Endocrine Questions

Question 1

*Which of the following factors can alter hormone production in endocrine disorders?**
- A) Allergies
- B) Traumas
- C) Sedentary lifestyle
- D) High carbohydrate diet

Answer 1

B) Traumas

Question 2

What is a key factor in the early detection and intervention of endocrine disorders?**
- A) Symptom self-monitoring
- B) Vitamin supplementation
- C) Diet only
- D) Hormone replacement

Answer 2

*D) Hormone replacement**

Question 3

When collecting a history on a suspected endocrine disorder, which of the following is particularly relevant?
- A) Eye color
- B) Recent travel history
- C) Growth pattern and recent alterations
- D) Financial situation

Answer 3

C) Growth pattern and recent alterations

Question 4

*What is a common diagnostic study used in evaluating growth disturbances in children?**
- A) Serum glucose
- B) Complete blood count
- C) Bone age radiograph
- D) Electrocardiogram

Answer 4

C) Bone age radiograph

Question 5

Which skin condition might be observed in a physical examination for endocrine disorders?**
- A) Rosacea
- B) Varicella
- C) Acanthosis nigricans
- D) Psoriasis

Answer 5

C) Acanthosis nigricans

Question 6

*What is a general management strategy for endocrine disorders?**
- A) Avoiding all medications
- B) Increasing protein intake
- C) Early detection and long-term follow-up
- D) Stopping any physical activity

Answer 6

C) Early detection and long-term follow-up**

Question 7

How important is genetic counseling in the management of endocrine disorders?**
- A) It is only necessary if there’s a family history.
- B) Not important at all.
- C) Crucial for educating families about congenital concerns.
- D) Only necessary for metabolic disorders.

Answer 7

*C) Crucial for educating families about congenital concerns.**

Question 8

A patient presents with unexplained fatigue and altered growth pattern. Which aspect of the history is most important?**
- A) Appetite changes
- B) Recent travel
- C) Pubertal development and recent changes
- D) Favorite foods

Answer 8

C) Pubertal development and recent changes

Question 9

What is a potential complication if endocrine disorders are not properly managed?**
- A) Temporary hearing loss
- B) Reversible hair color change
- C) Irreversible disability
- D) Allergic reactions

Answer 9

C) Irreversible disability**

Question 10

In terms of medical management, what is a key challenge with hormone replacement therapy?**
- A) Cost of medications
- B) Patient forgetting to take medication
- C) Long-term adherence
- D) Ingredients leading to allergies

Answer 10

C) Long-term adherence**

Question 11

Which of the following is a primary growth disorder?**
- A) Malnutrition
- B) Skeletal dysplasia
- C) Celiac disease
- D) Congestive heart failure

Answer 11

1. **B) Skeletal dysplasia

Question 12

How is a child’s predicted growth potential calculated for boys?**
- A) (Mother’s height + Father’s height) / 2
- B) (Mother’s height - 5”) + (Father’s height) / 2
- C) (Mother’s height + 5”) + (Father’s height) / 2
- D) (Father’s height - 5”) + (Mother’s height) / 2

Answer 12

2. **C) (Mother’s height + 5”) + (Father’s height) / 2*

Question 13

Which chronic condition is not typically a factor in inhibiting normal growth?**
- A) Cystic fibrosis
- B) Cyanotic heart disease
- C) Osteoporosis
- D) Hematologic disorders

Answer 13

3. **C) Osteoporosis

Question 14

Which factor is related to secondary growth disorders?**
- A) Skeletal dysplasias
- B) Genetic short stature
- C) Undernutrition
- D) Chromosomal abnormalities

Answer 14

4. **C) Undernutrition*

Question 15

*When is growth hormone (GH) primarily released?**
- A) During strenuous exercise
- B) In large bursts while sleeping
- C) In response to meals
- D) Continuously throughout the day

Answer 15

B) In large bursts while sleeping

Question 16

Which diagnostic study might be used to evaluate a suspected GH deficiency?**
- A) Electrolyte panel
- B) Bone age radiograph
- C) Electrocardiogram
- D) Liver function tests

Answer 16

6. **B) Bone age radiograph*

Question 17

What assessment should be included in the history when evaluating for growth hormone deficiency?**
- A) Patient’s diet preferences
- B) Daily activity level
- C) Parents’ and siblings’ height/weight/growth
- D) Favorite hobbies

