Endocrinology Flashcards
1
Q
BMI where a Pediatrician should intervene for the risk of obesity A. 75% B. 85% C. 97% D. 99.9%
A
85%tile
2
Q
- DM2 and obese. Age 12. Parents want to know what appropriate next step is.
A. Fasting glucose
B. OGTT
C. No screening unless symptomatic
A
Fasting glucose
If newly Dx'd obese: FPG, TG, LDL, HDL, chol, LFTs If T2DM, should be screening for everything at time of Dx then Q1Y: 1. Neuropathy 2. Nephropathy 3. Retinopathy 4. Dyslipidemia 5. NAFLD 6. HTN 7. PCOS 8. OSA 9. Depression 10. Binge eating
3
Q
- The parents of an 8 year old child present to you to ask about screening for Diabetes Mellitus type 2. Both parents have DM2 and they would like to know when their child should be screened.
A. Now
B. At 10 years of age
C. At puberty
D. Only if he develops symptoms suggestive of DM2
A
Only if he develops Sx suggestive of DM2
2018 Canadian guidelines: A. >=3 RFs if prepubertal >=8yo OR >=2 RFs if pubertal 1. Obesity 2. FDR with T2DM +/ exposure to diabetes in utero 3. At risk ethnicity 4. SSx of insulin resistance - acanthosis nigricans - dyslipidemia - NAFLD - HTN B. PCOS C. Impaired FPG +/ impaired glucose intolerance D. USe of antipsychotic med
If overweight and FHx of DM or signs of insulin resistance, should do FPG as per Nelson’s
4
Q
2. 10 year old 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
A
BMI
Nelson’s: “although longitudinal measures of waist circumference and the presence of intra-abdominal fat as determined by MRI is being conducted in the research setting, BMI remains surrogate for adiposity in pediatric clinical setting”
5
Q
- 11 year old 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
A
Lifestyle modification + low fat diet
Biochemical targets: LDL < 3.5, HDL ≥ 1.03, TG < 1.70
If TG ≥ 10, increased risk of pancreatitis
If TG ≥ 15, increased risk of early CAD in kids and teens
6
Q
9 year old overweight, father has history of myocardial infarction (previous hypercholesterolemia question)
A. Diet low fat + lifestyle
B. Add bile meds
C. Add simvastatin
A
Diet low fat and lifestyle
7
Q
- Kid with increased LDL. Family hx of CAD at 38 years. Management?
A. Exercise
B. Exercise + Low fat diet
C. Exercise + statin
D. Exercise + fibrate
——— - 8 year old with hypercholesterolemia. Father at 38 years old had heart attack and found to have hyperlipidemia. HDL and LDL both elevated on his evaluation. Weight >95th percentile. Management:
A. Lifestyle modification
B. Lifestyle modification and low fat diet
C. Lifestyle modification, low fat diet, and bile acid resin
D. Lifestyle modification, low fat diet, and statin
A
Exercise and low fat diet
Familial hypercholesterolemia
8
Q
83. 15 year old adolescent girl evaluated or obesity and irregular menses. Fasting blood glucose is 9. On examination, what would you be most likely to find. A. Thyroid nodule B. Acanthosis nigricans C. Sparse hair D. Pyodermagangrenosum
A
Acantosis nigricans
9
Q
- An obese adolescent is at risk for developing which of the following:
A. Avascular necrosis of the femoral head
B. Type 2 DM
C. Thyroid disease
A
Type 2 DM
Would expect SCFE, not AVM with Legg-Calve-Perthes
10
Q
- 2 year old child is adopted by obese parents. What can be said about this child?
A. Child will almost certainly be obese, irrespective of biological parents
B. Child will be thin if biological parents are thin
C. Obesity associated with higher socioeconomic status
D. Obese as infant = 90% chance of being obese adult
——————— - 2 year old child is adopted by obese parents. What can be said about this child?
