigantism?
- Surgery - Radiation - Medical management with octreotide - Bromocriptine
42
Define precocious puberty.
Onset of secondary sexual characteristics before age 8 in girls and before age 9 in boys.
43
Which type of precocious puberty has elevated GnRH and gonadotropins?
Central precocious puberty: Gonadotropin-dependent
44
Which type of precocious puberty has elevated gondal steroids and low gonadotropins?
Peripheral precocious puberty: Gonadotropin-independent
45
What are causes of Central precocious puberty: Gonadotropin-dependent?
- Idiopathic | - CNS tumors or abnormalities
46
What is the treatment for Central precocious puberty: Gonadotropin-dependent?
GnRH agonists
47
What is over 95% of congenital adrenal hyperplasia caused by?
21-hydroxylase deficiency
48
What is 21-hydroxylase activity not involved in the synthesis of?
Androgens
49
What syndrome is associated with short stature, aortic coarctation, and streaked gonads?
Turner's Syndrome
50
What syndrome is autosomal dominant, causes short stature, is associated with CHD/pulmonic stenosis, and has pectus sternal deformities?
Noonan Syndrome
51
What syndrome causes short stature due to a chromosome 15 defect and is the most common syndromic form of obesity?
Prader-Willi Syndrome
52
What syndrome is autosomal dominant, causes short stature, and is associated with disproportionate rhizomelic shortening of long bones, macrocephaly, and bradydactylyl?
Achondroplasia

Peds II (11 decks)

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