100+ Free Cert Endocrinology(SA) Paed Practice Questions

Explanation: In the presence of classic osmotic symptoms (polyuria, polydipsia, weight loss), a single random plasma glucose measurement of >=11.1 mmol/L (200 mg/dL) is sufficient to diagnose diabetes mellitus. Performing an OGTT in a symptomatic child with overt hyperglycaemia is unnecessary and potentially dangerous as it risks delaying treatment and precipitating DKA.

Explanation: ISPAD 2022 guidelines recommend initiating fluid resuscitation in paediatric DKA with 10–20 mL/kg of isotonic saline (0.9% NaCl or balanced crystalloid such as Plasma-Lyte) over 30–60 minutes. This restores circulating volume while avoiding rapid osmotic shifts that could contribute to cerebral oedema.

Explanation: Intravenous regular insulin should be initiated at a rate of 0.05 to 0.1 units/kg/hour starting approximately 1 hour after fluid replacement therapy has commenced. An initial insulin bolus is contraindicated as it precipitously drops serum osmolality and increases cerebral oedema risk.

Explanation: The international consensus recommendation for children and adolescents using CGM is to achieve >70% Time in Range (TIR: 3.9–10.0 mmol/L [70–180 mg/dL]), while maintaining Time Below Range (<3.9 mmol/L) at <4% and <3.0 mmol/L at <1%.

Explanation: Severe hypoglycaemia with altered consciousness or seizures outside of established IV access should be treated immediately with glucagon: 0.5 mg IM/SC for children <25 kg (or <5 years old), 1.0 mg for >=25 kg, or 3 mg intranasal glucagon if available.

Explanation: ISPAD guidelines recommend screening for coeliac disease at T1D diagnosis using serum anti-tissue transglutaminase (tTG) IgA antibodies combined with total serum IgA (to exclude IgA deficiency, which requires IgG-based testing e.g. tTG IgG or DGP IgG). Screening is repeated after 1–2 and 5 years.

Explanation: Annual screening for diabetic retinopathy (fundus photography/dilated eye exam) and diabetic nephropathy (urine albumin-to-creatinine ratio) is recommended starting at age 11 years (or at pubertal onset) after 2 to 5 years of diabetes duration.

Explanation: Partial clinical remission is defined by a total daily insulin dose (TDD) of <0.5 units/kg/day while maintaining an HbA1c <6.5% (48 mmol/mol). The Insulin Dose-Adjusted A1c (IDAA1c) formula [HbA1c (%) + 4 x insulin dose (U/kg/day)] <=9 also defines remission.

Explanation: For planned aerobic exercise when blood glucose is between 5.0 and 7.0 mmol/L, ISPAD guidelines advise consuming 10–15 g of fast-acting carbohydrate before starting exercise to prevent hypoglycaemia during activity.

Explanation: Potassium replacement should begin after initial fluid resuscitation once urine output is documented, regardless of whether serum potassium is normal (3.5-5.5 mmol/L). 40 mmol/L of potassium (50% KCl and 50% K-phosphate) should be added to IV fluids because insulin infusion drives potassium rapidly into cells.