Pediatrics - Diabetes mellitus and endocrine disorders Flashcards
PED - 9.2
Which of the following clinical signs imply hypoglycaemia in case of a diabetic child?
A) irritability
B) headache
C) nausea, vomiting
D) vertigo
E) all of the above
ANSWER
E) all of the above
EXPLANATION
If dyspnoea with polyuria and polydipsia (that are typical for diabetic metabolic disorder) occur,we have to of about diabetic ketoacidosis and have to examine the urine glucose and acetone levels with a urine test strip to diagnose it.
PED - 9.4
A child with symptoms of typical diabetic mellitus has blood sugar level of 18 mmol/l. What’s the next step?
A) Refer the patient to a hospital with the diagnosis of diabetes mellitus.
B) Since it turned out the patient ate apple two hours before the measurement, you order a blood sugar control the next day.
C) Do an oral glucose tolerance test in order to diagnose the illness.
D) Prescribe a sugar-free diet and order the patient back for follow-up.
E) Order a control examination because the patient had a non-febrile upper airway infection at the time of the measurement.
ANSWER
A) Refer the patient to a hospital with the diagnosis of diabetes mellitus.
EXPLANATION
The diabetic child’s therapy adjustment is the task of the diabetes care centre.
PED - 9.6
How do you help abolish the acidosis in diabetic ketoacidosis?
A) By administering TRIS buffer solution.
B) By administering bicarbonate.
C) By proper fluid therapy and by administering insulin hyperglycaemia and exsiccosis resolves and pH normalizes.
ANSWER
C) By proper fluid therapy and by administering insulin hyperglycaemia and exsiccosis resolves and pH normalizes.
EXPLANATION
After administration of insulin, acidosis resolves as soon as the production of ketone bodies stops, and the circulating ketone bodies are metabolised.
PED - 9.8
Paediatric diabetes mellitus is diagnosed based on the symptoms at the doctor’s office. What’s next?
A) We order the glucose tolerance test.
B) We order the patient back tomorrow to do a fasting blood sugar level test.
C) We use test strips to examine the blood sugar, urine glucose and acetone level and we refer the patient to a hospital immediately.
ANSWER
C) We use test strips to examine the blood sugar, urine glucose and acetone level and we refer the patient to a hospital immediately.
EXPLANATION
During childhood the apparent life-threatening diabetic ketoacidosis can occur.
PED - 9.9
Impaired glucose tolerance can be diagnosed based on:
A) the fasting blood sugar level
B) the oral glucose tolerance test
C) the urine sugar level
D) the typical clinical symptoms
ANSWER
B) the oral glucose tolerance test
EXPLANATION
People with impaired glucose tolerance have the fasting blood sugar level and the result of the oral glucose tolerance test between the upper normal range and diabetes mellitus. It is diagnosed via the oral glucose tolerance test.
PED - 9.10
The diabetic child’s diet:
A) contains the least amount of carbohydrate, because carbohydrate elevates blood sugar level
B) is high-protein and low-fat
C) carbohydrate covers at least 50 per cent of the energy intake
ANSWER
C) carbohydrate covers at least 50 per cent of the energy intake
EXPLANATION
Diet: 50% carbohydrate.
PED - 9.11
The diabetic child gets pale, trembles and complaints of headache:
A) lay her down and administer pain killer
B) in case of collapse her head has to be wiped with wet clothes until she gets conscious
C) think about hypoglycaemia and give her fast-acting carbohydrate
D) send her home to rest
ANSWER
C) think about hypoglycaemia and give her fast-acting carbohydrate
EXPLANATION
Symptoms imply hypoglycaemic episode that can be abolished by orally administered carbohydrate.