Answer 17

7. C) Parents’ and siblings’ height/weight/growth

Question 18

Which of the following diseases can inhibit normal growth by affecting the gastrointestinal system?**
- A) Chronic anemia
- B) Inflammatory bowel disease
- C) Congestive heart failure
- D) Anorexia nervosa

Answer 18

8. **B) Inflammatory bowel disease

Question 19

What is the primary management step if a child is suspected to have growth hormone deficiency?**
- A) Start a high-protein diet
- B) Begin oral supplements
- C) Refer to a pediatric endocrinologist
- D) Prescribe insulin therapy

Answer 19

9. C) Refer to a pediatric endocrinologist

Question 20

What is not likely to be part of the differential diagnosis when evaluating a child for growth hormone deficiency?**
- A) Anorexia
- B) Turner syndrome
- C) Malnutrition
- D) Asthma

Answer 20

10. **D) Asthma*

Question 21

What characterizes constitutional growth delay?**
- A) Abnormal neurological exam
- B) Rapid bone age advancement
- C) Delayed bone age with a normal growth rate for bone age
- D) Immediate referral to a pediatric endocrinologist

Answer 21

Delayed bone age with a normal growth rate for bone age**

Question 22

Which condition is NOT typically associated with growth excess?**
- A) Marfan syndrome
- B) Klinefelter Syndrome
- C) Turner syndrome
- D) Overnutrition

Answer 22

C) Turner syndrome

Question 23

Which of the following is a diagnostic characteristic of true precocious puberty?**
- A) Isolated thelarche
- B) Isolated menarche
- C) Early onset of multiple features of puberty
- D) Early removal of tonsils

Answer 23

C) Early onset of multiple features of puberty*

Question 24

When should a child with early and precocious puberty be referred to a pediatric endocrinologist?**
- A) When onset of puberty signs occurs after age 10
- B) If idiopathic causes are ruled out
- C) Upon accelerated linear growth and sexual maturity
- D) Only in boys if CNS tumors are suspected

Answer 24

4. **C) Upon accelerated linear growth and sexual maturity

Question 25

In the evaluation of precocious puberty, if LH and FSH are low indicating peripheral puberty, what test is used to distinguish central from peripheral causes?**
- A) Bone density scan
- B) Hypothalamic GnRH stimulation test
- C) Liver function panel
- D) Complete blood count (CBC)

Answer 25

5. B) Hypothalamic GnRH stimulation test

Question 26

Which clinical finding should be considered when assessing a child for constitutional growth delay?**
- A) Advanced bone age for chronological age
- B) Normal length and weight at birth but slowed growth at 1-3 years
- C) Immediate onset of puberty signs by age 9 or 10
- D) Absence of family history of similar growth patterns

Answer 26

B) Normal length and weight at birth but slowed growth at 1-3 years**

Question 27

What condition may present with early pubic/axillary hair but without other features and an increased risk of polycystic ovary syndrome (PCOS)?**
- A) Central precocious puberty
- B) Premature thelarche
- C) Premature adrenarche
- D) Isolated menarche

Answer 27

7. **C) Premature adrenarche

Question 28

What percentage of boys typically show increased testicular volume between ages 9 and 14?**
- A) 50%
- B) 65%
- C) 85%
- D) 95%

Answer 28

8. **C) 85%*

Question 29

What condition is characterized by isolated breast development without other signs of puberty?**
- A) Turner syndrome
- B) Premature thelarche
- C) Central precocious puberty
- D) Klinefelter Syndrome

Answer 29

9. B) Premature thelarche

Question 30

What diagnostic studies are recommended if true precocious puberty is suspected?**
- A) Thyroid stimulating hormone (TSH) only
- B) CBC and comprehensive metabolic panel (CMP)
- C) Bone age, LH, FSH, estradiol or testosterone levels
- D) Continuous glucose monitoring

Answer 30

10. **C) Bone age, LH, FSH, estradiol or testosterone levels*

Question 31

A 10-year-old boy is brought to the clinic because his parents are concerned about his height. They report he was born full-term and had normal length and weight. However, his growth seemed to decelerate between the ages of 2 and 4. Currently, his height is just below the 3rd percentile for his age. There is a family history of late bloomers with similar growth patterns. The boy has not yet shown signs of puberty, and his bone age is delayed compared to his chronological age.

