Paediatrics

Question 1

What are the classic presentation of diabetes

Answer 1

Polyuria
Polydipsia
(specifically asks about these in the under 2’s)
nocturnal enuresis - most common symptom (bedwetting)
Weight loss
General malaise

Question 2

Describe the DKA treatment in under 18’s

Answer 2

Based on weight
Have to be careful with fluid resuscitation as risk of cerebral oedema higher
Start insulin 1hr after IV fluids

Question 3

At what age do you start microvascular screening

Answer 3

From 12 onwards

Question 4

What are the effects of poor control of childhood diabetes

Answer 4

Social & emotional disruption
Sub-optimal physical growth
Biophysical changes due to microvascular disease

Question 5

List the early changes of vascular disease seen in children with Type 1 diabetes

Answer 5

Microalbuminuria
Cardiovascular autonomic neuropathy
Sensory nerve damage
Retinopathy
Cheiroarthropathy - thickened skin, joint contractures 
Skin vascular changes
Vascular endothelial pathology

Question 6

What are the symptoms of congenital thyroid disease in children

Answer 6

Delayed jaundice
Poor feeding but “normal” weight gain
Hypotonia - umbilical hernia and constipation
Skin and hair changes

Question 7

What are the causes of primary congenital thyroid disease

Answer 7

Gland dysplasia
Abnormal site - sublingual thyroid
Inborn error of thyroid hormone metabolism

Question 8

What are the causes of secondary congenital thyroid disease

Answer 8

Congenital pituitary disease

Usually associated with hypopituitarism (GH, ACTH, Gonadotrophin deficiency)

Question 9

How do you screen for congenital thyroid disease

Answer 9

Guthrie test on day 5 of life

Capillary blood spot test looking for TSH or T4 levels

Question 10

What is Cretinism

Answer 10

Permanent development delay

Caused by absence of thyroxine after 3 months of age

Question 11

List some causes of acquired thyroid disease in the young

Answer 11

Autoimmune
Post infectious
Iodine deficiency and nutrition
Delayed congenital
Other autoimmune diseases e.g. Type 1 diabetes

Question 12

How do you treat hypothyroidism in the young

Answer 12

Will need thyroxine replacement for life

Dose is related to the size of the child

Question 13

What are the signs of hypothyroidism in the young

Answer 13

Growth failure
Delayed puberty
Poor general health
Educational difficulties

Question 14

Is hyperthyroidism common in the young

Answer 14

NO

it is rare

Question 15

What are the symptoms of hyperthyroidism in the young

Answer 15

Behaviour problems
Sleep disturbance
Eating difficulties
Goitre 
High pulse rate 
Precocious puberty

Question 16

How do you treat hyperthyroidism in the young

Answer 16

Initial beta blockade
Suppressant therapy - at least for first 2 years (carbimazole)
Permanent cure is radio-iodine (for over 16s) or surgery

Question 17

List primary causes of underactive adrenal disease in the young

Answer 17

Adrenal hypoplasia (absent/dysplastic/destroyed)
Inborn error of metabolism
Congenital adrenal hyperplasia

Question 18

List secondary causes of underactive adrenal disease in the young

Answer 18

Pituitary disease (Congenital/Acquired)
Suppression secondary to steroid therapy

Question 19

When does adrenal hyperplasia present

Answer 19

From birth

Kids will be very sick

Question 20

List signs of congenital adrenal hyperplasia in children

Answer 20

Addison’s crisis - hyponatraemia, hyperkalaemia and hypotension
Due to absent cortisol and aldosterone
Virilisation - ambiguous genitalia in females and precocious puberty in males

Question 21

How do you treat an Addison crisis

Answer 21

Salt and cortisol therapy

Question 22

What are the potential causes of ambiguous genitalia

Answer 22

CAH or other steroid abnormalities
Gene and or chromosomal abnormalities
Congenital Defects