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Flashcards in Endocrine Deck (19):
1

What is the condition in which the baby will have bone age more than chronological age? A. Hypothyroid

B. Chronic kidney disease

C. Congenital adrenal hyperplasia

D. Reckitt

Answer: C

Medscape: A bone-age study is useful in evaluating a child who develops precocious pubic hair, clitoromegaly, or accelerated linear growth. Patients who have these symptoms because of adrenal hyperplasia have advanced skeletal maturation.

2

Child known case of dm 1, lost his consciousness at school. The last insulin injection is unknown.

A. Take him to the hospital

B. Iv ranger lactate

C. Im glucagon

D. Insulin

Answer: c

Because the patient could have hypoglycemic attack so give him shot of glucagon to increase his blood sugar.

3

When does girls get puberty as compared to boys?

A. 1 to 2 yrs before

B. 2 to 3 yrs before

C. Same time when boys do

D. After boys

Answer: a

➢ Average age for girls: 10 years old.

➢ Average age for boys: 11 to 12 years old.

4

7  years  old  girl  was  brought  by  her  mother,  she  developed  pubic  hair  and  her  height  70th  percentile  and  weight  50th percentile.  On  examination  there  are  no  signs  of  puberty  except  pubic  hair.  Abdominal,  chest,  cardiac  and  renal examination  were  normal.  What  is  the  most  likely  diagnosis?

A.      Congenital  adrenal  hyperplasia

B.      45x (turner  syndrome)

C.      Premature adrenarche.

D.     Normal puberty.

.   

Answer:  c

Premature  adrenarche  is  when  these  changes  begin  early,  before  age  8  for  girls  and  age  9  for  boys

5

12  year  boy came  to  the  clinic  complaining  that  he  is  short  comparing  to  his  colleagues,  his  height  was  155  and  his  weight is  similar  to  10  years  boys. His  mother  height  is  145,  father  is  178,  what  is  the  expected  height  of  the  pt.

A.  140_155

B.  155_160

C.  160_175

D.  175_195 

Answer : c is the closest 

To  calculate  mid-parental  height:  

For  boys:  [paternal  height  +  (maternal  height  +  5  inches  or  13  centimeters)]  /  2

178  +  (145+13)  /2  =  336/2=168  +-  8  =  160-176  cm  (range)

For girls: [maternal height + (paternal height – 5 inches or 13 centimeters)] / 2 

6

Newborn  in  endemic  area  of cretinism  suspect  to  have  cretinism  what's  your  action: A.  Iodine  supplements

B.  Repeat  thyroid  fun  after  1  or  2  month

C.  Thyroxine

 

Answer:  c ? 

Treatment  should  be  initiated  in  an  infant  with  a  clearly  positive  screening test  as soon  as  confirmatory  blood  samples  have been  drawn,  pending results.  In  cases  in  which  screening tests  are  borderline,  a  treatment  decision  can  be  made  after  results  of the  confirmatory  tests  return

7

Most  common cause of precocious  puberty  in  girls

A.  Idiopathic  

B.  Adrenal  tumor

C.  Ovarian  tumor

D.  Functional  ovarian  cyst

 

Answer: A

Idiopathic  — central  precocious  puberty  is  idiopathic  in  80  to  90  percent  of  cases  of  girls,  but  in  only  25  to  60  percent  of  boys 

8

Child  his  height  and  weight  below  normal  besides  growth  hormone  what  you  will  order:

A.  Somatomedin  c  

B.  Aldosterone

C.  Insulin

D.  Testosterone 

Answer:  a

If  the case  is  due  to  growth  hormone  deficiency  which  more  likely  here  so  the  answer  is  a  and  the  the  height  should  be  fallen  more than  2.5  sd  below  mean  for  chronological  age  sex  and  ethnicity.  (below  25%  in  growth  chart) Somatomedin  c  is  another  name  to  insulin  like  growth  factor  (igf-1) 

Somatomedin  c,  which  is  another  name  for  insulin-like  growth  factor  1  (igf-1),  while  (human  growth  hormone)  hgh  levels  vary throughout  the  day  depending  on  diet  and  activity  levels,  somatomedin  c  levels  in  the  blood  are  more  stable,  making  its measurement  a  fairly  reliable  indicator  of  how  much  hgh  the  pituitary  gland  is  producing  overall. 

9

Newborn  with  congenital  adrenal  hyperplasia  present  with;

A.  Hirsutism

B.  Infantile  acne

C.  Abdominal  striae

D.  Dehydration

 

Answer:  d

There  are  three  main  types  and  the  presentation  depends  on  the  type  nd  patient  gender.

Http://emedicine.medscape.com/article/919218-overview

 it  is  easier  and  more  exam  directed  if  you  read  from  first  aid. 

