Endocrinology MCQ COPY Flashcards by Chidera Nwaroh

4-year-old with bone age of 3 years. Growth charts provided. Weight is tracking. Height started at 3rd percentile and now is below the 3rd percentile.
a) Familial
b) Constitutional
c) GH deficiency
d) Malnutrition

b) Constitutional - bone age delay

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A 3-year-old girl presents with breast development. She has been otherwise well apart from recent growth spurt. On exam, she has Tanner 2 breast and pubic hair development and mucoid vaginal discharge. Growth chart shows increase from 50th to 85th percentile. What do you do?
a) US ovaries
b) MRI brain
c) Reassure and follow up in 3-6 mos
d) Serum testosterone/DHEAS

b) MRI Brain - to look for causes of central precocious puberty, central follows standard puberty sequence (just earlier), more common in girls

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15yo M with well-controlled T1DM. He complains of fatigue. He eats a varied diet, has a normal BMI and otherwise asymptomatic. He is found to have a microcytic anemia. TSH, creatinine, and UA are all normal. What is your next investigation?
a) Fecal calprotectin
b) Hbg electrophoresis
c) Vitamin B12 Level
d) TTG and IgA

TTG and IgA for celiac disease

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15y F presents to your clinic with a history of nausea, vomiting, and abdominal pain. She was also found to have postural tachycardia and hyperpigmentation underneath her tongue. Which of the following test would BEST identify her condition:
a) AM Cortisol level
b) ACTH Stim Test
c) ACTH Level
d) DHEA-S

ACTH Stimulation Test - this is gold standard diagnostic test for Adrenal Insufficiency. AM cortisol is a screening test. With primary adrenal insufficiency there is a suboptimal cortisol response because adrenal gland isn’t working properly and responding properly to signal from ACTH. Since we suspect primary, this would be the best test to identify the condition specifically.

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6-year old who has grown to the 85th percentile and has increased to the 95th percentile. He has multiple cafe au lait macules. He has evidence of precocious puberty with testicular enlargement. What lesion would you most likely find on MRI?
a) Hypothalamic hamartoma
b) Optic glioma
c) Craniopharyngioma
d) Pituitary adenoma

Optic nerve glioma - suspected

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Neurofibromatosis 1 Diagnostic Criteria (8)

C: > 6 or more Café-au-lait macules
>5mm pre-pubertal, >15mm post-pubertal
R: Affected 1st degree Relative
O: Optic nerve glioma
Importantly, they can also cause precocious puberty, as these tumors may affect the hypothalamic-pituitary-gonadal axis.
P: Pseudoarthrosis (distinctive osseous lesions can be sphenoid dysplasia or tibial pseudoarthrosis)
L: > 2 or more Lisch nodules
A: Axillary or inguinal freckling
N: > 2 neurofibromas OR 1 plexiform neurofibroma
Cutaneous neurofibromas are soft, benign tumors that develop on or under the skin
Plexiform neurofibromas can grow along nerve pathways and can be more complicated, sometimes causing deformities or functional impairment
D: Dysplasia of the sphenoid

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Indication for MRI in NF1

Symptomatic OPGs - proptosis, visual loss, and precocious puberty resulting from hypothalamic encroachment

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You are seeing a 15 year old female. She has had irregular menstrual periods in the three years since menarche. She has moderate to severe acne and hirsuitism. There is maybe an aunt with infertility? Which test is indicated as part of screening in her condition?
a) Serum lipids
b) Dexamethasone suppression test
c) Endometrial biopsy
d) OGTT

Serum lipids

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5 year old girl weighing 99 percentile, height 50th percentile, bmi 99th percentile, maternal grandfather died of MI at age 40. Labs show elevated total cholesterol, elevated ldl , low hdl elevated triglycerides. Normal exam. What is the best management
a) Start Asa
b) Start low carb diet
c) Start rosuvastatin
d) Start high fibre low fat diet

Start high fibre low fat diet - suspected Familial Combined Hyperlipidemia, a diagnosis is still needed before starting a statin (not indicated < 8 years)

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10 yo female, enlarged thyroid, firm, non-tender. Assessment otherwise unremarkable. Labs are T4 6.6 (low), TSH >50 (elevated). Next step:
a) Start methimazole
b) Start levothyroxine
c) Thyroid US
d) Technetium 99 scan

