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
33
Q
- A 9 year old girl presents due to short stature. Her parents state she used to be one of the tallest in her class and is now one of the shortest. On review of growth charts, her height has dropped from 50th to 10th percentile and her weight has dropped from 25th to 5th percentile. What investigation is likely to reveal the diagnosis?
A. TSH
B. Anti-tissue transglutaminase
C. Growth hormone
A
Anti-TTG
Wt + ht down suggests systemic or nutritional problem
34
Q
- A mother comes into your office because she is concerned about her 10 year old daughter’s decreased rate of growth. She is otherwise completely healthy.
A. Growth hormone stimulation testing
B. Karyotype
C. The growth rate is likely to increase soon
A
Karyotype
35
Q
6. A child is newly diagnosed with diabetes with lethargy, glucose 18, pH 7.18, ketones. 2 hours after you start an insulin infusion, she is found to be more lethargic than before. What do you do? A. Check bedside glucose B. IV mannitol C. CT head D. Bolus
A
Check bedside glucose
36
Q
25. When do you give insulin in DKA? A. After fluid resuscitation B. Immediately C. After start fluid resuscitation -------------------- 34. Based on the newest DKA guidelines, when should you start insulin following a diagnosis of DKA? A. Immediately B. Following initial fluid resuscitation C. Only after fluid resuscitation is complete D. Once you know their electrolytes
A
After start fluid resuscitation
at least 1 hour
37
Q
11. 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%
A
7.5
38
Q
- 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. Noncompliance with insulin
———————- - Diabetic girl with weight loss. T1DM, straight A student fell off curve from 25% to 5% for weight. HbA1C 8%. Which is most likely cause of her weight loss?
A. Eating disorder
B. Celiac disease
A
Eating disorder
39
Q
- Diabetic with weight loss and diarrhea and bullous itchy rash on extensors and over trunk. Abdominal pain that’s nonspecific. No hematochezia.
A. Celiac disease
B. Eosinophilic gastroenteropathy
A
Celiac disease
40
Q
- 14 year old has T1DM since he was 3 years old. He is found to have proteinuria. What drug do you prescribe?
A. Enalapril
B. Insulin pump
A
Enalapril
41
Q
- Diabetic going to OR. NPO since midnight. BS is now 5. To get IV D5NS. What are your insulin orders?
A. Keep same NPH, R
B. Don’t give R, give 50% NPH
C. Give 50% of R, no NPH
A
Don’t give rapid, give 50% NPH
Peri-op mgmt
- Basal: give full levemir (Determir) or glargine (lantus)
give 50% NPH
- Bolus: hold rapid
Intra-op, target BG 5-10. If major surgery, may need IV insulin
42
Q
- 6 year old child with daily insulin BID, going for elective hernia repair. NPO since midnight. Now it’s 7 am and he’s going to the OR at 9:00 a.m. His blood glucose is 5. His usual insulin regime is some NPH and some short acting insulin in the a.m. What should you give?
A. Give insulin as per his usual dose
B. Omit rapid acting insulin and give regular dose of NPH
C. Omit rapid acting insulin and give NPH at 50% of the regular dose
————- - A child with type 1 diabetes is awaiting inguinal hernia repair. He has been NPO since midnight. He comes into hospital at 7:00 for his OR time at 9:00. He is normally on regular insulin and NPH twice per day. What do you do with his insulin?
A. Give his normal dose of both R and N
B. Give his normal dose of R but hold his N
C. Hold his R, but give his regular dose of N
D. Hold his R, but give 50% of his dose of N
A
Hold his rapid acting insulin, give NPH at 50% of regular dose
Peri-op mgmt
- Basal: give full levemir (determir) or glargine (lanus)
give 50% NPH
- Bolus: hold rapid
Intra-op, target BG 5-10. If major surgery, may need iV insulin
43
Q
- 15 year old obese black male presents with polyuria, abdominal pain, and vomiting. Blood glucose is 40, bicarb 21, and ketone 1+. What is the most likely diagnosis?
A. DM1
B. DM2
C. Hypercortisolemia
A
T2DM
Hyperglycemic hyperosmolar syndrome
44
Q
7. Which test do you do to determine nutritional Vitamin D status? A. 1-25-OH-D B. 25-OH-D C. Calcium D. PTH
A
25 OHD
25D is a weird bra size, measure it!
