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Exam 1 PNP > Paediatrics and Endocrinology > Flashcards

Paediatrics and Endocrinology Flashcards

1
Q

how many children have type 1 diabetes

A

1 in 450

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2
Q

are more or less kids getting diagnosed with diabetes

A

more

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3
Q

what should you not expect in a child who is vomiting

A

them to keep peeing/ bedwetting as vomiting makes you dehydrated
think DKA

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4
Q

what are the signs of DKA in children

A 
vomiting
stomach pain 
sighing breathing 
ketones on breath
altered consciousness
pH<7.3
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5
Q

what are the signs of diabetes in children

A

increased drinking and peeing
bedwetting (especially if a child is usually dry at night)
weight loss
general malaise

(constipation, blurred vision. oral or vulval candida)

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6
Q

what are the diagnostic markers for diabetes in children

A

FBG >7 mmol/L

RBG >11 mmol/L

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7
Q

management for:
Elevated blood glucose*
No ketones
Clinically well

A

Urgent phone contact with
duty Paediatric team clinical
review arranged
within 24 hours

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8
Q

treatment for:
Elevated blood glucose*
Ketones present
Clinically well

A

Urgent phone referral to

duty Paediatric Team – same day review.

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9
Q 
Treatment for:
Elevated blood glucose*
Ketones present
Clinical symptoms/signs:
• Abdominal pain
• Vomiting
• dehydration
• Rapid and deep respirations
(Kussmaul breathing)
• Altered conscious level
A

Emergency referral to Paediatrics

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10
Q

what is the main different in treatment for DKA in kids

A

start fluid first carefully (1 hour) before starting insulin as risk of cerebral oedema

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11
Q

how does cerebral oedema happen

A

In DKA there is a high osmolar gradient (due to high BG) leading to fluid shift from ICF to ECF space and contraction of cell volume. If fluid is replaced rapidly this leads to a reversal of the osmolar gradient and causing rapid ICF volume expansion causing cerebral oedema

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12
Q

when do kids start attending microvascular screening

A

at age two

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13
Q

what age is diabetes especially hard to manage

A

teenage years- getting more independent, alcohol, risk taking, health no priority

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14
Q

what are the effects if poor diabetes control in children

A

social and emotional disruption
sub-optimal physical growth
biophysical changes of microvascular disease

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15
Q

what are the early changes of vascular disease in children with T1DM

A 
Microalbuminuria
cardiovascular autonomic neuropathy 
sensory nerve damage 
retinopathy 
cheiroarthropathy (thickened skin, joint contractures)
skin vascular changes 
vascular endothelial pathology
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16
Q

what does tight glycaemic control increase the risk of

A

hypos

17
Q

what type of insulin do pumps give you

A

continuous novorapid

18
Q

what are the forms of congenital thryoid disease

A

primary- gland dysplasic +/- abnormal site (sublingual). inborn error of thyroid hormone metabolism

secondary/ tertiary- congenital pituitary disease, usually associated with hypopituitarism (GH< ACTH, gonadotrophin deficiency)

19
Q

what are the symptoms of congenital thyroid disease

A

delayed jaundice
poor feeding but normal weight gain
hypotonia (umbilical hernia, constipation)
skin and hair changes

20
Q

what is the screening for congenital thyroid disease

A

guthrie test (day 5)
capillary blood spot on to dry blotting paper
measurement of TSH and/or T4 levels

21
Q

why does congenital thryoid disease nor affect foetus

A

as protected by placental thyroid hormones

22
Q

what does absence of thyroxine after 3 months of age lead to

A

permanent developmental delay- cretinism

23
Q

what are the causes of acquired thyroid disease in the young

A 
delayed congenital 
post infectious 
autoimmune 
iodine deficiency and nutrition 
other autoimmune diseases (T1DM)
24
Q

what are the features of hypothyroidism in children

A 
often slow progress 
general growth failure, delayed puberty
poor general heath
educational difficulties 
goitre 
thyroid function tests (high TSH, low free T4 and T3 levels)
high thyroid cell antibody titres
25
Q

what is the treatment for hypothyroidism in kids

A

thyroxine for life

dose related to child size

26
Q

what are the symptoms of hyperthyroidism in kids

A

behaviour problems, sleep disturbance, eating difficulties

goitre
high pulse rate

precocious puberty

27
Q

what will test show in hyperthyroidism in kids

A

thyroid function tests (suppressed TSH, high free T4 and T3 levels)
high thyroid cell antibody titres

28
Q

what is the therapy for hyperthyroidism in kids

A

initial therapy- beta blockade

suppressant therapy (first two years): carbimazole +/- thyroxine

permanent cure: radio-iodine, surgery

29
Q

what are the primary causes of underactive adrenal disease in the young

A

adrenal hypoplasia (absent/ dysplastic/ destroyed)
inborn error of metabolism
congenital adrenal hyperplasia

30
Q

what are the secondary causes of underactive adrenal disease in the young

A 
pituitary disease (cong/acquired) 
suppression secondary to steroid therapy (high dose and prolonged)
31
Q

what are the causes of overproduction of steroids (adrenal disease) in the young

A

cushing syndrome

  • high dose cortical therapy
  • cushing disease (primary adrenal, secondary pituitary)
32
Q

what is produces by the adrenal cortex

A 
mineralocorticoids aldosterone)  
glucocorticoids (cortisol) 
adrenal androgens (testosterone)
33
Q

what is produced by the adrenal medulla

A

catecholamines- adrenaline and noradrenaline

34
Q

what happens in congenital adrenal hyperplasia

A

21 hydroxylase enzyme is defective so aldosterone and cortisol aren’t produced and testosterone is produced in excess

35
Q

what are the features of congenital adrenal hyperplasia

A

absent cortisol and aldosterone= ‘addison crisis’ (hyponatraemia, hyperkalaemia, hypotension)

excess testosterone= virilisation: female - ambiguous gentialia, male - precocious puberty

36
Q

what is the treatment for addisons crisis

A

urgent therapy of salt and cortisol

37
Q

what can be the DDX for ambiguous genitalia

A

CAH or other steroid abnormalities
gene and chromosomal abnormalities
congenital defects

Exam 1 PNP (21 decks)

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