A. Child will almost certainly be obese, irrespective of biological parents
B. Child will be thin if biological parents are thin
C. Obesity associated with higher socioeconomic status
D. Obese as infant = 90% chance of being obese adult
A
Child will be thin if biological parents are thin
11
Q
4. There is a 4 year old girl who comes to your clinic with recent growth acceleration. She is Tanner Stage 3 for breast and pubic hair. She has several large hyper pigmented macules and a tender shin. An X-ray of her leg reveals fibrous dysplasia. In addition to investigating the precocious puberty, what other investigations should you do? A. Work up for NF-1 B. Endocrine work up C. Ultrasound D. MRI head
A
Endocrine work up
McCune Albright Syndrome
12
Q
- 3 year old girl presents with vaginal bleeding. Tanner 3 breasts, café au lait spots and bump on her leg.
A. Cardiac echocardiography
B. Other endocrinopathies
A
Other endocrinopathies
McCune Albright syndrome
13
Q
59. 6 year old with vaginal bleeding, irregular hyperpigmented macules, bone dysostosis. Premature thelarche also noted. What is the next step apart from working up the vaginal bleeding? A. Work up for polyendocrinopathies B. Cardiac ultrasound C. Renal ultrasound D. Total body scan ------------ 60. Kid presents with vaginal bleeding. You note she is Tanner 3, has café au lait patches and has a bump on her leg. X-ray confirms fibrous dysplasia. What do you look for? A. Neurofibromas B. Other endocrinopathies C. Cardiac echography
A
Other endocrinopathies
14
Q
- A boy (? 5 years old) has pubic hair but testes < 2 mL. What is the most likely reason for this?
A. Exogenous testosterone
B. Klinefelter’s
C. Normal variant
A
Normal variant
Premature adrenarche
- Sexual hair before 9yo in male suggests premature adrenarche
- Klinefelter’s usually have small testes and no pubic hair
- Exogenous testosterone is possible but may not be most likely reason
15
Q
6 year old female has pubic and axillary hair. No other signs of puberty. Where should you look for pathology? A. Hypothalamus B. Pituitary C. Adrenals D. Ovaries
A
Adrenals
Premature adrenarche
16
Q
- Two year old kid with thelarche; bone age and 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
A
Will resolve by 3y
Premature thelarche
17
Q
47. A 14 year old girl present with concerns about delayed puberty. She has no breast development or pubic hair, and has never had a period. Her height is below the 3rd percentile for age and her bone age is normal. Most likely diagnosis: A. Hypothyroidism B. Turner syndrome C. Androgen insensitivity syndrome D. Constitutional growth delay
A
Turner syndrome
18
Q
- Babe with CAH. Likely clinical picture?
A. Non ambiguous boy with low sodium and high K
B. Virilized boy
C. Virilized female with high sodium and high K
——————————
What might you find on physical findings of a baby with suspected CAH?
A. Genetic male with hyponatremia, hyperkalemia
B. Genetic female with ambiguous genitalia with hypernatremia, hyperkalemia
A
Non ambiguous boy with low sodium and high K
19
Q
- 6 year old girl with pubic hair, no other sexual characteristics. All labs are normal:
A. Premature adrenarche
———— - 6 year old child with pubic hair. Bone age 6 ½ years. Most likely diagnosis?
A. Craniopharyngioma
B. Benign premature adrenarche
A
Benign premature adrenarche
20
Q
- 6 year old child with vaginal bleeding, no foreign body, no exogenous sources. Has bone age of 7.5 years, 17-OHP normal, what is the diagnosis?
A. CAH
B. Craniopharyngioma
C. Premature adrenarche
A
- Unlikely CAH because no adrenarchal signs
- Not premature adrenarche because vaginal bleeding indicates gonadarche
- Craniopharyngioma associated with hypopit and delayed puberty
21
Q
100. Which is the last to appear in female pubertal development? A. Breast development B. Menarche C. Axillary hair D. Acne
A
Menarche
22
Q
105. Boy present with pubic hair at age 8. What would you do? A. Observe B. Testicular US C. Karyotype D. Image head
A
Observe
Premature adrenarche
Consider BA if that was an option
23
Q
What investigation would you do in an 8 year old boy presenting with precocious puberty?
A. MRI head
B. Observe only
A
MRI Head!