Vitamin D is transported bound to vitamin D–binding protein to the liver, where 25-hydroxlase converts vitamin D into 25-hydroxyvitamin D (25-D), the most abundant circulating form of vitamin D
Because there is little regulation of this liver hydroxylation step, measurement of 25-D is the standard method for determining a patient’s vitamin D status.
45
Q
38. 3 year old boy with rickets. Which test is most helpful in establishing the diagnosis? A. PTH B. Alkphos C. 25-OHD D. 1-25 OHD
A
25 OHD will be low in Vitamin D deficiency and normal in the other causes of rickets
46
Q
103. 16 month old African American child who has normal developmental parameters, except for him having gross motor delay (not walking). Eats veg and fruits only. On exam notable tibial bowing and widened wrists. The test would show: A. Low ALP B. Low 25 OH vitamin D C. High calcium D. Low PTH ------------------ 104. 18 month old black kid who’s not walking but otherwise developmentally normal. Bowed legs and widened wrists on exam. Diet mostly breastfeeding and fruits. What test best supports the diagnosis? A. Low PTH B. Low Vitamin D C. Low ALP D. High calcium ----------------- Parents bring their 15 month old African American son to your office because he is not yet walking or pulling to stand. X-ray of the limbs reveals metaphyseal splaying and bowing of the tibia. Which investigation is most likely: A. High serum calcium B. Low PTH C Low 25-OH-vitamin D
A
Low 25 OH vitamin D
Would expect
- low Ca -> high PTH
- high ALP
47
Q
8. A child is born with a blind vaginal opening and micropenis. At puberty, he has normal pubertal development and spermatogenesis. What is the diagnosis? A. Smith-Lemli-Opitz B. 21-hydroxylase deficiency C. 5-alpha reductase deficiency D. Androgen insensitivity syndrome
A
5-alpha reductase deficiency
48
Q
- A 6 day old girl with elevated 17-OHP on newborn screening, which of the following is most likely?
a) Hypernatremia
b) Hypokalemia
c) Clitoromegaly
d) Palpable gonads
A
Clitoromegaly
Hyponatremia
Hyperkalemia
Increased peripheral androgens, but still normal gonads
49
Q
- Newborn with ambiguous genitalia. What will help most with your differential diagnosis?
a) Palpable gonads
A
Palpable gonads
50
Q
- 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) Pseudohermaphrodism
A
Partial androgen insensitivity
Palpable gonads => male
- partial androgen insensitivity or 5-alpha reductase deficiency
51
Q
- Newborn with penile-scrotal hypospadias, short phallus and no palpable gonads. Diagnosis?
a) Male pseudohermaphrodism with partial AIS
b) 5 alpha reductase resistance
- ———- - Child with perineoscrotal hypospadias, enlarged phallus, non-palpable testicles.
a) Congenital adrenal hyperplasia
b) 5-alpha reductase deficiency
c) Partial androgen insensitivity
d) Normal male
A
Non-palpable testicles…
I’d say CAH (virilized female) until proven otherwise
PAIS: spectrum from perineoscrotal hypospadias, bifid scrotum + cryptorchidism to extreme undervirilization appearing as clitoromegaly + labial fusion
5-alpha reductase deficiency: boys with small phallus, bifid scrotum, urogenital sinus with perineal hypospadius + blind vaginal pouch. Testes in inguinal canals or labioscrotal folds.
52
Q
- Amniocentesis is done for a mother because of advanced maternal age. Chromosomes are 46XY. When baby is born, however, phenotypically appears to be a normal female. What is the reason for this?
a) Impossible situation
b) Testicular feminization syndrome
c) Chimera
d) Sampled maternal cells instead of fetus during amniocentesis
- ————– - 35 year old pregnant woman had an amniocentesis revealing a fetus is 46XY chromosomes. At birth, the baby is a healthy baby girl. Possible reason for the amniocentesis result:
a) Amniocentesis sampled maternal cells instead of fetal cells
b) Testicular feminization
c) This never happens
A
Testicular feminization
Assuming this means complete AIS
53
Q
- Shocky infant with sodium 116 and potassium 8.2. I can’t remember if they mentioned ambiguous genitalia. What should you test?
