Endocrine Disorders Flashcards
Secondary hypothyroidism results from:
a) excess release of thyroid hormone beyond the newborn period
b) intrauterine exposure to thyrotoxic drugs
c) disease or disorder of the thyroid gland itself
d) disease or disorder of the hypothalamus or pituitary gland compromising thyroid function
d) disease or disorder of the hypothalamus or pituitary gland compromising thyroid function
Congenital hypothyroidism has a higher incidence in which of the following populations?
a) African-Americans
b) Hispanic and Native Americans
c) Asian-Americans
d) Euro-Americans
b) Hispanic and Native Americans
Which of the following is not a sign or symptom of congenital hypothyroidism?
a) hoarse cry
b) frequent stooling
c) coarse features
d) lethargy
b) frequent stooling
The most common cause of hyperthyroidism in children and adolescents is:
a) Graves’ disease
b) thyroid cancer
c) thyroid nodules
d) pituitary tumor
a) Graves’ disease
Which of the following is not found in an adolescent with untreated Graves’ disease?
a) behavioral problems
b) sleep disturbances
c) tendency to gain weight easily
d) tachycardia
c) tendency to gain weight easily
In which one of the following children would you most suspect hyperthyroidism?
a) a 16 yo male who complains about restlessness
b) a 14 yo adolescent female who is heat intolerant and has amenorrhea
c) a male preteen with behavior problems
d) a 6 yo female who complains of tiredness
b) a 14 yo adolescent female who is heat intolerant and has amenorrhea
The most common thyroiditis is:
a) subacute thyroiditis caused by a viral infection of the gland
b) acute suppurative thyroiditis caused by a bacterial infection
c) caused by exposure to radiation or trauma
d) Hashimoto’s or chronic autoimmune thyroiditis
d) Hashimoto’s or chronic autoimmune thyroiditis
Nephrogenic, or vasopressin-resistant diabetes insipidus:
a) is caused by anatomic defects in the brain causing hypofunction of the pituitary or hypothalamus
b) results from damage to the hypothalamus or pituitary from surgical trauma or infection
c) is caused by reduced renal responsiveness to antidiuretic hormone (ADH)
d) Has oliguria as a primary presenting symptom
c) is caused by reduced renal responsiveness to antidiuretic hormone (ADH)
An infant with polydipsia, polyuria, irritability, and FTT should be evaluated for:
a) diabetes insipidus
b) homocytinuria
c) growth hormone deficiency
d) hyperglycemia
a) diabetes insipidus
Which one of the following is not characteristic of constitutional growth delay?
a) there is generally no history of a similar growth pattern in other family members
b) the child usually remains constitutionally small as an adult
c) final adult stature tends to be normal
d) weight and height at birth are generally in the lower percentiles
c) final adult stature tends to be normal
A newborn or infant with birth length
a) growth hormone deficiency
An adolescent male who fails to develop secondary sex characteristics at puberty and who has small, underdeveloped testes should be suspected of having:
a) adrenal hyperplasia
b) klinefelter’s syndrome
c) marfan syndrome
d) cerebral gigantism (Sotos syndrome)
b) klinefelter’s syndrome
Individuals with chronic adrenal insufficiency often have:
a) frequent OM
b) high energy levels
c) love for physical activity
d) a craving for salt
d) a craving for salt
In the newborn period, infants of diabetic mothers (IDMs) are particularly at risk for:
a) small size for gestational age
b) IUGR
c) disorders in bone development
d) hypoglycemia
d) hypoglycemia
Which statement is true about true (complete) precocity or incomplete (pseudoprecocity)?
a) true precocity occurs because of hormonal stimulation from the pituitary or hypothalamus causing gonadal maturation and fertility
b) pseudoprecocity does not involve development of any secondary sex characteristics
c) incomplete precocity is caused by adrenal or gonadal tumor or dysfunction and results in increased linear growth but no development of secondary sex characteristics
d) incomplete or pseudoprecocity leads to testicular growth and ovulation
a) true precocity occurs because of hormonal stimulation from the pituitary or hypothalamus causing gonadal maturation and fertility
An adolescent who has tall stature, increased arm span, arachnodactyly, laxity of joints, pectus excavatum, and an abnormal echocardiogram would be suspected of having:
a) Turner’s
b) Beckwith-Wiedemann syndrome
c) Marfan
d) Klinefelter’s syndrome
c) Marfan
Which one of the following is not found in children with growth hormone excess?
a) tall stature
b) prominent mandible and supraorbital ridge
c) high or normal plasma growth hormone
d) short stature
d) short stature
A pathognomonic skin finding in children with chronic adrenal insufficiency (Addison’s) is:
a) purple striae
b) increased pigmentation in the axilla, groin, areola, hand creases, and surgical scars
c) dry, thickened skin
d) increased perspiration
b) increased pigmentation in the axilla, groin, areola, hand creases, and surgical scars
Which of the following findings is not characteristic of children and infants with hyperadrenocorticism?
