PEDIATRICS UPDATES: TID and T2D

PEDIATRICS UPDATES

Q#01

What laboratory features are helpful to distinguish T1D from T2D?

Although classification can usually be made on the basis of clinical characteristics, measurement of levels of fasting insulin and C-peptide (low in T1D; normal or elevated in T2D) or islet cell autoantibodies (positive in T1D; absent in T2D) may be useful to distinguish T1D from T2D. Be mindful that there can be overlap in the laboratory evaluation.

Q#02

What is acanthosis nigricans?

Acanthosis nigricans is hyperpigmented and often highly rugated patches that are foundmost prominently in intertriginous areas, especially on the nape of the neck. This is a marker of insulin resistance.

Q#03

How is T2D diagnosed?

The diagnosis of diabetes is based on blood glucose level cutoffs and the levels used are the same for T1D and T2D. The diagnosis is made when any of the following criteria are met:

• Random glucose concentration of 200 mg/dL or higher (if accompanied by classic symptoms: polyuria, polydipsia, weight loss)

• Fasting (>8 hours) glucose concentration of more than 125 mg/dL

• Abnormal oral glucose tolerance test defined as a glucose concentration of more than 200 mg/dL measured 2 hours after drinking 1.75 g/kg of glucose (with a maximum dose of 75 g)

• Hemoglobin A1C≥6.5%

Q#04

Which pediatric patients should be screened for T2D?

The American Diabetes Association recommends screening beginning at 10 years of age (or earlier if puberty initiates before age 10 years). Screening should be performed using a fasting plasma glucose, oral glucose tolerance test, or hemoglobin A1C for patients with the following risk factors:

• Body mass index more than 85th percentile for age and sex, plus

• Any two of following risk factors: positive family history in first- or second-degree relative; high-risk race/ethnicity; presence of associated conditions (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome)

• Maternal history of diabetes or gestational diabetes during the child’s gestation

Q#05

What hemoglobin A1C level is sufficient to diagnose diabetes?

A level≥6.5% on two occasions using a laboratory method is sufficient for the diagnosis. Levels between 5.7 and 6.4 place a person at increased risk for diabetes.

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRICS MCQS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRICS MCQS: PEDIATRICS MCQS Q#01 A 16-year-old boy developed left homonymous hemianopsia. Most likely site of lesion:  a) Left optic tract b...

PEDIATRICS MCQS

PEDIATRICS MCQS

Q#01

A 16-year-old boy developed left homonymous hemianopsia. Most likely site of lesion: 

a) Left optic tract

b) Left optic nerve 

c) Right optic nerve 

d) Left retina

e) Right optic tract

Q#02

A 7-day-old boy appears in a clinic for routine check-up. Her mother noticed at home that the boy stops breathing for about 2-5 seconds which is followed by a rapid breathing. She denies any cyanotic episode. The next step in management:

a) Reassurance only 

b) Pneumogram

c) Chest X-ray 

d) EKG

e) Admit for sepsis work up

Q#03

The true statement about pyloric stenosis:

a) More common in first-born female child.

b) Incidence of pyloric stenosis is 20% if father has pyloric stenosis. 

c) Usually presents with bilious vomiting.

d) Hypochloremic metabolic alkalosis is present. 

e) Ultrasonographic finding is not conclusive.

Q#04

A rapid correction of fluid in a child with hypernatremic dehydration results in: a) IVH

b) Subdural hemorrhage 

c) Cerebral cells atrophy 

d) Cerebral cells swelling

e) PVL (periventricular leukomalacia)

Q#05

A child is diagnosed with a neuromuscular disorder. The definitive diagnostic study: 

a) CPK

b) EMG (electromyography) 

c) Nerve conduction study 

d) MRI

e) Muscle biopsy

Pediatrics Pearls: VACCINATION

Pediatrics Pearls: VACCINATION

Q 01: What is the derivation of the word “vaccination”?