a) Aldosterone
b) 17-OHP
- ———- - 3 week old male infant with vomiting, lethargy, decreased PO intake. Na 118, K 8. Most important lab test?
a) Vasopressin
b) 17-OHP
c) Cortisol
d) Calcium
e) Renin
A
17-OHP
54
Q
- A child presents with vomiting and ambiguous genitalia. Most likely laboratory findings?
a) Metabolic acidosis
b) Isolated hyperkalemia
c) Hypokalemia
d) Hyponatremic hyperkalemic alkalosis
A
Hyponatremia
Hyperkalemia
from CAH with salt wasting
Alkalosis from vomiting
55
Q
- Septo-optic dysplasia in shock. Electrolytes: Na normal, K low??? What to do?
a) IV hydrocortisone
—————–
Child present to ER. Has septic optic dysplasia. Is in shock. Na 148, K 6.2, glucose 3.2. After fluid resuscitation, what is your next step?
a) Antibiotics
b) IV hydrocortisone
c) Glucose bolus
d) D5 ½ NS at some rate
————— - A patient with septo-optic dysplasia presents hemodynamically unstable. He is mottled and has a low blood pressure. WBC is normal, Na 138, K 6.1. After fluid resuscitation, what is your next management step?
a) Give IV hydrocortisone
b) Start antibiotics
c) Give hypotonic saline
d) Start kayexalate
A
IV hydrocortisone
56
Q
- Infant with septo-optic dysplasia, vomiting and diarrhea for 3 days. After giving bolus, what do you do?
a) IV hydrocortisone
b) IV antibiotics
A
IV hydrocortisone
57
Q
- A boy comes with a seizure. He is hypotensive. His Na is 128, K 6.1, glucose 1.1. Which investigation would be most helpful in your diagnosis?
a) EEG
b) Acylcarnitine profile
c) Serum cortisol
A
Serum cortisol
58
Q
- Teenage girl with pigmented tongue, hyponatremia. What is the best way to make a definitive diagnosis?
a) ACTH level
b) AM cortisol
c) ACTH stim test
d) 17 OHP
A
ACTH stim test
59
Q
- 2 day history of fever, N/V, hypotension, WBC N, Na 131, K 5.1. What is definitive management?
a) IV hydrocortisone
b) 20cc/kg NS
c) Inotropes
d) D10/0.9NS
——————-
Babe in shock with Na 131, K 5.9. What is the BEST thing to do right now?
a) IV hydrocortisone
b) NS bolus
c) D10
d) D5W
———————-
Child fatigued and tanned, K 5.2, Na 132, glucose 2.6, shocky, vomiting and has diarrhea. What is used to treat the underlying condition?
a) D5 0.25NS
b) Nothing – just observe
c) NS 20cc/kg
d) IV hydrocortisone
A
IV hydrocortisone is definitive management
BEST thing for shock is NS bolus
60
Q
- 6 year old female with hirsutism. Most likely source of androgens?
a) Ovarian
b) Hypothalamic
c) Adrenal
d) Pituitary
A
Adrenal
61
Q
- A girl presents with enlarged thyroid that is firm and non-tender. TSH is normal. Anti-TPO and anti-thyroglobulin antibodies are normal. She does not have any symptoms or signs of hypothyroidism. What is your next step in management?
a) Follow up in 6 months
b) Ultrasound
c) Technetium scan
d) Start synthroid
A
F/U in 6mo
Simple goiter
- girls, peaks before + during pubertal years
- euthyroid, N/low TSH, no thyroid Ab
- not due to inflammation or neoplasma
Nat Hx: decrease in size
Tx:
- re-evaluate periodically (some have Ab neg lymphocytic thyroiditis)
- thyroid hormone may help prevent progression to large multinodular goiter
Multinodular Goiter
- firm goiter with lobulated surface
- single/multiple palpable nodules
- normal thyroid studies
- U/S: multiple nodules. Scintiscans show not functional
- If become >=1cm: FNA to r/o malignancy
Toxic multinodular goiter
- Hyperthryoidism
- low TSH, high T4
- McCune Albright sydnrome
62
Q
- 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
A
Order TSH + free T4
63
Q
- Child has autoimmune thyroiditis, want to monitor therapeutic treatment of levo, how do you do this?