a) advanced skeletal maturation
b) “moon” facies
c) delayed onset of secondary sex characteristics
d) “buffalo type” adiposity of face, neck, and trunk
a) advanced skeletal maturation
Transient neonatal hypoglycemia is:
a) most common in AGA infants
b) low in premature SGA infants
c) most common in LGA infants
d) least common in LGA infants
c) most common in LGA infants
Regular insulin:
a) has a quicker onset of effect and longer duration than NPH
b) has a slower onset of effect and shorter duration than NPH
c) has a quicker onset of effect and shorter duration than NPH
d) has the longest duration of the insulins available
c) has a quicker onset of effect and shorter duration than NPH
The preferred name now for insulin-dependent diabetes mellitus (IDDM) is:
a) maturity-onset diabetes
b) Type 1 diabetes
c) Type 2 diabetes
d) Insulin resistance syndrome
b) Type 1 diabetes
Blood glucose levels of younger children with diabetes should be maintained between:
a) 70-180
b) 100-200
c) 60-80
d) slightly over 200
a) 70-180
Blood glucose levels of younger children with diabetes are maintained at slightly higher levels than blood glucose levels of older children because:
a) children have a greater need for available glucose in the blood system
b) younger children tend to be more active
c) younger children become more irritable than do older children
d) lowering the risk of hypoglycemia in younger children is particularly important in order to avoid the potential for hypoglycemia with consequent neurological system damage
d) lowering the risk of hypoglycemia in younger children is particularly important in order to avoid the potential for hypoglycemia with consequent neurological system damage
Glucagon should be used to treat:
a) children with mild hypoglycemia
b) children with moderate hypoglycemia
c) children with severe hyperglycemia
d) children with severe hypoglycemia
d) children with severe hypoglycemia
Which finding is not a sign or symptom of diabetes onset in children?
a) alopecia
b) glycosuria
c) polydipsia
d) polyuria
a) alopecia
Abdominal pain and vomiting are particularly critical to monitor in children with diabetes because these findings may represent the onset of:
a) ketoacidosis
b) gastrointestinal infection
c) hyperglycemia
d) autoimmune response to the pancreas
a) ketoacidosis
Which of the following statements is not true about type 1 diabetes?
a) the honeymoon period post diagnosis is of variable duration
b) diabetes is a relatively common disease in childhood
c) children with type 1 diabetes can switch to oral insulin agents once they reach adulthood
d) three factors influence a child’s potential to develop diabetes–genetic disposition, autoimmune response, and exposure to viral or chemical agents
c) children with type 1 diabetes can switch to oral insulin agents once they reach adulthood
Precocious pubertal development is defined as the development of secondary sexual characteristics in boys before age ___ and menses in girls before age ___.
a) 10, 10
b) 6, 8
c) 9, 9.5
d) 6, 9
c) 9, 9.5
In boys, lack of secondary sexual characteristics after 17 years suggests:
a) castration
b) abnormal testicular function
c) true hermaphroditism
d) pituitary adenoma
b) abnormal testicular function
The peak incidence for adolescent gynecomastia occurs at:
a) 10 years
b) 13-14 year
c) 16 years
d) 18 years
b) 13-14 year
The most common cause of primary amenorrhea is:
a) obstructions of menstrual flow
b) primary ovarian insufficiency
c) secondary ovarian insufficiency
d) constitutional or familial
d) constitutional or familial
You receive the results of a newborn screening and find that the TSH, done at day 2, is 82. What is your best option?
a) have the child come to the clinic next week for a reevaluation
b) re-screen the child in one month
c) begin thyroid supplementation immediately
d) reassure the family that these are normal results
c) begin thyroid supplementation immediately
If T4 > 6.5 and TSH > 20 the infant should be started on thyroid replacement immediately and referred to endocrinology.
You are evaluating a 13 yo girl for Graves’ disease. Which of the following signs would not support this diagnosis?
a) an enlarged thyroid
b) exopthalmos
c) a positive family history
d) an elevated TSH level
d) an elevated TSH level
In hyperthyroidism the TSH level is suppressed.
The routine screening of a newborn in your practice indicates that the baby has congenital hypothyroidism and is in need of a referral to an endocrinologist. The treatment of choice for congenital hypothyroidism is:
a) levothyroxine
b) propylthiouracil
c) potassium iodide
d) radiation therapy
a) levothyroxine
A child is being evaluated for short stature. Pertinent findings include delayed bone age, delayed onset of puberty and a stature that is normal for the child’s bone age. In addition, the mother states that the child’s father grew taller in college and wonders if this will happen with their son. The most likely cause is:
a) familial short stature
b) chromosomal abnormality
c) constitutional delay of growth and puberty
d) endocrine abnormality
c) constitutional delay of growth and puberty
Which chromosomal abnormality is associated with short stature in girls?
a) down syndrome
b) turner syndrome
c) klinefelter’s syndrome
d) prader-willi syndrome
b) turner syndrome
Achondroplasia refers to a growth delay that is:
a) due to malabsorption
b) associated with Noonan syndrome
c) associated with endocrine disorders
d) manifested by disproportionately short stature
d) manifested by disproportionately short stature
You are following a 4 yo girl in your practice with a h/o breast development that appeared 12 months ago and appears to be progressing. She is growing rapidly. Ordering a bone age would be appropriate because premature thelarche in girls is:
a) a result of enzymatic defects
b) due to systemic CNS disease
c) idiopathic
d) a result of hypothyroidism
c) idiopathic
Sexual precocity is idiopathic in 80% of girls.
