Paediatric Endocrinology and Diabetes

Question 1

What instrument is used to measure height?

Answer 1

Stadiometer

Question 2

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

Answer 2

Seated height

Question 3

How is head circumference in children measured?

Answer 3

Tape round forehead and occipital prominence (maximal circumference)

Question 4

What should be done after measuring a childs height?

Answer 4

Plot onto a graft accurately (centile chart)

Question 5

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

Answer 5

Charts for predicting future height, and condition specific growth charts

Question 6

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

Answer 6

Potential height a child could reach

Question 7

What is bone age?

Answer 7

Degree of maturation of a child’s bones

Question 8

What is used to predict a childs adult height?

Answer 8

Childs height and bone age

Question 9

What is the method called for staging puberty?

Answer 9

Tanner method:

B (breast development)

G (genital development)

PH (pubic hair)

AH (axillary hair)

T (testes volume)

Question 10

What does B for Tanners method range from?

Answer 10

1 to 5 (breast development)

Question 11

What does G for Tanners method range from?

Answer 11

1 to 5 (genital development)

Question 12

What does PH for Tanners method range from?

Answer 12

1 to 5 (pubic hair)

Question 13

What does AH for Tanners method range from?

Answer 13

1 to 3 (axillary hair)

Question 14

What does T for Tanners method range from?

Answer 14

2ml to 20ml (testes volume)

Question 15

What is used to measure testicular maturation?

Answer 15

Prader orchidometer

Question 16

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

Answer 16

Birth weight and gestation

PMH

Family history/social history/schooling

Systemic enquiry

Dysmorphic features

Systemic examination

Question 17

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

Answer 17

Height/length/weight

Growth charts and plotting

MPH and target centiles

Growth velocity

Bone age

Pubertal assessment

Question 18

Why is a precise definition of normal growth difficult?

Answer 18

Wide range within healthy population

Different ethnic subgroups

Inequality in basic health and nutrition

Normally relate to individuals or populations (genetic influence)

Question 19

What are some factors influencing height?

Answer 19

Age

Sex

Race

Nutrition

Parental heights

Puberty

Skeletal maturity (bone age)

General health

Chronic disease

Specific growth disorders

Socio-economic class

Emotional well-being

Question 20

Shape of normal growth has stages, what are these?

Answer 20

Infantile

Childhood

Pubertal

Question 21

What hormones are involved in puberty?

Answer 21

LH

FSH

Testosterone

Question 22

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

Answer 22

Question 23

What are the most important pubertal stages?

Answer 23

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

Question 24

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

Answer 24

They do until they are about 13

Question 25

What are some indications for referral for growth disorders?

Answer 25

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

Question 26

What are some common causes of short stature?

Answer 26

Familial Constitutional delay of growth and puberty (CDGP) Small for gestational age (SGA)

Question 27

What does SGA stand for?

Answer 27

Small for gestational age

Question 28

What does CDGP stand for?

Answer 28

Constitutional delay in growth and puberty

Question 29

What are some pathological causes of short stature?

Answer 29

Undernutrition Chronic illness (JCA, IBD, Coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (Turner, Prader-Willi, Noonan's, Achondroplasia)

Question 30

When are boys considered to have early/late puberty?

Answer 30

Early - \<9 years (rare) Late - \>14 years (common)

Question 31

When are girls considered to have early/late puberty?

Answer 31

Early - \<8 years Late - \>13 years (rare)

Question 32

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

Answer 32

Late

Question 33

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

Answer 33

Early

Question 34

Who does CDGP usually affect?

Answer 34

Boys

Question 35

What is seen in CDGP?

Answer 35

Family history in dads or brothers Bone age delay Need to exclude organic disease

Question 36

What are some causes of delayed puberty?

Answer 36

CDGP 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)

Question 37

What is central precocious puberty?

Answer 37

Condition that causes early sexual development in girls and boys

Question 38

What are some signs of early sexual development?

Answer 38

Question 39

What are some signs of central precocious puberty?

Answer 39

Breast development in girls Testicular enlargement in boys Growth spurt Advanced bone age

Question 40

What is the treatment for central precocious puberty?

Answer 40

GnRH agonist

Question 41

What is precocious pseudopuberty?

Answer 41

Partial pubertal development that results from autonomous production of testosterone in a prepubertal boy (low/prepubertal levels of LH and FSH) Virilising or feminising

Question 43

What is ambigous genialia?

Answer 43

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

Question 44

Wha examination should be done for ambiguous genitalia?

Answer 44

Examination of the gonads/internal organs

Question 45

What investigation should be done for ambiguous genitalia?

Answer 45

Karyotype

Question 46

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

Answer 46

Congenital adrenal hyperplasia

Question 47

What is the incidence of congenital hypothyroidism?

Answer 47

1/4000 births

Question 48

Is there newborn screening for congenital hypothyroidism?

Answer 48

Yes

Question 49

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

Answer 49

Autoimmune (Hashimoto's) thyroiditis

Question 50

What are some complications of acquired hypothyroidism in children?

Answer 50

Lack of height gain Pubertal delay Poor school performance

Question 51

Is FH important for acquired hypothyroidism?

Answer 51

Yes, family history of thyroid/autoimmune disorders often seen

Question 52

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

Answer 52

31%

Question 53

What assessments should be done for obese children?

Answer 53

Weight BMI (kg/m²) Height Waist circumference Skin folds History and examination Complications

Question 54

What is the formula for BMI?

Answer 54

Weight (kg) / Height² (m)

Question 55

Over what centile of BMI are children overweight?

Answer 55

85th centile

Question 56

Over what centile of BMI are children obese?

Answer 56

Over 97.5

Question 57

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

Answer 57

Diet Physical activity Family history

Question 58

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

Answer 58

Syndrome Hypothalamic-pituitary pathology Endocrinopathy Diabetes

Question 59

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

Answer 59

Question 60

What are some causes of children being obese and short?

Answer 60

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

Question 61

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

Answer 61

Diet Exercise Psychological input Drugs

Question 62

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

Answer 62

Growth failure

Question 63

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

Answer 63

Learning difficulties

Question 64

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

Answer 64

Loss of appetite control

Question 65

Why is early important for diabetic children important?

Answer 65

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

Question 66

What does DKA stand for?

Answer 66

Diabetic keoacidosis

Question 67

What symptoms should you think about for diagnosis diabetes early?

Answer 67

Thirsty (polydipsia) Thinner Tired (fatigue) Using toilet more (polyuria) Return to bedwetting at night or day wetting (nocturnal enuresis)

Question 68

What test should be done to diagnose diabetes early?

Answer 68

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

Question 69

What result for the finger prick test indicates diabetes?

Answer 69

\>11mmol/L

Question 70

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

Answer 70

Refer to local specialist for same day review

Question 71

What are some DKA symptoms?

Answer 71

Nausea and vomiting Abdominal pain Sweet smelling breath Drowsiness Rapid, deep sighing respiration Coma

Question 72

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

Answer 72

Request a returned urine specimen Arrange a fasting blood glucose test Arrange an oral glucose tolerance test Wait for lab results (urine or blood)