Questions:

1. What is the most likely diagnosis for this boy?
   
   • A) Growth Hormone Deficiency
   • B) Marfan Syndrome
   • C) Constitutional Growth Delay
   • D) Precocious Puberty
2. Why is it important to note the family history in this case?
3. Is immediate endocrinology referral indicated in this case?

Answer 31

C) Constitutional Growth Delay**

Explanation: This boy’s presentation is typical of constitutional growth delay, characterized by normal birth parameters, slowed growth during early childhood, and delayed bone age. The shared family history of “late bloomers” strongly supports this diagnosis as a normal variation.

2. Family history is important because constitutional growth delay often runs in families, indicating a genetic pattern of growth resembling delayed but eventual attainment of normal adult height.
3. No immediate referral is needed. This condition is a common variation, and patients often catch up with their peers later, particularly if there is a reassuring family history.

Question 32

An 8-year-old girl comes in for a routine check-up. Her mother is concerned because she has started developing breast buds and pubic hair. The girl’s growth rate is normal for her bone age which is slightly advanced, and the development of pubic hair and breast tissue happened over the past 6 months.

Questions:

1. What initial workup might be appropriate for this presentation?
   
   • A) Pelvic ultrasound only
   • B) TSH and Free T4
   • C) LH, FSH, estradiol, and bone age
   • D) Immediate MRI of the brain
2. How would the possibility of precocious puberty affect this child socially/emotionally?
3. Would this case require referral to a specialist?

Answer 32

*C) LH, FSH, estradiol, and bone age**

Explanation: These evaluations help determine whether puberty is central or peripheral. Bone age will help assess bone maturity, while hormone levels can identify whether the development is consistent with true precocious puberty.

2. Precocious puberty might lead to emotional distress, as the child could be developing physically more rapidly than her peers, possibly leading to social challenges or awkwardness.
3. Yes, referral to a pediatric endocrinologist is recommended to further evaluate the cause and consider appropriate management, especially since early onset is significant.

Question 33

A 13-year-old boy of above-average height presents with noticeable growth in stature over the past year. The family describes no recent significant illnesses, but the patient’s facial features appear somewhat elongated, and he has long fingers. His bone age is consistent with his chronological age.

Questions:

1. Which condition should be considered and potentially ruled out in this child?
   
   • A) Constitutional growth delay
   • B) Klinefelter Syndrome
   • C) Marfan Syndrome
   • D) Precocious Puberty
2. What additional assessments might be advised?

Answer 33

C) Marfan Syndrome**

Explanation: The described phenotype, including tall stature, elongated facial features, and long fingers, is suggestive of Marfan syndrome. These physical characteristics should prompt further evaluation.

2. Additional assessments may include a thorough cardiac evaluation to assess for aortic dilation, genetic consultation, and further skeletal examinations by an orthopedic specialist. Regular ophthalmologic exams are also recommended due to the risk of lens dislocation associated with Marfan syndrome.

Question 34

What is the primary cause of delayed puberty characterized by a delayed bone age?

A) Growth Hormone Deficiency
B) Turner Syndrome
C) Constitutional Growth Delay
D) Hyperprolactinemia

Answer 34

Answer: C) Constitutional Growth Delay

Explanation: Constitutional growth delay is a common cause of delayed puberty and is primarily characterized by delayed bone age with otherwise normal eventual growth outcomes.

Question 35

Which condition is associated with both anosmia and gonadotropin deficiency?

A) Turner Syndrome
B) Isolated Gonadotropin Deficiency
C) Kallmann Syndrome
D) Vanishing Testes Syndrome

Answer 35

Answer: C) Kallmann Syndrome**

Explanation: Kallmann syndrome is characterized by the coexistence of anosmia (loss of the sense of smell) and gonadotropin deficiency, leading to delayed or absent puberty.

Question 36

Which chronic condition should be evaluated in a child with signs of delayed puberty such as the failure of the hypothalamic-pituitary-gonadal axis?

A) Hypothyroidism
B) Anorexia Nervosa
C) Gastrointestinal disease
D) Marfan Syndrome

Answer 36

Answer: B) Anorexia Nervosa**

Explanation: Functional deficiency due to extreme calorie restriction or excessive exercise such as seen in anorexia nervosa can lead to dysfunction in the hypothalamic-pituitary-gonadal axis, causing delayed puberty.

