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7. Endocrinology (Medical Knowledge)a > Paediatric Endocrinology and Diabetes > Flashcards

Paediatric Endocrinology and Diabetes Flashcards

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USMLE® Step 1 flashcards
1
Q

What instrument is used to measure height?

A

Stadiometer

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2
Q

As well as standing height, what other kind of height should be measured in children?

A

Seated height

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3
Q

How is head circumference in children measured?

A

Tape round forehead and occipital prominence (maximal circumference)

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4
Q

What should be done after measuring a childs height?

A

Plot onto a graph accurately (centile chart)

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5
Q

As well as centile charts, what other growth charts are there?

A

Charts for predicting future height, and condition specific growth charts

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6
Q

What is target height and mid parental height (MPH)?

A

Potential height a child could reach

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7
Q

What is bone age?

A

Degree of maturation of a child’s bones

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8
Q

What is used to predict a childs adult height?

A

Childs height and bone age

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9
Q

What is the method called for staging puberty?

A

Tanner method:

B (breast development)

G (genital development)

PH (pubic hair)

AH (axillary hair)

T (testes volume)

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10
Q

What does B for Tanners method range from?

A

1 to 5 (breast development)

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11
Q

What does G for Tanners method range from?

A

1 to 5 (genital development)

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12
Q

What does PH for Tanners method range from?

A

1 to 5 (pubic hair)

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13
Q

What does AH for Tanners method range from?

A

1 to 3 (axillary hair)

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14
Q

What does T for Tanners method range from?

A

2ml to 20ml (testes volume)

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15
Q

What is used to measure testicular maturation?

A

Prader orchidometer

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16
Q

As well as height, what else is important for assessing a childs growth?

A
  • birth weight and gestation
  • PMH
  • family history/social history/schooling
  • systemic enquiry
  • dysmorphic features
  • systemic examination
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17
Q

Give a summary of assessment tools for measuring a childs growth?

A
  • height/length/weight
  • growth charts and plotting
  • MPH and target centiles
  • growth velocity
  • bone age
  • pubertal assessment
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18
Q

Why is a precise definition of normal growth difficult?

A
  • wide range within healthy population
  • different ethnic subgroups
  • inequality in basic health & nutrition
  • normally relate to individuals or populations (genetic influence)
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19
Q

What are some factors influencing height?

A

Age

Sex

Race

Nutrition

Parental heights

Puberty

Skeletal maturity (bone age)

General health

Chronic disease

Specific growth disorders

Socio-economic class

Emotional well-being

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20
Q

Shape of normal growth has stages, what are these?

A

Infantile

Childhood

Pubertal

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21
Q

What hormones are involved in puberty?

A

LH

FSH

Testosterone

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22
Q

What is the relationship between growth and other changes in puberty?

A
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23
Q

What are the most important pubertal stages?

A

Breast budding (tanner stage B2) in a girl

Testicular enlargement (tannger stage G2, T3-4ml) in a boy

these are earliest objective signs of puberty

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24
Q

Do girls and boys tend to grow at the same rate?

A

They do until they are about 13

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25
Q

What are some indications for referral for growth disorders?

A
  • extreme short or tall stature (off centiles)
  • height below target height
  • abnormal height velocity (crossing centiles)
  • history of chronic disease
  • obvious dysmorphic syndrome
  • early/late puberty
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26
Q

What are some common causes of short stature?

A
  • familial
  • constitutional delay of growth and puberty (CDGP)
  • small for gestational age (SGA)
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27
Q

What does SGA stand for?

A

Small for gestational age

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28
Q

What does CDGP stand for?

A

Constitutional delay in growth and puberty

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29
Q

What are some pathological causes of short stature?

A

Undernutrition

Chronic illness (JCA, IBD, Coeliac)

Iatrogenic (steroids)

Psychological and social

Hormonal (GHD, hypothyroidism)

Syndromes (Turner, Prader-Willi, Noonan’s, Achondroplasia)

30
Q

When are boys considered to have early/late puberty?

A

Early - <9 years (rare)

Late - >14 years (common)

31
Q

When are girls considered to have early/late puberty?

A

Early - <8 years

Late - >13 years (rare)

32
Q

Is it more common for boys to have early or late puberty?

A

Late

33
Q

Is it more common for girls to have early or late puberty?

A

Early

34
Q

Who does CDGP usually affect?

A

Boys

35
Q

What is seen in CDGP?

A

Family history in dads or brothers

Bone age delay

Need to exclude organic disease

36
Q

What are some causes of delayed puberty?

A
  • gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
  • chronic disease (Crohn’s, asthma)
  • impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
  • peripheral (cryptorchidism, testicular irradication)
37
Q

What is central precocious puberty?