Start levothyroxine - hypothyroidism with a goiter, likely Hashimotos

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A 10-year-old child assigned female at birth has always preferred boy clothes and wanted to be referred to as a boy. The onset of puberty has been very distressing. What is the PRIMARY reason to start GnRH agonists in this child?
a) Allow for lower doses of gender-affirming hormones later on
b) to protect bone density prior to starting hormone replacement therapy
c) Prevent the development of secondary sex characteristics after onset of puberty
d) Facilitate gender-affirming surgery later on

Prevent the development of secondary sex characteristics after onset of puberty

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3 day old noted to have persistent hypoglycemia. Weight is at the 15th percentile and there was no maternal gestational diabetes or administration of antihypertensives during pregnancy. On exam noted to have a micropenis but otherwise his exam is normal. What would you most likely find on MRI brain?
a) Absent septum pellucidum
b) Agenesis of the corpus callosum
c) Arachnoid cyst
d) Subcortical heterotopia

Absent septum pellucidum - suspected septo-optic dysplasia

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16-year-old female with primary amenorrhea. She has SMR5 breasts and SMR1 pubic hair. What is the underlying etiology?
a) Prolactinoma
b) Pituitary insufficiency
c) Complete androgen insensitivity
d) Congenital absence of the uterus (Rokitansky syndrome)

complete androgen insensitivity - in keeping with primary amenorrhea, little public hair and normal breast development

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A 14 year old is worried that he hasn’t started puberty yet. He is growing 5cm/year along the 3% and weight is the 10%. His parents are 50%. On exam he has no auxiliary or pubic hair. Testicles are 4 and 5cm. What do you think is the most likely diagnosis?
a) GH deficiency
b) Hypergonadotropic Hypogonadism
c) Hypogonadotropic Hypogonadism
d) Constitutional delay

Constitutional Delay - this patient has delayed, not “stalled” pubertal development, which differentiates from the rest

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4y male presents with muscle cramping. He has a history of mucocutaneous candidiasis as an infant, but he is otherwise healthy. He was found to have a Calcium of 0.8 (low with normative range given) and phosphate of 2.8 (high with normative range given). What labs will most likely give you the diagnosis?
a) 25 Vitamin D
b) 1-25 Vitamin D
c) Parathyroid hormone
d) Urine Ca:creatinine ratio

Parathyroid hormone - autoimmune polyglandular syndrome

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autoimmune polyglandular syndrome clinical features (Whitaker triad)

Chronic mucocutaneous candidiasis (onset around age 5yrs)
Hypoparathyroidism (onset around age 10yrs)
Primary adrenal insufficiency (onset around age 15yrs)

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Baby presents on day 3 of life with ambiguous genetalia what is the most likely abnormality:

Elevated K - secondary to aldosterone deficiency

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Girl in DKA, has been started on insulin infusion. Initial labs had pH 7.16 with normal sodium and k. Chloride was 113? Eight hours later she is doing well. PH now is7.19 with sodium 147 K 3.8 chloride 133.
What is the cause of her persistent acidosis?

Hyperchloremia

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5 year old female with 2 episodes of vaginal bleeding. On exam, she has Tanner ?3 breasts, Tanner 1 pubic hair, and several cafe au lait macules. Her height is on the 97th percentile and her weight on the 50th (?). What is her underlying condition.
A) NF-1
B) McCune Albright
C) Ovarian Tumor
D) Pituitary Adenoma

McCune Albright

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McCune Albright Triad

triad of café au lait macules, fibrous dysplasia and PPP (from estrogen secreting ovarian cysts)

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“Coast of Maine” café au lait lesions

McCune Albright - also cross midline

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“Coast of California” café au lait lesions

Neurofibromatosis 1

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7-year-old patient with type 1 diabetes mellitus. Has had 1 day of abdominal pain and vomiting. Has recently transitioned to an insulin pump 2 weeks ago. Patient has very high glucose with ketones. What is your immediate next step?
a) Present to the emergency department for assessment
b) Administer correction with insulin pen and change insulin pump site
c) Bolus with pump and repeat BG in 2 hours
d) Change basal rate

