Endocrine Disorders

Question 1

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

Answer 1

d) disease or disorder of the hypothalamus or pituitary gland compromising thyroid function

Question 2

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

Answer 2

b) Hispanic and Native Americans

Question 3

Which of the following is not a sign or symptom of congenital hypothyroidism?

a) hoarse cry
b) frequent stooling
c) coarse features
d) lethargy

Answer 3

b) frequent stooling

Question 4

The most common cause of hyperthyroidism in children and adolescents is:

a) Graves’ disease
b) thyroid cancer
c) thyroid nodules
d) pituitary tumor

Answer 4

a) Graves’ disease

Question 5

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

Answer 5

c) tendency to gain weight easily

Question 6

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

Answer 6

b) a 14 yo adolescent female who is heat intolerant and has amenorrhea

Question 7

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

Answer 7

d) Hashimoto’s or chronic autoimmune thyroiditis

Question 8

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

Answer 8

c) is caused by reduced renal responsiveness to antidiuretic hormone (ADH)

Question 9

An infant with polydipsia, polyuria, irritability, and FTT should be evaluated for:

a) diabetes insipidus
b) homocytinuria
c) growth hormone deficiency
d) hyperglycemia

Answer 9

a) diabetes insipidus

Question 10

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

Answer 10

c) final adult stature tends to be normal

Question 11

A newborn or infant with birth length

Answer 11

a) growth hormone deficiency

Question 12

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)

Answer 12

b) klinefelter’s syndrome

Question 13

Individuals with chronic adrenal insufficiency often have:

a) frequent OM
b) high energy levels
c) love for physical activity
d) a craving for salt

Answer 13

d) a craving for salt

Question 14

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

Answer 14

d) hypoglycemia

Question 15

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

Answer 15

a) true precocity occurs because of hormonal stimulation from the pituitary or hypothalamus causing gonadal maturation and fertility

Question 16

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

Answer 16

c) Marfan

Question 17

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

Answer 17

d) short stature

Question 18

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

Answer 18

b) increased pigmentation in the axilla, groin, areola, hand creases, and surgical scars

Question 19

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

Answer 19

a) advanced skeletal maturation

Question 20

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

Answer 20

c) most common in LGA infants

Question 21

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

Answer 21

c) has a quicker onset of effect and shorter duration than NPH

Question 22

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

Answer 22

b) Type 1 diabetes

Question 23

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

Answer 23

a) 70-180

Question 24

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

Answer 24

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

Question 25

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

Answer 25

d) children with severe hypoglycemia

Question 26

Which finding is not a sign or symptom of diabetes onset in children?

a) alopecia
b) glycosuria
c) polydipsia
d) polyuria

Answer 26

a) alopecia

Question 27

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

Answer 27

a) ketoacidosis

Question 28

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

Answer 28

c) children with type 1 diabetes can switch to oral insulin agents once they reach adulthood

Question 29

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

Answer 29

c) 9, 9.5

Question 30

In boys, lack of secondary sexual characteristics after 17 years suggests:

a) castration
b) abnormal testicular function
c) true hermaphroditism
d) pituitary adenoma

Answer 30

b) abnormal testicular function

Question 31

The peak incidence for adolescent gynecomastia occurs at:

a) 10 years
b) 13-14 year
c) 16 years
d) 18 years

Answer 31

b) 13-14 year

Question 32

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

Answer 32

d) constitutional or familial

Question 33

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

Answer 33

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.

Question 34

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

Answer 34

d) an elevated TSH level

In hyperthyroidism the TSH level is suppressed.

Question 35

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

Answer 35

a) levothyroxine

Question 36

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

Answer 36

c) constitutional delay of growth and puberty

Question 37

Which chromosomal abnormality is associated with short stature in girls?

a) down syndrome
b) turner syndrome
c) klinefelter’s syndrome
d) prader-willi syndrome

Answer 37

b) turner syndrome

Question 38

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

Answer 38

d) manifested by disproportionately short stature

Question 39

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

Answer 39

c) idiopathic

Sexual precocity is idiopathic in 80% of girls.

Question 40

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

Answer 40

d) 9

Question 41

Treatment of true (central) precocious puberty is best achieved with:

a) synthetic follicular stimulating hormone
b) gonadotropin releasing hormone
c) dexamethasone
d) thyroid hormone

Answer 41

b) gonadotropin releasing hormone

Central precocious puberty is suppressible with analogues of long-acting gonadotropin-releasing hormone (GnRH).

Question 42

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

Answer 42

a) autoimmune destruction of the pancreatic beta cells

Question 43

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

Answer 43

a) diabetes mellitus

Question 44

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

Answer 44

c) 3 months

Question 45

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

Answer 45

d) congenital hearing loss

Question 46

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

Answer 46

b) have little glucose stores in the form of glycogen and fat

Question 47

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

Answer 47

c) congenital adrenal hyperplasia (CAH)

Question 48

Which of the following signs or symptoms is not associated with congenital adrenal hyperplasia?

a) hypernatremia
b) progressive weight loss
c) dehydration
d) hyperkalemia

Answer 48

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.

Question 49

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

Answer 49

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.

Question 50

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

Answer 50

c) reassure, educate the family, and follow up

After age 16 a referral may be indicated if menarche has not occurred.

Question 51

Primary dysmenorrhea is due to:

a) elevated prostaglandin level
b) pelvic inflammatory disease
c) endometriosis
d) fibroids

Answer 51

a) elevated prostaglandin level

Primary dysmenorrhea is due to an excessive production of uterine prostaglandins causing uterine hypercontractility, tissue ischemia, and nerve hypersensitivity.

Question 52

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

Answer 52

b) anemia

Anemia is a complication of dysfunction uterine bleeding rather than a cause.

Question 53

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

Answer 53

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.