24
Q
113. 6 year old female with 6 months of pubic hair. No other secondary sexual characteristics. Blood work including testosterone, estradiol, 17-OHP progesterone, gonadotropin all normal. Bone age 6 years, 6 months. What is the cause? A. CAH B. Craniopharyngioma C. Physiologic adrenarche D. Adrenocortical tumor ------------- A 6 year old female presents with pubic hair. There is increased ketosteroids, normal 17-OHP, normal testosterone. After ACTH stimulation, there is no increase in 17-OHP. The diagnosis is: A. CAH B. Premature pubarche C. Adrenal tumor D. Cushing syndrome ------------- 115. 6 year old female with pubic hair. No other secondary sexual characteristics. Blood work including testosterone, estradiol, 17-OHP progesterone, gonadotropin all normal. Bone age 6 years 6 months. What is the cause? A. CAH B. Craniopharyngioma C. Physiologic adrenarche D. Adrenocortical tumor
A
Premature adrenarche
25
Q
5. A boy presents with short stature. His father was 175 cm. His mother was 155 cm. What is the mid-parental height? A. 158 cm B. 161 cm C. 165 cm D. 171 cm
A
171cm
26
Q
- A boy is growing along the 3rd % for height. His dad is 175 cm and his mom is 155cm. What do you do?
A. Follow up in 6 months
B. Do TSH
C. Do IGF-1
A
? F/U in 6mo
MPH = 171cm = (~20%tile on CDC)
If growing along the 3rd percentile, seems like appropriate growth velocity
Need BA
Also compare with wt
If high wt:ht, suggests endocrinopathy:
- GH deficiency
- hypopit
- hypothyroidism
- glucocoritcoid excess
If low wt: ht, suggests systemic illness/nutritional issue: A. intake - malnutrition -psychosocial/abuse/neglect - anorexia nervosa B. malabsorption - celiac - IBD C. increased demands - CHD - CKD - chronic infection - immunodeficiency/inflammatory - malignancy
27
Q
- What investigation to do in a male child whose height is on 3rd percentile, with parents having heights of 155 cm (mom) and 175 cm (dad)?
A. Bone age
B. GH
C. Karyotype
A
Bone age
28
Q
13. 6 year old 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 3cm/year and her bone age is 4 years. What is the most likely diagnosis? A. Growth hormone deficiency B. Turner syndrome C. Chondrodysplasia D. Constitutional growth delay
A
GH deficiency
Low growth velocity
High wt:ht => suggests endocrinopathy
Delayed bone age
Note: Turner’s has normal BA
29
Q
30. 14 year old girl, tanner 1, normal BA, normal weight, 3rd percentile height… what is the diagnosis? A. Turner B. Hypothyroidism C. GH deficiency ------------------ 40. 14 year old girl. Tanner 1 for breast and pubic hair. Height 5%ile for age. Absent menses. Bone age is equal to chronological age. What is her most likely diagnosis? A. Hypothyroidism B. Turners C. GH deficiency D. Nutritional
A
Turner syndrome
Normal BA!
30
Q
68. 6 year old girl with Ht < 5th %ile and weight = 50th%ile. Bone age is 3 years old. Diagnosis: A. GH deficiency B. Celiac disease ---------------- 69. 6 year old child who was growing 2cm/year, height now <5th percentile and 50% for weight. Bone age 4 years. Diagnosis? A. Celiac disease B. GH deficiency C. Turner syndrome
A
GH deficiency
High wt: ht ratio
BA delayed
For celiac: expect low wt:ht ratio
For Turner: expect normal BA
31
Q
72. Which type of short stature has consistent bone and chronological age? A. Familial B. Constitutional C. Psychological dwarfism D. Hypothyroidism
A
Familial short stature
32
Q
- In which population would growth hormone studies be considered:
A Children with height < 3rd %ile
B. Short children with tall parents
C. Children with growth velocity of 6cm/year
D. Children with height > 3 SD below the mean
—————- - Who should get GH studies?
A. Short kid with tall parents
B. All children below 3rd percentile
C. Children with > 3 SD below the mean
D. Growth of 6cm/year
——–
Repeat 110. What group of patients should get tested for growth hormone deficiency?
A. Short kids of tall parents
B. All kids below 3rd percentile
C. Anyone less than 3 standard deviations below the mean
A
Children with ht >3SD below the mean
SPRING Tall! SHOX gene mutation Prader Willi Renal failure Idiopathic short stature (>2SD) Noonan GH deficiency Turner