Present to the emergency department for assessment

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15 year old girl with T1DM, diagnosed at the age of 7 years old. Presents with 2kg weight loss. HbA1c is 9.7%. What is the most likely cause of her weight loss?
A- Insulin Resistance
B- Nonadherence
C- Hyperthyroidism
D- Celiac Disease

Nonadherence-given increase HbA1c

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5 year old boy with lethargy associated with being ill. Labs show hypoglycemia around 2.1 with urinary ketones. Lytes, liver enzymes, all normal. Child has had previous episodes of mild lethargy with illnesses this year. What do you recommend a) Avoid fasting and pay attention to nutrition during illness forever b) Avoid fasting and pay attention to nutrition during illness until 8-9 years old c) Glucagon during hypoglycemia d) Hydrocortisone during illnesses

Avoid fasting and pay attention to nutrition during illness until 8-9 years old

A 14yo girl presents with restlessness and a mass in her neck. TSH low. FT4 and T3 both clearly elevated. How do you treat? a) Methimazole b) PPU c) Iodine d) Levothyroxine

Methimazole

A 12 year old girl has been gaining weight for 3 years. Her BMI is 33. She has appropriate caloric intake and activity levels for her age. Her height was tracking along the 25th % but is now tracking along the 10th%. She has abdominal obesity and wide abdominal straie (no color mentioned) as well as mild acne. Her blood pressure is 140/80s. What is the most likely cause? A) Cushing's syndrome B) Craniopharyngioma C) Hypothyroid D) Exogenous obesity

Cushing's syndrome - abdominal adiposity, striae, HTN, short stature

Girl on risperidone presents with amenorrhea and galactorrhea. What is the mechanism of action? A) TRH agonist B) Dopamine antagonist C) LH and FSH agonist

Dopamine antagonist

8yo boy with increase in height, deepening of voice, some pubic hair and testes 3 mL. What is the most likely cause? A- Klinefelters B- Adrenal carcinoma C- Pituitary adenoma D- Idiopathic precocious puberty

Adrenal carcinoma

Child with congenital adrenal hyperplasia is having elective tonsillectomy. What do you order for her post-operatively? a) 30mg/m2 divided QID b) her home steroids once she is taking oral fluids c) 100mg/m2 divided QID d) Routine care

30mg/m2 divided QID - stress dosing for moderate surgery

A 13 year old female has an LDL of 6.82. Her HDL and triglycerides were normal. Her BMI is above the 97th percentile. Her TSH is 4.9. Her father is obese and had a MI at age 42. What is the most likely diagnosis? a) Familial hypercholesterolemia b) Subclinical hypothyroidism c) Familial combined dyslipidemia d) Obesity related dyslipidemia

Familial hypercholesterolemia - isolated elevated LDD

Child presents in DKA. pH 6.9, BG 30, looked unwell, tachycardic, and GCS 13. What do you do next? a) Bolus 10mL/Kg NS b) Hypertonic saline c) CT head d) Insulin infusion

Bolus 10mL/Kg NS

7yo boy with autism is referred to your office for obesity. He was hypotonic as an infant and parents report he snacks constantly and his weight is now above the 97th percentile with length at the 75th percentile. He has pale abdominal striae on exam and a dorsocervical fat pad. What is the best diagnostic test? a) CGH microarray b) DNA methylation studies c) Morning cortisol d) MRI brain

DNA methylation studies

A 1-year-old girl is referred to you for breast development. Previous history non-contributory, and she has not had a recent growth spurt. She is well appearing and general exam is normal except for Tanner Stage 2 breasts. What is the best next step? a) Bone age b) Estradiol, LH, FSH c) Abdominal ultrasound d) Reassure and reassess in 6 months

Reassure and reassess in 6 months for premature thelarche

A school-aged girl has a growth velocity of 2cm/year. Did not mention anything about a bone age nor was this one of the options. What should you do next? a) Continue measuring her height for 6 more months b) TSH c) CT Head d) Nocturnal growth hormone

TSH - This child has delayed growth velocity as for her age (age 4yr-puberty) she should be growing 4-7cm/yr. First line investigation for all children with delayed growth velocity / short stature