Q 02: When administering an IM vaccination, is aspiration necessary before injection?

Q 03: What is the “grandparent effect” of vaccination?

Q 04: What are the recommendations regarding the administration of live-virus vaccines to patients receiving corticosteroid therapy?

Q 05: Why are the buttocks a poor location for intramuscular (IM) injections in infants?

PEDIATRICS UP-DATES

PEDIATRICS UP-DATES

Q#01

Which patients with UTIs are at higher risk for having an abnormality? Mention only 5.

Q#02

After what period can AEDs be safely discontinued?

Q#03

When the decision is made to discontinue AEDs, should the tapering period be long or short?

Q#04

What are the two most common pediatric vasculitides?

Q#05

Which laboratory tests are useful for monitoring the effectiveness of therapy in patients with SLE?

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC MCQS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC MCQS: PEDIATRIC MCQS MCQ#01 A full-term female neonate weighing 3,700 g is born to a 32-year-old woman with hepatitis C virus infection....

PEDIATRIC MCQS

PEDIATRIC MCQS

MCQ#01

A full-term female neonate weighing 3,700 g is born to a 32-year-old woman with hepatitis C virus infection. The mother was diagnosed during this pregnancy and has not received antiviral therapy. Her human immunodeficiency virus test results are negative. Her husband’s test results for hepatitis C virus infection are negative. As a child, she received a blood transfusion after sustaining an injury during a motor vehicle collision. She inquires about the long-term prognosis if the baby were to acquire hepatitis C virus infection from her.

Of the following, you are MOST inclined to inform the mother that

A. Decompensated cirrhosis in adulthood is likely

B. Hepatocellular carcinoma without cirrhosis is likely

C. Rapidly progressive fibrosis in adulthood is likely

D. Slowly progressive fibrosis in childhood is likely

E. Spontaneous clearance of the virus in infancy is likely

MCQ#02

A 4-year-old boy is brought to the urgent care center for fever, vomiting, diarrhea, and reduced urine output. On physical examination, the boy is alert and able to answer some questions. He has a mildly elevated heart rate, normal blood pressure, dry mucous membranes, and sunken eyes. You diagnose him with acute gastroenteritis, and begin treatment with oral ondansetron and frequent, small aliquots of oral rehydration solution (ORS). However, he resists any oral intake and after 1 hour, has taken only 5 mL/kg of ORS. You order placement of an intravenous (IV) line for hydration. Despite the staff’s best efforts, 3 attempts at placing an IV failed. His father is visibly upset and asks if there is another option for giving his son fluids.

Of the following, the BEST next step in managing this child’s dehydration is to

A. Administer ORS via nasogastric tube

B. Place an intraosseous line for hydration

C. Reattempt oral rehydration using small aliquots of ORS

D. Reattempt oral rehydration using small aliquots of water

E. Request that a nurse from the intensive care unit place the IV line

MCQ#03

You are evaluating a 10-day-old term newborn who is in the emergency department because of decreased activity, poor feeding, and respiratory distress. The baby was born by normal spontaneous vaginal delivery with no pregnancy or delivery complications. Maternal history is negative for premature or prolonged rupture of membranes, group B Streptococcus colonization, genital herpes, hepatitis B surface antigen, human immunodeficiency virus, and rapid plasma reagin.

The newborn is critically ill and has a temperature of 35.3°C. He is in respiratory failure and shock. Skin examination findings are normal. Laboratory data are significant for leukopenia, thrombocytopenia, disseminated intravascular coagulation, and severe hepatitis. A chest radiograph shows bilateral pulmonary infiltrates. Blood and urine cultures were obtained, but the newborn is not stable enough for lumbar puncture.

Of the following, the BEST initial antimicrobial treatment is ampicillin, cefotaxime, and

A. Acyclovir

B. Amphotericin B

C. Oseltamivir

D. Trimethoprim-sulfamethoxazole

E. Vancomycin