Question 37

Which of the following diagnostic tests is NOT typically warranted in the initial evaluation of delayed puberty?

A) Bone age assessment
B) Serum prolactin levels
C) Cardiac echocardiogram
D) Free T4 and TSH

Answer 37

Answer: C) Cardiac echocardiogram**

Explanation: While cardiac evaluation might be needed in certain conditions (like suspecting associations with Marfan syndrome), it’s not part of the initial standard workup for delayed puberty; bone age, serum prolactin, and thyroid function tests (Free T4 and TSH) are.

Question 38

In a case of confirmed hypogonadism in delayed puberty, what is the primary management step?

A) Referral to a pediatric gastroenterologist
B) Hormonal replacement therapy
C) Increased caloric intake
D) Pelvic ultrasound

Answer 38

Answer: B) Hormonal replacement therapy**

Explanation: In cases of hypogonadism resulting in delayed puberty, referral to a pediatric endocrinologist for hormonal replacement is the appropriate management step to help induce puberty.

Question 39

What primarily regulates the production and secretion of ACTH by the pituitary gland?

A) Renin-angiotensin system
B) Corticotropin-releasing hormone (CRH)
C) Serum aldosterone levels
D) Blood glucose levels

Answer 39

Answer: B) Corticotropin-releasing hormone (CRH)**

Explanation: CRH is secreted by the hypothalamus and stimulates the production and secretion of ACTH from the pituitary gland, thereby playing a crucial role in regulating adrenal steroid production.

Question 40

Which condition is characterized by a deficiency of both mineralocorticoids and glucocorticoids?

A) Secondary adrenal insufficiency
B) Congenital adrenal hyperplasia (CAH)
C) Primary adrenal insufficiency
D) Isolated glucocorticoid deficiency

Answer 40

Answer: C) Primary adrenal insufficiency**

Explanation: Primary adrenal insufficiency, also known as Addison’s disease, is characterized by a deficiency of both mineralocorticoids (like aldosterone) and glucocorticoids (like cortisol), resulting in significant symptoms such as hyponatremia and hyperkalemia.

Question 41

Which symptom is indicative of a deficiency in aldosterone?

A) Hyperglycemia
B) Hypernatremia
C) Dehydration
D) Hypertension

Answer 41

Answer: C) Dehydration**

Explanation: Aldosterone deficiency leads to problems with sodium retention and potassium excretion, causing hyponatremia, hyperkalemia, and dehydration, frequently resulting in hypotension.

Question 42

What is a common presentation in female infants with congenital adrenal hyperplasia (CAH)?

A) Hypernatremia
B) Mucosal hypopigmentation
C) Ambiguous genitalia
D) Elevated aldosterone levels

Answer 42

Answer: C) Ambiguous genitalia**

Explanation: Female infants with CAH may present with ambiguous genitalia due to excess androgen production as a result of enzyme deficiencies in the cortisol biosynthesis pathway.

Question 43

Which laboratory finding would you expect in a patient with primary adrenal insufficiency?

A) Low ACTH levels
B) Elevated serum cortisol levels
C) Elevated ACTH levels
D) Normal glucose and electrolyte levels

Answer 43

Answer: C) Elevated ACTH levels**

Explanation: In primary adrenal insufficiency, the adrenal glands cannot produce sufficient cortisol and aldosterone, leading to elevated ACTH levels due to lack of feedback inhibition.

Question 44

What management strategy is essential in treating adrenal crisis?

A) Antihypertensive medication
B) Hormonal replacement therapy
C) Insulin therapy
D) Diuretic therapy

Answer 44

Answer: B) Hormonal replacement therapy**

Explanation: During an adrenal crisis, immediate hormonal replacement with glucocorticoids (such as hydrocortisone) is critical to address the acute deficiency and stabilize the patient.

Question 45

Age: 9 months
- Gender: Female

Clinical Presentation:

Claire is brought to the clinic by her parents because they are concerned about her poor feeding, recurrent vomiting, and lethargy over the past two weeks. The parents mention that she has had minimal weight gain despite regular feeding. On physical examination, you notice signs of dehydration and hyperpigmented skin folds.