Male teen with gynecomastia, Tanner Stage 5. He is extremely distressed. a) Refer to plastic surgery

Refer to plastic surgery

Obese boy without dev delay, rapid weight gain, pale abdominal striae, what diagnosis? a) Cushing syndrome b) Exogenous hormones c) Prader-Willi syndrome

Prader-Willi syndrome

An 8 year-old boy presents with 3 weeks of polydipsia, polyuria, and fatigue. He presents to ED with a BG of 22. His blood gas is normal. He is started on subcutaneous insulin and was discharged the next day. At home, he is having frequent episodes of hypoglycemia despite dramatically reducing his insulin dose. What is the most likely cause? a) Inappropriate dosing of insulin b) Inappropriate diagnosis of T1DM c) Resolution of stress-related hypoglycemia d) Honeymoon period of diabetes

Honeymoon period of diabetes

An 8-year-old girl is referred to you because of breast development. She has Tanner Stage 3 breasts but no other signs of puberty. On dermatological exam she has axillary freckling and 7 large cafe au lait macules. What is the cause of her symptoms? a) Ovarian cyst b) Granulosa cell tumor c) Hypothalamic hamartoma d) Optic glioma

Optic glioma (associated with NF-1)

A one-week-old infant presents to the ED with a seizure. They were born at term after an uncomplicated pregnancy with a birth weight of 4.8kg. They are normally formula fed every 1-2 hours, but parents let him go a bit longer between feeds and found him unresponsive and jerking. He is hypoglycemic with a BG of 1.8. After stopping the seizure and drawing a clinical sample, he is admitted to hospital. Besides IV fluids, what other medical management would you initiate? a) Diazoxide b) Glucagon c) Azathioprine d) Hydrocortisone

Glucagon

A 16-year-old gymnast has had irregular periods since menarche. She also has upper lip hair and moderate acne on her forehead and back. BMI 15. What is she most likely to also have? a) Polycystic ovaries on ultrasound b) Insulin resistance c) Elevated LH/FSH ratio (originally written as FH/LSH ratio) d) Elevated serum testosterone

elevated serum testosterone

Girl with very high T4 and high T3. TSH <0.02 (low). Has maternal aunt with hypothyroidism. What will you use to treat? a) Propylthiouracil (PTU) b) Radioactive iodine c) Methimazole d) Levothyroxine

Methimazole

6 year old obese boy. Having behavioural and learning difficulties. Weight is > 99.9th percentile, height is 15th percentile. Daytime somnolence. Mild hypotonia. a) Cytogenetic testing b) Leptin Level c) 24h urine cortisol d) TSH

Cytogenetic testing - this is prader willi

Term newborn noted to be hypotonic after birth. Required CPAP for 48 hours. He is stlll requiring NG feeds. He is noted to have bilateral undescended testes. What investigations is most likely to give you the diagnosis? a) 17-hydroxyprogesterone level b) DNA methylation studies c) MRI of the pituitary d) Chromosomal microarray

DNA methylation studies

9 year old female presenting in DKA Initial bloodwork: Blood glucose 27, pH 7.12, HCO3 5, sodium was normal, K 4.9 She was started on IV normal saline + 40 meq/L KCl and Insulin 0.1 units/kg/hr. 2 hours later: BG 15, pH 7.19, HCO3 9, sodium still normal, K 3.7, Anion gap calculated at 15 (did yourself) What do you do next? a) Increase potassium IV b) Continue current management c) Add dextrose to the IV

Add dextrose to the IV

12 yo F w recent anorexia, abdominal pain, fatigue, malaise. Labs with increased PTH and mildly elevated serum calcium (3.43). Mother with recent diagnosis of prolactinoma. Family history of a few uncles with kidney stones. What is the diagnosis? A. MEN 1 B. sarcoidosis C. autoimmune polyglandular syndrome D. Albright’s osteodystrophy

MEN 1

MEN 1 Diagnosis

2 classic endocrine tumor types (parathyroid, pit, pancreas) or presence of one of these tumors in 1st degree relative of a patient with known MEN1

What is the best test for Vit D deficiency a) 25 dihydroxy b) PTH c) Calcium d) 1,25 dihydroxy