A

Condition that causes early sexual development in girls and boys

38
Q

What are some signs of early sexual development?

A
39
Q

What are some signs of central precocious puberty?

A

Breast development in girls

Testicular enlargement in boys

Growth spurt

Advanced bone age

40
Q

What is the treatment for central precocious puberty?

A

GnRH agonist

41
Q

What is precocious pseudopuberty?

A
  • partial pubertal development resulting from autonomous production of testosterone in a prepubertal boy
  • gonadotropin independent (low/prepubertal levels of LH and FSH)
  • virilising or feminising
42
Q
A
43
Q

What is ambigous genialia?

A

Infants external genitals dont appear to be clearly either male or female

44
Q

Wha examination should be done for ambiguous genitalia?

A

Examination of the gonads/internal organs

45
Q

What investigation should be done for ambiguous genitalia?

A

Karyotype

46
Q

What should be excluded from the differential diagnosis before diagnosing ambigous genitalia?

A

Congenital adrenal hyperplasia

47
Q

What is the incidence of congenital hypothyroidism?

A

1/4000 births

48
Q

Is there newborn screening for congenital hypothyroidism?

A

Yes

49
Q

What is the most common cause of acquired hypothyroidism in children?

A

Autoimmune (Hashimoto’s) thyroiditis

50
Q

What are some complications of acquired hypothyroidism in children?

A

Lack of height gain

Pubertal delay

Poor school performance

51
Q

Is FH important for acquired hypothyroidism?

A

Yes, family history of thyroid/autoimmune disorders often seen

52
Q

What percentage of children (aged between 2 and 15) are overweight or obese?

A

31%

53
Q

What assessments should be done for obese children?

A
  • weight
  • height
  • BMI (kg/m2)
  • waist circumference
  • skin folds
  • history and examination
  • complications
54
Q

What is the formula for BMI?

A

Weight (kg) / Height2 (m)

55
Q

Over what centile of BMI are children overweight?

A

85th centile

56
Q

Over what centile of BMI are children obese?

A

Over 97.5

57
Q

What parts of the history are important for children who are short and obese?

A

Diet

Physical activity

Family history

58
Q

Symptoms suggestive of what things should be looked for in the history for short obese children?

A
  • syndrome
  • hypothalamic-pituitary pathology
  • endocrinopathy
  • diabetes
59
Q

What are examples of some possible complications of children being short and obese?

A
60
Q

What are some causes of children being obese and short?

A

simple obesity

drugs

  • insulin, steroids, antithyroid drugs, sodium valproate

syndromes

  • Prader Willi syndrome, Laurence-Moon-Beidl syndrome, pseudohypoparathyroidism type 1, down’s syndrome

Endocrine disorders

  • hypothyroidism, growth hormone deficiency, glucocorticoid excess, hypothalamic lesion, androgen excess, insulinoma, insulin resistance syndromes

hypothalamic damage

61
Q

What kinds of things are used for the treatment of obese and short children?

A
  • diet
  • exercise
  • psychological input
  • drugs
62
Q

What’s the main complication of endocrine disorders in short and obese children?

A

Growth failure

63
Q

What’s the main complication of syndromes in short and obese children?

A

Learning difficulties

64
Q

What’s the main complication of hypothalamic causes in short and obese children?

A

Loss of appetite control

65
Q

Why is early important for diabetic children important?

A

Otherwise children can present critically unwell, such as with DKA, and perhaps die

66
Q

What does DKA stand for?

A

Diabetic keoacidosis

67
Q

What symptoms should you think about for diagnosis diabetes early?

A
  • thirsty (polydipsia)
  • thinner
  • tired (fatigue)
  • using toilet more (polyuria)
  • return to bedwetting at night or day wetting (nocturnal enuresis)
68
Q

What test should be done to diagnose diabetes early?

A

Finger prick capillary glucose test, result > 11mmol/L

69
Q

What result for the finger prick test indicates diabetes?

A

>11mmol/L

70
Q

After identifying the symptoms and performing a finger prick test, what should be done to diagnose diabetes early?

A

Refer to local specialist for same day review

71
Q

What are some DKA symptoms?

A
  • nausea and vomiting
  • abdominal pain
  • sweet smelling breath
  • drowsiness
  • rapid, deep sighing respiration
  • coma
72
Q

What should not be done, that perhaps would be done for a suspected diabetes diagnosis, when you suspect a child has DKA?

A

Request a returned urine specimen

Arrange a fasting blood glucose test

Arrange an oral glucose tolerance test

Wait for lab results (urine or blood)

7. Endocrinology (Medical Knowledge)a (28 decks)

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