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Diabetes & Endocrinology > Paediatric endocrinology and diabetes > Flashcards

Paediatric endocrinology and diabetes Flashcards

1
Q

Briefly describe how to measure height in a child

A

use a stadiometer
stand up straight with legs together, look forward with heels, buttocks and scapulae against wall
remove shoes and socks
straighten head and take deep breath in
be very accurate and read height to last complete mm

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2
Q

Why do we measure length in children?

A

cannot stand or walk

under 2

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3
Q

Why do we measure sitting height in children?

A

trunk in respect to limbs

body problems eg achondroplasia

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4
Q

How to measure head circumference in children

A

routine in children under 2

forehead to occipital prominence

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5
Q

What is the maximal circumference of the head?

A

forehead to occipital prominence

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6
Q

What shape do we use to plot on a graph?

A

dots - for accuracy

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7
Q

List some things found on the RCPCH UK 2-18 growth chart?

A

predicted adult height scale
parent height comparison
birth centiles
WHO standards until age 4

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8
Q

List some condition specific growth charts

A

downs syndrome
turners syndrome
boy/girl

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9
Q

What is the mid parental centile?

A

average adult height centile to be expected for all children of those parents

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10
Q

How do we do bone age?

A

TW 20 - 20 bones in hand

radiograph

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11
Q

Osteopenia

A

bone mineral density is lower than normal

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12
Q

How do we plot bone age?

A

on a graph using a triangle

plot chronological age on same graph

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13
Q

Assessment tools

A 
Height/ length/ weight 
• Growth Charts and plotting 
• MPH and Target centiles
 • Growth velocity 
• Bone age
 • Pubertal assessment
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14
Q

List the letters used in tanner staging of puberty and the numbers

A 
B 1-5
G 1-5
PH 1-5
AH 1-3
T 2ml - 20ml
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15
Q

What do the number in tanner staging mean?

A 
1 = pre pubertal 
2 = start of puberty 
5 = adult
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16
Q

What is used to measure testicular volume?

A

prader orchidometer

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17
Q

Why is a precise definition of normal growth difficult?

A 
wide range in healthy population 
ethnic subgroups 
inequality in basic health and nutrition 
normality to individuals and populations
genetics
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18
Q

List some factors which influence height

A

sex, race, nutrition, chronic disease, emotional status, parental height, bone age, puberty, general health, specific growth disorders, socio-economic status

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19
Q

Describe briefly the increase in height per year in infancy, childhood and puberty

A

I - very rapid
C - constant
P - large peak - girls earlier

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20
Q

What are the types of hormones involved in puberty?

A

sex and growth

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21
Q

List the chronological pubertal changes in boys

A

testicular growth, penile growth, facial hair

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22
Q

List the chronological pubertal changes in girls

A

breast bud, breast development, menstruation

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23
Q

What stage in tanner is breast budding?

A

B2

24
Q

What stage in tanner is testicular enlargement?

A

G2

T 3-4 ml

25
Q

Earliest objective signs of puberty in boys and girls

A

breast bud

testicular enlargement

26
Q

What does obesity do to height and puberty?

A

make you tall
stimulate puberty
obese and small is worrying

27
Q

List some indications for referral for growth disorders

A 
extreme tall or short - off centiles 
height below target height 
abnormal height velocity - cross centiles 
history of chronic disease 
obvious dysmorphic syndrome 
early/late puberty
28
Q

3 common causes of short stature

A

SGA/IUGR
familial
constitutional

29
Q

What do SGA babies benefit from?

A

growth hormone

30
Q

What is constitutional growth?

A

period of delayed growth

31
Q

List some pathological causes of short stature

A 
undernutrition 
chronic illness eg IBD 
iatrogenic eg steroids 
psychological and social eg in care 
hormonal eg GHD, hypothyroidism 
syndromes eg turner, noonans
32
Q

Early and delayed puberty in boys

A

early <9 = rare

delayed >14 - common, especially CDGP

33
Q

Early and delayed puberty in girls

A

early <8

delayed >13 rare

34
Q

Constitutional delay in growth and puberty

A

mainly boys
FH - hard to obtain
bone age delay
exclude organic disease

35
Q

List some other causes of delayed puberty

A

gonadal dysgenesis
chronic disease
impaired HPG axis
peripheral eg testicular irradiation

36
Q

Thelarce

A

onset of female breast development

37
Q

precocious

A

developed earlier than usual

38
Q

adrenarche

A

early sexual maturation - adrenals

39
Q

menarche

A

menstruation

40
Q

What is central precious puberty and describe it

A

early onset of breast and testicular development

growth spurt and advanced bone age

41
Q

central precocious puberty: worrying for boys or girls?

A

boys
girls - normal, pituitary imaging
boys - underlying cause eg brain tumour

42
Q

Treatment of central precocious puberty

A

GnRH agonist

43
Q

What is precocious pseudopuberty?

A

gonadotrophin independent - low hormone levels
abnormal sex steroid secretion
secondary sexual characteristics

44
Q

How to manage ambiguous genitalia in newborn

A

do not guess
karyotype
MDT, exam of genitalia and internal

45
Q

What should you exclude in newborns with ambiguous genitalia?

A

congenital adrenal hyperplasia

46
Q

Management of congenital hypothyroidism and causes

A

hypoplastic, dyshormogenic

screen and start treatment within 2 weeks

47
Q

Causes and consequence of acquired hypothyroidism

A

autoimmune
FH
lack of height gain, pubertal delay and poor school performance

48
Q

How to assess an obese child

A

BMI, height, weight

skin folds, waist circumference, history, exam, complications

49
Q

Causes of child obesity

A 
simple 
drugs eg insulin, CCS, sodium valproate
syndromes 
endocrine disorders eg GHD, hypothyroidism, leptin deficiency 
hypothalamic damage
50
Q

Treatment of obesity

A

exercise
diet
psychological
drugs??

51
Q

Syndromes causing obesity

A

PW, downs

52
Q

4 T’s of type 1 diabetes

A

thirst
thinner
toilet
tired

53
Q

Testing for type 1 diabetes and DKA

A

skin prick capillary glucose

>11mM

54
Q

What do you do for child with type 1 diabetes with DKA?

A

same day review

55
Q

red flag for type 1 DKA

A

wetting bed

56
Q

under 5 signs/symptoms of type 1 diabetes

A

heavy nappies
irritable
recurring skin infections
blurred vision

57
Q

DKA symptoms

A 
nausea and vomiting 
coma 
drowsiness 
acetone breath 
abdominal pain 
deep, rapid respiration

Diabetes & Endocrinology (24 decks)

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