Serum 25OHD

2 year old boy 3 days of vomiting and diarrhea. Lethargic. Glucose low (2.4?). Ketones 2+. Most likely diagnosis? a) fatty acid oxidation b) glycogen storage c) adrenal insufficiency d) ketotic hypoG

Idiopathic ketotic hypoglycaemia

A healthy 16 year old male has noticed breast tissue increase over the last 2 years. His BMI is at the 85th percentile. He has adult sized testes, SMR 5 pubic hair and SMR 4 breast tissue. He is extremely distressed about the breast tissue. Other than healthy active living, what will be included in your management? a) Plastic surgery referral b) Ultrasound of both breasts c) Trial of anti-estrogen medication d) Trial of aromatase inhibitor

Plastic surgery referral

Familial hypercholesterolemia

Child with vomiting, lethargy, fatigue. Labs given. Hyponatremia, hyperkalemia, low chloride, normal glucose. Sosm > Uosm. What is the diagnosis? a) SIADH b) Diabetes Insipidus c) Barters d) Adrenal insufficiency

Adrenal insufficiency

14 yo girl who is treated with levothyroxine for Hypothyroidism. She has been on it for 2 weeks but still has fatigue and a 5 kg weight loss. She has a borderline low blood pressure. Her lab work reveals: Na 127, K 5.8, Glucose 3.4. TSH 90. What is the next best step: a) IV hydrocortisone b) IV dextrose c) 3% hypertonic saline d) Increase levothyroxine dose

IV hydrocortisone

12yo female with menarche 1yr ago periods every 3mos for 5d and mild dysmenorrhea. Upper lip hair and some on lower abdomen. BMI 20. Maternal aunt infertility. Best management? a) Pelvis U/S b) Start OCP c) Serum androgens, A1C, glucose, insulin d) Reassure and re-assess in 1yr

reassure and reassess in 1 yr (can take up 2 yrs to get a regular period)

A baby is born to a mom with Graves disease. Mom had positive TRABs. Baby is now 36 hours old and “ready for discharge.” What is the next step in management? a) Monitor in hospital for another 36 hours b) Check thyroid function at 3-5 days c) Start methimazole and check function in 1? 2 ? weeks d) Check function in 2 weeks

Check thyroid function at 3-5 days

Girl who is non-symptomatic, with firm diffuse enlarged thyroid, with normal skin and hair, no cold intolerance, normal school, normal growth, normal TSH (4.6); what to do? a) thyroid ultrasound b) refer to endocrinology c) follow-up 6 months

follow up in 6 months

13mo female presents to the emergency room with convulsions. She is found to have an ionized calcium of 0.81. She has been exclusively breast fed. Her physical exam shows widened wrists and ankles. What other laboratory abnormalities are likely to be present? a) Low PTH b) Low Mg c) High ALP d) High phosphate

High ALP

Maternal risk factors for Rickets (5)

1. Low intake of VitD rich foods (consuming <2cups/day of milk or fortified soy beverage, low consumption of fish and sea mammals) 2. Lack of Vit D supplementation during pregnancy 3. Use of certain medications (ex: some antiretrovirals and antiepileptics 4. Multiple pregnancies 5. Smoking

Infant Risk Factors for Rickets (1)

Mother not ingesting sufficient Vit D supplements or otherwise at risk for for Vit D deficiency (regardless of infant feeding mode)

Child risk factors for Rickets (3)

1. Low intake of Vit D rich foods 2. Mother has risk factors for VitD deficiency 3. Lack of Vit D supplementation during infancy

General Risk Factors for Rickets (7)

1. Darker skin pigmentation 2. Food insecurity 3. Obesity 4. Living in communities North of 55* latitude (Edmonton is 53) 5. Living i area where Vit D deficiency is prevalent 6. Extensive use of sun block or skin coverage by clothing or lack of exposure to outdoors 7. Low socio-economic status

A 6 year old girl presents with one breast that is SMR 2 and one that is SMR 3. Exam otherwise normal. What is the most likely cause? A) Premature thelarche B) Precocious puberty C) Breast cyst