The mother of an 11 yo boy is concerned that he is developing secondary sexual characteristics too early. Your counseling is based on the knowledge that puberty is considered precocious in boys id secondary sex characteristics appear prior to age:
a) 12
b) 11
c) 10
d) 9
d) 9
Treatment of true (central) precocious puberty is best achieved with:
a) synthetic follicular stimulating hormone
b) gonadotropin releasing hormone
c) dexamethasone
d) thyroid hormone
b) gonadotropin releasing hormone
Central precocious puberty is suppressible with analogues of long-acting gonadotropin-releasing hormone (GnRH).
The pathophysiology of type 1 diabetes is:
a) autoimmune destruction of the pancreatic beta cells
b) primary insulin receptor resistance
c) increased hepatic glucose production
d) reduced glucose uptake by target tissue
a) autoimmune destruction of the pancreatic beta cells
An 11 yo girl presents with symptoms of polyuria and polydipsia. Which of the following diagnoses must be ruled out?
a) diabetes mellitus
b) hyperthyroidism
c) adrenocortical insufficiency
d) nephrotic syndrome
a) diabetes mellitus
For children with diabetes, in addition to home monitoring of blood glucose and urine ketone levels, glycosylated hemoglobin (Hgb A1C) should be measured every:
a) 1 week
b) 1 month
c) 3 months
d) 6 months
c) 3 months
A pregnant mother is worried about possible risks to her fetus because she has gestational diabetes. Which of the following conditions is the fetus not at risk for?
a) congenital anomalies
b) hypoglycemia
c) birth trauma
d) congenital hearing loss
d) congenital hearing loss
Infants with IUGR are prone to hypoglycemia primarily because they:
a) have a decreased metabolic rate
b) have little glucose stores in the form of glycogen and fat
c) become acidotic
d) are prone to sepsis
b) have little glucose stores in the form of glycogen and fat
During the PE of a 2 wo male you notice that his scrotum is hyperpigmented. You know that the most common cause of ambiguous genitalia is:
a) idiopathic
b) a chromosomal defect
c) congenital adrenal hyperplasia (CAH)
d) an embryologic disorder
c) congenital adrenal hyperplasia (CAH)
Which of the following signs or symptoms is not associated with congenital adrenal hyperplasia?
a) hypernatremia
b) progressive weight loss
c) dehydration
d) hyperkalemia
a) hypernatremia
Hyponatremia is a sign of CAH as there is extensive sodium loss through the kidneys and an inability to maintain serum electrolyte balance.
Families of children with congenital adrenal hyperplasia must be educated about:
a) the self-limiting aspect of the disorder
b) the need for genetic counseling
c) dietary restrictions
d) the need for strict replacement therapy
d) the need for strict replacement therapy
Counseling is needed regarding lifelong medication therapy and follow-up. Education regarding “stress dosing” for fevers > 101, trauma, surgery, and persistent vomiting is also required.
A 14 yo girl has not started menstruation. The history is noncontributory and the PE is normal. Breast development and pubic hair have been present for 12 months. The most appropriate step would be:
a) do a pregnancy test
b) obtain a buccal smear for chromosomal analysis
c) reassure, educate the family, and follow up
d) draw LH and FSH levels
c) reassure, educate the family, and follow up
After age 16 a referral may be indicated if menarche has not occurred.
Primary dysmenorrhea is due to:
a) elevated prostaglandin level
b) pelvic inflammatory disease
c) endometriosis
d) fibroids
a) elevated prostaglandin level
Primary dysmenorrhea is due to an excessive production of uterine prostaglandins causing uterine hypercontractility, tissue ischemia, and nerve hypersensitivity.
The differential diagnosis of dysfunctional uterine bleeding includes all but which of the following?
a) pregancy-related disorders
b) anemia
c) foreign body
d) endometriosis
b) anemia
Anemia is a complication of dysfunction uterine bleeding rather than a cause.
An 11 mo African American boy has just started walking and is found to have severely bowed legs. In the history, you learn that he is exclusively breast fed with very little other food intake. You must consider:
a) trauma
b) developmental variation
c) chromosomal abnormality
d) rickets
d) rickets
Rickets is often connected to nutrition. By age 11 months babies need a wide variety of foods. Additionally, breast milk in African American mothers is lower in vitamin D concentrations than breast milk from mothers of other ethnicities.