PED - 9.12
The diabetic patient with high fever starts to vomit and breathes unusually:
A) have to order a thorax X-ray because she likely has pneumonia
B) have to send her to a hospital immediately because she is in the severe state of diabetic ketoacidosis
C) have to start antibiotic therapy immediately with the suspicion of pneumonia
D) have to order a cardiac examination
ANSWER
B) have to send her to a hospital immediately because she is in the severe state of diabetic ketoacidosis
EXPLANATION
Kussmaul breathing indicates severe metabolic acidosis and needs urgent treatment in the inpatient setting.
PED - 9.14
A diabetic child arrives for hospital admission due to fever and vomiting:
A) checking the blood sugar level is enough, because the blood sugar level reflects the severity of the problem
B) beside the blood sugar level, the level of the ketosis and the examination of the acid-base parameters are essential
C) we plan the therapy based on the blood and urine sugar examination
ANSWER
B) beside the blood sugar level, the level of the ketosis and the examination of the acid-base parameters are essential
EXPLANATION
In case of paediatric diabetic mellitus every intercurrent illness comes with the danger of ketoacidosis therefore it is important to check the acid-base status simultaneously.
PED - 9.15
A diabetic child arrives for hospital admission due to fever and vomiting:
A) have to make her drink because vomiting leads to dehydration
B) have to implement sugar-containing infusion, because inability to eat obviously leads to the drop of blood sugar level
C) rapid blood sugar level examination has to be followed by the start of fluid therapy with physiologic sodium solution, before the rest of the laboratory results arrive
ANSWER
C) rapid blood sugar level examination has to be followed by the start of fluid therapy with physiologic sodium solution, before the rest of the laboratory results arrive
EXPLANATION
The first step of treatment must be the supplementation of the volume deficit: saline infusion corrects hypovolaemia and the inadequate perfusion.
PED - 9.17
The following are true regarding delayed puberty, except:
A) above the age of 13 in case of girls and above the age of 15 in case of boys signs of puberty are missing
B) most of the cases are constitutional delayed puberty
C) tumour of the hypophysis or the hypothalamus can be the cause
D) predisposition to diabetic insipidus
ANSWER
D) predisposition to diabetic insipidus
EXPLANATION
If delayed puberty is constitutional, the elongated development alone does not predispose to other endocrine illnesses.
PED - 9.21
Which of the following is not true regarding congenital hypothyroidism?
A) none or few external signs at birth
B) anaemia occurs
C) decreases appetite but no sign of leanness
D) early treatment can provide good results
E) serum TSH level is low
ANSWER
E) serum TSH level is low
EXPLANATION
TSH level is either normal or increased but never decreased in congenital hypothyroidism.
PED - 9.22
What are the typical changes of the plasma hormone levels in case of congenital primer hypothyroidism?
A) decreased TSH, increased T4
B) increased TSH, normal T4
C) increased TSH, increased T4
D) increased TSH, decreased T4
E) decreased TSH, decreased T4
ANSWER
D) increased TSH, decreased T4
EXPLANATION
The dysgenesis of the thyroid gland leads to decreased thyroid hormone production that results in increased TSH production via the TSH-thyroid gland axis in the hypophysis.
PED - 9.23
When is it practical to start the treatment of congenital hypothyroidism?
A) immediately after weaning, when the infant doesn’t receive hormones from the mother via the milk
B) when the serum TSH level begins to increase
C) with the result of the new-born screening (NBS), after detailed examination, as soon as possible because delayed treatment greatly worsens the prognosis
D) in case of the pathological result of the NBS, when the heart rate is below 80/min
ANSWER
C) with the result of the new-born screening (NBS), after detailed examination, as soon as possible because delayed treatment greatly worsens the prognosis
EXPLANATION
With immediate hormone supplementation the clinical signs of infant hypothyroidism are avoidable and the mental development of the infant can be uninterrupted.
PED - 9.32
The levels of the following hormones rise significantly during puberty, except:
A) oestrogen
B) growth hormone
C) IGF1
D) testosterone
E) thyroxin
ANSWER
E) thyroxin
EXPLANATION
The onset of puberty does not affect the thyroxin release.
