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
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.
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
Because the patient could have hypoglycemic attack so give him shot of glucagon to increase his blood sugar.
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
➢ Average age for girls: 10 years old.
➢ Average age for boys: 11 to 12 years old.
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.
Premature adrenarche is when these changes begin early, before age 8 for girls and age 9 for boys
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.
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
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
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
Most common cause of precocious puberty in girls
B. Adrenal tumor
C. Ovarian tumor
D. Functional ovarian cyst
Idiopathic — central precocious puberty is idiopathic in 80 to 90 percent of cases of girls, but in only 25 to 60 percent of boys
Child his height and weight below normal besides growth hormone what you will order:
A. Somatomedin c
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.
Newborn with congenital adrenal hyperplasia present with;
B. Infantile acne
C. Abdominal striae
There are three main types and the presentation depends on the type nd patient gender.
it is easier and more exam directed if you read from first aid.
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
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
An adolescent boy came to the clinic with unilateral gynecomastia. No other complaints. Everything was normal. How will you manage?
b. Give hormonal therapy
c. Breast US
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)
boy with rickets (Picture was provided). What is the deficient vitamin?
Answer: Vitamin D
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
Patient diagnosed with congenital adrenal hyperplasia. What is the next step?
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
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
Pediatric patient with classical symptoms of Diabetes + elevated blood glucose . What will you do next?
A. Urine dipstick
B. Genetic testing
Urine dipstick to pick up DKA early and to prevent further complications.
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
11 years old child obese with abdominal stria what is investigation you do
A. Adrenal CT
B. morning & evening urine cortisol.
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.
Baby with delayed sitting, labs showed normal calcium, low PO4, what is the diagnosis ?
Vitamin D deficiency