Premature thelarche

A 7 yo boy has difficulties with attention and has become ataxic over the last few months, gradually worsening. He still has tan lines and it’s March. What test would you order? A) VLCFA B) AM Cortisol C) MRI brain D) Microarray

VLCFA (Very Long Chain Fatty Acids test) for X-linked adrenoleukodystrophy

2 year old boy with FTT, polyuria, polydipsia. He has a large liver. Investigations show normal anion gap metabolic acidosis. He has glucosuria with normal serum glucose. What will give you the diagnosis? A- CT abdomen B- urine organic acids C- plasma amino acids D- FFA

urine organic acids

4y male with SMR3 pubic hair, enlarged penis but prepubertal testes. Next step? a) LHRH stimulation test b) Adrenal androgen levels c) MRI brain d) Testicular ultrasound

Adrenal hormone levels

11 yr old girl complains she is the shortest in her class. with school difficulties, esp math. Has had many AOMs and unilateral SNHL. Has bicuspid aortic valve. What is the diagnosis? A. CHARGE syndrome B. Noonan C. Turner D. Williams

Turner Syndrome

2yo with 1 day of vomiting and diarrhea in the ER is lethargic. Blood glucose 2.0. Gets better after IV glucose. What will support your diagnosis? A. Low GH B. hyperinsulinism C. urine for reducing substances D. elevated urine ketones

elevated urine ketones

2 ½ month-old with Prader Willi Syndrome comes to your office for a weight check. Currently feeds 120mL of 20kcal/30mL formula q3h. Weight is 3.1kg. He has gained 12g/day over the last week. What do you recommend for his feeds? a) Insert nasogastric tube for feeds b) Decrease feed volumes because he is at risk of obesity c) Increase caloric density of feeds d) No change to current feeds

Increase caloric density of feeds

Teen girl with acne, hirsutism, purple striae on abdomen and legs. BP 140/90. What is the BEST test for diagnosis? a) Dexamethasone suppression test b) Random urine cortisol c) Morning serum cortisol d) Aldosterone: renin ratio

Dexamethasone suppression test

You are trying to diagnose complete diabetes insipidus. Which of the following would you expect post-water deprivation test? a) Rise in serum osmolarity b) Drop in serum osmolarity c) Rise in urine osmolarity d) Drop in urine osmolarity

Rise in serum osmolarity

15 year old gymnast with menarche at age 11 and presenting with periods q2-3months. BMI at the 25th percentile. She has hirsutism and Grade III acne. She has mildly elevated LH and testosterone. FSH, DHEAS and prolactin are normal. What is the diagnosis? a) Cushings b) Congenital adrenal hyperplasia c) PCOS d) Physiologic anovulatory cycles

PCOS

An amenorrheic teenage girl has SMR 5 breasts and SMR1 pubic hair. What is the most likely diagnosis? a) Prolactinoma b) Pituitary Insufficiency c) Complete Androgen Insensitivity Syndrome d) Congenital Absence of the Uterus

Complete Androgen Insensitivity Syndrome

A 7 year old boy has had type 1 diabetes for the last 3 years. If this does not result in excessive hypoglycemia, what should the target be for his HbA1C? a) 6.5% b) 7.0% c) 7.5% d) 8.0%

7.5%

A neonate’s newborn screen shows a TSH of 45. What is the NEXT step in management? a) Book a visit for a physical exam b) Order a TSH + free T4 c) Order a radionuclide thyroid scan

Order a TSH + free T4

6 yo girl is referred to you for short stature. She is growing on the 3rd %, weight on the 50%. Her physical exam is normal. Her growth velocity is 3 cm/year and her bone age is 4 years. What is the most likely diagnosis? a) Growth hormone deficiency b) Turner syndrome c) Chrondrodysplasia d) Constitutional growth delay

Growth hormone deficiency

A boy (? 5y) has pubic hair but testes < 2ml. What is the most likely reason for this? a) Exogenous testosterone b) Klinefelters c) Normal variant

Normal variant

A boy is growing along the 3rd % for height. His parents are 175cm (dad) and 155cm (mom). What do you do? a) F/U in 6 months b) Do TSH c) Do IGF-1

