Paediatrics Flashcards

1
Q

What percentage of children with Type 1 diabetes present in Diabetic Ketoacidosis (DKA)?

A

25%

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2
Q

What symptoms do parents notice their children developing prior to a diagnosis of T1D?

A

Drinking more
Peeing more
Bedwetting (when this is atypical for the child)
Weight loss

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3
Q

How would you ask a parent if they had noticed their child losing weight?

A

Have their clothes/school uniform been hanging off them or felt looser lately?

often parents don’t notice chlidren getting slimmer

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4
Q

What symptoms are experienced by kids who present in DKA?

A

Vomiting
Stomach pains
Sighing breathing
“Pear drops” smell on breath

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5
Q

Above what values in a fasting or random blood glucose may indicate Type 1 diabetes?

A

fasting blood glucose >7.0 mmol/l

random blood glucose >11.0 mmol/l

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6
Q

If a child presents clinically well with polyuria, polydipsia, nocturnal enuresis and weight loss. Their blood sugar is markedly raised (>17mmol/L). How should they be referred?

A
  • Urgent phone contact with duty Paediatric team

- Clinical review arranged within 24 hours

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7
Q

A child presents clinically well with polyuria, polydipsia, nocturnal enuresis and weight loss, and when tested has a raised blood glucose and ketones in their urine. How should they be referred?

A
  • Urgent phone referral to duty Paediatric Team

- same day review

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8
Q

A child presents clinically unwell with symptoms of DKA. How should they be referred?

A

Emergency referral to Paediatrics

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9
Q

How should fluids be given in DKA?

A

CAREFULLY (don’t fluid overload)

based on child’s weight

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10
Q

What are children at risk of if they are fluid overloaded in DKA?

A

Risk of cerebral oedema

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11
Q

When should insulin be started in DKA?

A

1 hour after iv fluids started

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12
Q

What are the 4T’s of Type 1 Diabetes to make the public aware of the presenting symptoms?

A

Toilet
Tired
Thirsty
Thinner

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13
Q

What is the name of the national diabetes database used to store patient’s information to be used at each follow up appointment?

A

SCI diabetes Database

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14
Q

What are the main aims of the Children’s Diabetic team?

A
  • Normal growth and development
  • Minimal effects on school attendance.
  • Local protocols for emergency events
  • Best HbA1c for each individual child
  • Microvascular screening from age 12
  • Avoid hospital readmission <1year after diagnosis
  • Avoid Hypoglycaemic fit/ Episode of DKA
  • Transitional care through teenage years
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15
Q

What are the targets for children’s blood sugars during the day (pre-meal, post-meal and bedtime)?

A

Pre-meal (inc. breakfast) = 4-7 mmol/L
2 hrs post-meal = 5-9 mmol/L
Bedtime = 4-7 mmol/L

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16
Q

If diabetes is poorly controlled in childhood, what can this result in?

A
  • Social and emotional disruption
  • Sub-optimal physical growth
  • micro-vascular disease
17
Q

What early changes of vascular disease can be seen in Type 1 diabetes patients?

A
  • Microalbuminuria
  • Cardiovascular autonomic neuropathy
  • Sensory nerve damage
  • Retinopathy
  • Cheiroarthropathy (thick skin/joint contractures)
  • Skin vascular changes
  • Vascular endothelial pathology
18
Q

Why may strict glycaemic control worry parents?

A

Children are at more of a risk of Hypo with strict control

=> need to convince parents that strict control is better in the long run to minimise complications

19
Q

Why are the teenage years particularly a problem when implementing strict glycaemic control?

A
  • health not priority
  • may miss their insulin
  • May be embarassed to administer insulin in front of others
20
Q

What do children and their families need to think about before administering their insulin?

A
What was their last blood glucose?
Have they/Are they planning to exercise?
What have they/ what are the planning to eat?
What type of insulin is it?
How sensitive are they to insulin?
21
Q

Give an example of a device used to interpret all required information before administration of an insulin dose?

A

Accu-check Aviva Expert

22
Q

Aside from an insulin pump, what other device is now being implanted in patients to improve their glycaemic control?

A

Continous glucose monitor

has the potential to interact with an insulin pump to automatically decide insulin requirements

23
Q

What is the largest drawback of the insulin pump?

A

If it breaks and this isnt noticed (i.e. during sleep)

Insulin stops being infused and patient can go into DKA

24
Q

What are the main symptoms of congenital thyroid disease?

A
Delayed jaundice
Poor feeding but “normal” weight gain
Hypotonia
umbilical hernia; constipation
Skin and hair changes
25
Q

What test is used to check for congenital thyroid disease and when is it performed?

A

Guthrie Heel Prick Test
Day 5 post birth
Measure TSH and T4 levels

26
Q

How early should thyroxine therapy be given in congenital thyroid disease?

A

2-3 months

27
Q

After 3 months, what complication of congenital thyroid disease can present?

A

leads to permanent developmental delay “Cretinism”

28
Q

What can cause acquired thyroid disease in the young?

A
  • Delayed congenital
  • Post infectious
  • Autoimmune (T1D)
  • Iodine deficiency and nutrition
29
Q

Hyperthyroidism can cause early onset puberty. TRUE/FALSE?

A

TRUE

30
Q

What therapy can be used in hyperthyroidism to suppress symptoms?

A

beta-blockade

31
Q

What treatments are considered more permanent in treating hyperthyroidism rather than just anti-thyroid drugs?

A

radio-iodine

surgery

32
Q

What conditions are considered PRIMARY adrenal disease in the young?

A
  • Adrenal hypoplasia (absent/dysplastic/destroyed)
  • Inborn error of metabolism
  • Congenital adrenal hyperplasia
33
Q

What can cause SECONDARY adrenal disease in the young?

A
  • Pituitary disease (Congital/Acquired)

- steroid therapy (high dose/ prolonged can cause suppression)

34
Q

Why does virilisation occur in congenital adrenal hyperplasia?

A

Enzyme defect means that cholesterol cant make aldosterone or cortisol
=> all is shunted to make androgens e.g. testosterone

This means females are born with ambiguous genitalia
Males often go through puberty very early (preocious puberty)