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Endocrine > Pregnancy & Paediatrics > Flashcards

Pregnancy & Paediatrics Flashcards

1
Q

The first stage of the ovarian cycle is driven by which hormone?

A

FSH

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2
Q

The third phase of the ovarian cycle is driven by which hormone?

A

LH

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3
Q

The follicle is an important source of which hormone?

A

Oestradiol

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4
Q

All follicles will produce progesterone, true or false?

A

False - only if it develops into the corpus luteum (luteal phase) if implanted

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5
Q

What do pregnancy tests measure?

A

Human Chorionic Gonadotrophin

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6
Q

What effect do progesterone & hCG have on blood sugar/ diabetes?

A

They induce insulin resistance (physiological as this makes more glucose available to the foetus)

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7
Q

Gestational diabetes usually occurs in the first trimester, true or false?

A

False - usually in the third

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8
Q

Gestational diabetes requires a predisposition to develop, true or false?

A

True

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9
Q

Foetal organogensesis begins at which week of development?

A

Week 5

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10
Q

What effect does hyperglycaemia have on a developing foetus?

A

Congenital malformations (e.g. ancephaly, spina bifida), prematurity, neonatal complications (e.g. ARDS, hypoglycaemia)

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11
Q

ACEi and statins are recommended for hypertensive diabetics in pregnancy, T/F?

A

False - strictly avoided

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12
Q

Gestational diabetics should aim to have their BG below what 2-hours post meal?

A

<7mmol/L

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13
Q

What’s the ideal target for pre-meal BG in gestational diabetes?

A

4.5-5.0mmol/L

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14
Q

Diabetics with MODY can be treated with which drug? (1)

A

-Glibenclamide (a SUR)

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15
Q

How is gestational diabetes differentiated from T2DM?

A

Give an OGTT 6 weeks post-natally; if not resolved they have T2DM, not G-DM.

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16
Q

What % of patients with gestational diabetes will go onto develop T2DM?

A

50% (80% if obese)

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17
Q

Acarbose can be used to reduce chance of developing T2DM in G-DM. How does it work?

A

It inhibits glucose hydrolases at the brush-border of intestine, limiting glucose uptake

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18
Q

Maternal thyroxine is particularly important for what aspect of foetal development?

A

Myelinogenesis

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19
Q

If a patient on thyroxine falls pregnant, how much should their thyroxine dose be adjusted by immediately?

A

25mcg increase

20
Q

How often should TFTs be checked in pregnancy? (2)

A

1) Monthly for the first 20 weeks

2) 2-monthly after

21
Q

Hypothyroidism has been associated with which pregnancy complications? (3)

A

1) Abortion
2) Pre-eclampsia
3) Abruption

22
Q

The thyroid should increase in size in pregnancy, true or false?

A

True - to accommodate an increased production of thyroid hormones

23
Q

hCG has what effect on thyroid hormones?

A
  • Increases fT4

- Lowers TSH

24
Q

hCG is thought to be responsible for which common side-effect of pregnancy?

A

Hyperemesis gravidarum

25
Q

Hyperthyroidism in pregnancy needs to be differentiated from what other condition?

A

hCG-induced thyrotoxicosis

26
Q

How can gestational hCG associated thyrotoxicosis be differentiated from hyperthyroidism? (3)

A

1) Gestational hCG wil have a raised hCG and low TSH
2) No TRAb antibody present (important remember as TRAb antibodies will pass placenta)
3) Gestational will resolve within 20 weeks

27
Q

Graves’ Disease is often worsened by pregnancy, true or false?

A

False - it often settles

28
Q

Graves’ Disease can be managed with which medications safely in pregnancy (2)?

A

1) Beta-blockers

2) Low-dose ATDs (PTU in 1st trimester as carbimazole risks cutis aplasia, with carbimazole in 2nd and 3rd)

29
Q

What’s the main “risk” of using PTU?

A

Liver toxicity

30
Q

Thyroiditis can occur up to how long after pregnancy?

A

1 year

31
Q

What is the incidence of T1DM in children?

A

1:450

32
Q

Around which % of T1DMs will present with DKA?

A

25%

33
Q

C-peptide is often undetectable in the first presentation of T1DM, T/F?

A

False - it is often residual but dwindles after

34
Q

A random glucose over what is WHO criteria for T1DM?

A

> 11.0mmol/L

35
Q

A fasting glucose over what is WHO criteria for T1DM?

A

> 7.0mmol/L

36
Q

What are the symptoms/ signs of DKA? (3)

A

1) Vomiting, abdominal pain
2) pH <7.3, urine ketones +++
3) Acute dehydration

37
Q

What are the key differences between management of DKA in children versus adults? (3)

A

1) Guidance says NOT to give any fluids unless shock is present (due to risk of cerebral oedema)
2) Insulin should be commenced 1 hour after IV fluids
3) Treatments based upon weight

38
Q

Why is it important to stress the potential danger of misusing insulin, particularly in adolescents?

A

Insulin triggers weight gain (lipogenesis) and some patients may run their sugars high as a weight-loss strategy

39
Q

A continuous insulin infusing pump can remain in place for how long?

A

3 days

40
Q

What is insulin sensitivity?

A

The ratio by which 1 unit of insulin will lower BG (e.g. 1:2 = 1 unit will lower by 2mmol/L)

41
Q

What is a carb ratio in insulin dosing?

A

The amount of insulin that must be administered for a given amount of carbs (e.g. 1:10 = 1 unit of insulin every 10 carbs)

42
Q

Thyroid status must be controlled within which period in pregnant mothers? Why?

A

Ideally within 2 weeks, but up to 2/3 months. After this cretinism can develop (permanent)

43
Q

Which test screens for congenital thyroid status?

A

Guthrie heel prick test at day 5

44
Q

Hyperthyroidism is likely to persist permanently in the young, T/F?

A

False - usually will spontaneously resolve within 2-3 years

45
Q

Absence of CYP21A2 hydroxylase leads to which condition?

A

Congenital adrenal hyperplasia (leads to Addisonian crisis)

Endocrine (17 decks)

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