Do TSH

You are following a 16 year old diabetic girl and notice that she has lost a significant amount of weight since her last visit to clinic. You suspect: a) an eating disorder b) non compliance with insulin

non compliance with insulin

A child is noted to be drinking ++ water and has very dilute urine. What is the most likely diagnosis? a) Psychogenic polydipsis b) SIADH c) Diabetes

Diabetes

A 5 month old boy who has been unwell for 48 hours (not feeding, lethargic) presents with glucose 0.8, metabolic acidosis, no urine ketones. Glucagon is given and raises the blood sugar to 1.2. What is the most likely diagnosis? a) Glycogen storage disease b) Fatty acid oxidation disorder c) Hyperinsulinism

Fatty acid oxidation disorder (need a 1.7 rise in blood glucose to be considered a response)

6-day old baby girl with elevated 17-OHP on newborn screening, which of the following is most likely? a) Hypernatremia b) Hypokalemia c) Clitoramegaly d) Palpable gonads

Clitoramegaly

11 yo male who is obese. His father had a myocardial infarction at the age of 38 years. His total cholesterol is 6.3 and his LDL is 3.8. What is the best management? a. lifestyle modification b. lifestyle modification and low-fat diet c. lifestyle modification and bile acid sequestrant d. lifestyle modification and statin

lifestyle modification and low fat diet (need to confirm familial hypercholesterolemia genetically before starting a statin)

Diabetic girl with weight loss. T1DM, straight A student fell of curve from 25% to 5% for weight. HbA1C 8%. Which is the most likely cause of her weight loss? a) Eating disorder b) celiac

Diabetic with weight loss and diarrhea and bullous itchy rash on extensors and over trunk. Abdominal pain that’s nonspecific. No hematochezia. a) Celiac b) Eosinophilicgastroenteropathy

Celiac

When do you give insulin to give in DKA? a) After fluid resucitation B) Immediately c) After start fluid resucitation

After fluid resucitation

Mid parental height 155cm and 175cm of mom and dad for a male child. a. 161 b. 168 c. 171

171

What investigation to do in a male child whose height is on 3rd percentile, with parents having heights of 155cm mom, 175cm dad a) Bone age b) GH c) Karyotype

Bone age

Child has autoimmune thyroiditis, want to monitor therapeutic treatment of levo, how do you do this? a) TSH b) FT4 c) T4 d) Thyroid peroxisome

TSH - you do not need to monitor Free T4 as per Choosing Wisely

14 yo girl, tanner 1, normal BA, Normal weight, 3Rd percentile height. What is the diagnosis? a) Turner b) Hypothyroid c) GH deficiency

Turner Syndrome

Boy on risperidone with gynecomastia. What would we look for before switching?

Prolactin

10 y.o with metabolic syndrome. What is the best measure of adiposity to follow? a. BMI b. Hip-to-waist circumference ratio c. Waist circumference d. Triceps fat fold thickness

BMI

Kid w SIADH, what happens? a. Urine osmol is more than serum osmol

Urine osmol is more than serum osmol

2 year old kid with thelarche; bone age & stature age is 3 years; what do you tell parents? a. Will resolve by 3 years b. Fast progression to puberty c. Slow progression to puberty

Will resolve by 3 yrs

3y boy with rickets. Which test is most helpful in establishing the diagnosis? a. PTH b. Alkphos c. 25 OHD d. 1-25 OHD

25 OHD - vit D rickets

Newborn with ambiguous genitalia. What will help most with your differential diagnosis?

Palpable gonads

14 year old girl. Tanner 1 for breast and pubic hair. Height 5%ile for age.Absent menses. Bone age is equal to chronologic age. What is her most likely diagnosis? a. Hypothyroid b. Turners c. GH deficiency d. Nutritional

Turner’s syndrome

The parents of an 8 year old child present to you to ask about screening for Diabetes Mellitus type 2. Both parents have DMII and they would like to know when their child should be screened? a. Now b. at 10 years c. at puberty d. only if he develops symptoms suggestive of DMII

at puberty

A question describing a baby with ambiguous genitalia, palpable gonads. Which is most likely? a. CAH b. Partial androgen insensitivity c. 5 alpha reductase deficiency d. Pseudohermaphroditism

Partial androgen insensitivity

10d poor feeding, lost 12% of BW, with low Na 120s, high chloride 110s, low bicarb 18, no anion gap, K 3.5, Glucose 4.1? a) Wrong mixing of formula b) CAH c) Galactosemia d) Urea cycle defect

wrong mix of formula

15-year-old girl with type 1 diabetes presents with weight loss, muscle wasting, and dry skin. Her diabetes is very well controlled with a HbA1c of 7.1%. She is stressed about school, even though she is a straight A student. What is her most likely diagnosis?