Diagnostic Findings:

• Electrolytes: Hyponatremia, hyperkalemia
• Serum cortisol: 10 μg/dL (low)
• Renin: Elevated
• ACTH: Elevated
• 17-OHP: Elevated
  ### Questions

1) What condition is most likely affecting Claire?

A) Secondary adrenal insufficiency
B) Congenital adrenal hyperplasia (CAH)
C) Primary adrenal insufficiency
D) Isolated aldosterone deficiency

Answer 45

Answer:** B) Congenital adrenal hyperplasia (CAH)

Explanation: The elevated 17-OHP and characteristic electrolyte disturbances suggest CAH, commonly due to 21-hydroxylase deficiency, causing deficits in cortisol and aldosterone synthesis with compensatory increased androgen production.

Question 46

*What management approach should be initiated immediately for congenital adrenal hyperplasia?**

A) Diuretic therapy
B) Dietary sodium restriction
C) Hormonal replacement therapy with glucocorticoids and mineralocorticoids
D) Antihypertensive medication

Answer 46

Answer:** C) Hormonal replacement therapy with glucocorticoids and mineralocorticoids

Explanation: Claire needs glucocorticoid replacement to correct cortisol deficiency and mineralocorticoid replacement (such as fludrocortisone) to address aldosterone deficiency to manage her symptoms effectively.

Question 47

Patient Profile:**

• Name: Mark Johnson
• Age: 35
• Gender: Male

Clinical Presentation:

Mark reports feeling fatigued, having lost weight unintentionally, and experiencing increased skin darkening over the past few months. He also reports episodes of dizziness upon standing. His blood pressure is noted to be 90/60 mmHg. Examination reveals hyperpigmented mucosal membranes.

Diagnostic Findings:

• Serum cortisol: 6 μg/dL at 8 AM (low)
• ACTH: Significantly elevated
• Electrolytes: Hyponatremia, hyperkalemia
  Questions

1) What is the most likely diagnosis for Mark?

A) Secondary adrenal insufficiency
B) Addison’s disease (Primary adrenal insufficiency)
C) Cushing’s syndrome
D) Pheochromocytoma

Answer 47

Answer:** B) Addison’s disease (Primary adrenal insufficiency)

Explanation: The presence of hyperpigmentation, hypotension, hyponatremia, hyperkalemia, and elevated ACTH are consistent with primary adrenal insufficiency or Addison’s disease.

Question 48

Why is Mark experiencing hyperpigmentation (Addisons disease)?**

A) Melanin-decreasing hormone excess
B) Overproduction of aldosterone
C) Excessive stimulation of melanocyte-stimulating hormone (MSH)
D) Elevated levels of catecholamines

Answer 48

Answer:** C) Excessive stimulation of melanocyte-stimulating hormone (MSH)

Explanation: Elevated ACTH secretion can lead to higher levels of MSH due to its structural similarity to ACTH precursors, resulting in hyperpigmentation.

Question 49

Patient Profile:**

• Name: Emily Davis
• Age: 58
• Gender: Female

Clinical Presentation:

Emily presents with fatigue, abdominal pain, and recent episodes of hypoglycemia. Her medical history is significant for prior pituitary surgery. She denies any hyperpigmentation or changes in skin color.

Diagnostic Findings:

• Serum cortisol: 5 μg/dL (low)
• ACTH: Low
• Electrolytes: Normal
  Questions

1) What is the most likely diagnosis for Emily?

A) Addison’s disease
B) Secondary adrenal insufficiency
C) Congenital adrenal hyperplasia
D) Hyperaldosteronism

Answer 49

Answer:** B) Secondary adrenal insufficiency

Explanation: Low cortisol with low ACTH and absence of hyperpigmentation, along with a history of pituitary surgery, is indicative of secondary adrenal insufficiency.

Question 50

What is the primary cause of Emily’s hypoglycemia (she has Secondary adrenal insufficiency)
**

A) Mineralocorticoid excess
B) Deficiency in glucocorticoids
C) Increased insulin secretion
D) Hyperactivity of the adrenal medulla

Answer 50

Answer: B) Deficiency in glucocorticoids

Explanation: Cortisol is crucial for gluconeogenesis and maintaining blood glucose levels, so its deficiency in secondary adrenal insufficiency can lead to hypoglycemia.