10

8  years  old  girl,  parent  complains  that  she  looks  older  than  her  classmates  ,  wt  and  hight  above  the  95th  percentile  , otherwise  normal  :

A.  Reevaluate  after  12  months

B.  Obesity  medications

C.  Life  style  modification  

D. Surgical intervention

Answer:  c

Explanation:  this  is  most  likely  due  to  obesity.  Familial  tall  stature  also  known  as  constitutional  tall  stature  is  the  most  common cause  of  tall  stature.  The  second  most  common  cause  is  nutritional.  The  height  as  well  as  the  weight  are  at  higher  percentile. 

Again  the  bone  age  is  marginally  to  moderately  advanced  so  final  predicted  height  is  not  much.  Nutritional  tall  stature  is managed  by  life-style  changes  

11

An adolescent boy came to the clinic with unilateral gynecomastia. No other complaints. Everything was normal. How will you manage?      

a. Reassure                                            

b. Give hormonal therapy                    

 c. Breast US                                          

 

 Answer: A

Gynecomastia (transient development of breast tissue) is a common self-limited condition seen in 50% of male during puberty (but any discharge from nipple or fixed mass should be investigated)

12

boy with rickets (Picture was provided). What is the deficient vitamin? 

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Answer:  Vitamin D

13

15  years  old  has  DM with  dehydration?  

 

Explanation:  DKA  is  the  2nd  most  common  presentation  of  type1  diabetes  and  it  presents  with  polyuria, vomiting  ( which lead to  dehydration )

other symptoms : abdominal pain drowsniss and lathergy and fruity smelling 

14

Patient  diagnosed  with  congenital  adrenal  hyperplasia.  What  is  the  next  step?

 

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  Answer: IV  hydrocortisone

Initial  management  is  hydration  ,  long  term  is  Oral  steroids genetics

Mangment : 1- glucocorticoid... is necessary in children who have classical 21-hydroxylase deficiency and in symptomatic non classical 21 hydroxylase deficiency 

2- meneralocoticods and NACL is recommended in all pt who have classical CAH wether or not salt losing form e.g. Fludrocotisone 

response to therapy is monitor by measuring serum 17 hydroxyprogestrone , androstenedione, plasma renin activity and growth velocity 

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15

case  of  ambiguous  genitalia.  Which  hormone  you  would  like  to  check?

 

Answer:  17-hydroxyprogesterone  (Hormone)

 should  be  measured promptly  in  all infants  with  non  palpable  gonads  presenting  with  genital  ambiguity  to  exclude  congenital  adrenal  hyperplasia  (CAH)  due to  21-hydroxylase  deficiency.  

This  is  the  most  common  cause  of  genital  ambiguity  and  can  lead  to  lifethreatening adrenal insufficiency within the first weeks of life. Reference: Uptodate 

16

Pediatric  patient  with  classical  symptoms  of  Diabetes  +  elevated  blood  glucose  .  What  will  you  do next?

A. Urine  dipstick

  B. Genetic  testing  

C. HbA1c

 

Answer:  A

Urine  dipstick  to  pick  up  DKA  early  and  to  prevent  further  complications.

17

4  weeks  old  infant,  mother  happy  he  never  cries.  on  examination:  Jaundice  +  Umbilical  hernia  + Distended  Abdomen  +  Coarse  face  features  +  Bulging  frontal  fontanel.  Diagnosis?

A-  Congenetal  Hypothyroidism

B-  Gilbert's  Syndrome

C-  Cerebral  Palsy 

D-  Rickets

Answer:A

18

11 years old child obese with abdominal stria what is investigation you do

A. Adrenal CT

 B. morning & evening urine cortisol.

 

Answer:B

The case is most likely Cushing then, first we establish the presence of hypercortisolism The best initial test is 24 hr urine cortisol(more specific). If this is not in the choices, then 1 mg overnight dexamethasone suppression test  

Following are the best initial diagnostic tests:  

1 mg overnight dexamethasone suppression testing: A normal person will suppress the 8:00 a.m. level of cortisol if given dexamethasone at 11:00 p.m. the night before. A normal 1 mg overnight dexamethasone suppression test excludes hypercortisolism of all kinds. An abnormal test can still be falsely elevated from various stresses, such as these: -Depression -Alcoholism -Emotional or physical stress

 24-hour urine cortisol: This test is done to confirm that an overnight dexa-methasone suppression test is not falsely abnormal. The 24-hour urine cor-tisol adds specificity to the overnight test. If the overnight dexamethasone test is abnormal (fails to suppress), then get the 24-hour urine cortisol to confirm hypercortisolism (Cushing syndrome).

24-hour cortisol testing is more accurate (gives fewer false positives) than 1 mg overnight testing.

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19

Baby with delayed sitting, labs showed normal calcium, low PO4, what is the diagnosis ?

 

Vitamin D deficiency