Eating disorder

8-hour old neonate has an elevated 17-OHP. What is the next best test? a) Glucose b) Electrolytes c) Testosterone d) Karyotype

blood sugar or karyotype both are correct per dr martin glucose is fair for an 8 hr old usually 17-OHP are stable with lytes and blood sugar, so karyotype is best test dr martin would choose karyotype

A 2-year-old girl presents with thelarche. Growth velocity is normal. There is no leukorrhea, menarche, or pubarche. Her bone age is 3 years. What is the most likely diagnosis? a) Premature thelarche that will remain until onset of puberty b) Premature thelarche that will resolve spontaneously c) Central precocious puberty d) Peripheral precocious puberty

Premature thelarche that will resolve spontaneously

Which is true regarding puberty? a) In boys, peak growth velocity occurs during tanner stage II b) In girls, menarche follows onset of puberty by about 2 years c)Pubertal progression is similar in boys and girls d) In boys, testicular enlargement during puberty is secondary to increasing testosterone levels

In girls, menarche follows onset of puberty by about 2 years

Which is true regarding central precocious puberty? a) A CNS abnormality is more likely to be seen in girls than boys b) Bone age corresponds with chronological age in boys c) Stimulated gonadotropin levels demonstrate elevated LH and FSH with LH predominance d) 21-hydroxylase enzyme defect is the most likely cause

Stimulated gonadotropin levels demonstrate elevated LH and FSH with LH predominance

A 16-year-old-boy comes in with delayed puberty. He has sensorineural hearing loss since infancy. He is otherwise healthy aside from anosmia attributed to allergic rhinitis. Exam shows testes are 2mL and pubic hair is tanner 1. What diagnosis is most consistent? a) Klinefelter syndrome b) Constitutional delay of growth and puberty c) Prader-Willi syndrome d) Kallmann syndrome

Kallmann syndrome

9-year-old boy presents with short stature, < 3rd percentile. He is otherwise healthy with no past medical history. What investigation will help distinguish between familial short stature and constitutional delay of growth and puberty? a) Bone age b) Mid-parental height c) Growth velocity d) IGF1 leve

bone age

10-year-old girl with an enlarged thyroid, diffuse nontender. T4 6.6 TSH >50, thyroid antibodies positive. What is your next step in management? a. Start methimazole b. Order thyroid ultrasound c. Order radionuclide scan d. Start levothyroxine

Start levothyroxine - this hashimoto

8-month-old child with VSD, hypocalcemia, hypertelorism and cleft palate. Ionized calcium of 0.81. Asymptomatic. How do you manage his hypocalcemia? a. Calcium supplements b. PO Vitamin D c. PO Calcitriol d. IV Calcium due to severity

PO Calcitriol this is DiGeorge and hyperparathyroidism if you just gave calcium, they wouldn't absorb it

After discontinuing sources of vitamin D and Ca, what is your initial management of hypercalcemia? a. Calcitonin b. IV fluids c. Furosemide d. Pamidronate

IV Fluids

13-month-old with low calcium, seizure. Exclusively breastfed, no supplementations or medications. Solid foods appropriately introduced at 6 months. Not yet ambulatory and has difficulty standing, even with assistance. Which lab value matches the most likely diagnosis: a. Decreased alk phos b. Decreased PTH c. Increased 1,25 Vitamin D d. Low phosphate

low phosphate (vit D def would lead to low phos) if stem indicated more so digeorge then decr alk phos is the beter answer

Mediterranean teen with coarse hair on chest, bum, legs, arms. Mod-severe acne. Most likely dx? a. CAH b. PCOS c. Familial hirsutism

PCOS - as long as they are female! (if male, familial hirstutism)

Endocrinology MCQ COPY Flashcards

(111 cards)