a) TSH
b) Free T4
c) T4
d) Thyroid peroxisome
A
TSH
TSH more stable + represents more steady state of thyroid function
64
Q
- Phytoestrogen, can’t give to?
a) Congenital hypothyroidism
A
Congenital hypothyroidism
I.e. Soy is contraindicated b/c phytoestrogens inhibit TPO -> lower fT4
65
Q
- Girl who is non-symptomatic with firm homogeneous 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 in 6 months
A
F/U in 6mo
66
Q
- Asymptomatic goiter. What is your management?
a) See in 6 months
b) Thyroid ultrasound
c) TSH (wasnt on here but in Caitlins questions it was an option)
A
F/U in 6mo
Do TSH if it’s an option
67
Q
- Which maternal antiarrhythmic is associated with congenital goiter?
a) Amiodarone
b) Sotalol
c) Digoxin
d) Procainamide
- ———– - Neonatal goiter. What antiarrhythmic was mom on?
a) Digoxin
b) Procainamide
c) Amiodarone
d) Sotalol
A
Amiodarone b/c iodine content
68
Q
- Family with hypothyroidism on Synthroid brings daughter with growth 5cm/year. Normal exam. What to do?
a) TSH, T4
b) T4, T3
c) Free T4, T4
d) Nothing
A
Do TSH, fT4 if pubertal b/c that would mean growing too slowly
Otherwise, nothing
69
Q
- A 12 year old girl is falling off her height curve. She has also gained weight recently and is cold intolerant. What test would you order?
a) TSH
A
TSH
70
Q
- A child is noted to be drinking ++ water and has very dilute urine. What is the most likely diagnosis?
a) Psychogenic polydipsia
b) SIADH
c) Diabetes
A
DI vs psychogenic polydipsia. I don’t think you can tell based on just those two things. Need to know serum osmol. High in DI, low in PP.
SIADH = more concentrated urine Diabetes = high urine osmolatlity from glucosuria
71
Q
- What is the result when you have a diagnosis of central DI post water deprivation test?
a) Decrease urine osmolality
b) Increase urine osmolality
c) Decreased serum osmolality
d) Increased serum osmolality
A
Increase urine osmolality
DDAVP helps differentiate between central vs peripheral DI. Response to DDAVP with increased urine osmolality indicates central (not producing vasopressin). No response indicates peripheral (no receptors to vasopressin)
72
Q
- Kid with complete DI. Lab values?
a) Increased serum osmolarity
b) Decreased urine osmolarity
c) Increased urine osmolarity
d) Decreased serum osmolarity
————–
Complete diabetes insipidus. After water deprivation, what finding would you expect to see?
a) Increased serum osmolarity
b) Increased urine osmolarity
c) Decreased urine osmolarity
d) Decreased serum osmolarity
A
If complete DI
- would have high serum osmol, low urine osmol
- after water deprivation,
would have increased serum osmol, low urine osmol
- after DDAVP, would have increased urine osmolality
73
Q
- What would be the difference between psychogenic polydipsia and diabetes insipidus?
a) Dilute urine
b) Diarrhea
c) Hypernatremia
A
Hypernatremia
74
Q
- A 5 month old boy who has been unwell for 48 hours (not feeding, lethargic) present 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
A
FAOD
hypoketotic hypoglycemia
met acidosis
minimal response to glucagon
75
Q
- Hypoglycemia in child with illness and ketones +. Happened in the past. Diagnosis?
a) Ketotic hypoglycemia
A
Ketotic hypoglycemia
- 18mo-5yo
- fasting leadings to physiologic hypoglycemia + ketonuria
- appropriately low insulin, increased GH, increased cortisol, increased BHB
- no lactic acidosis, no hepatomegaly
- Dx: ketosis with hypoglycemia during 24H monitored fast
- Do critical sample at time of hypoglycemia
- Mgmt: self-limiting condition, avoid prolonged fasts
76
Q
- 1 year old with glucose 1.4 and seizures. What is most important test
a) Urine ketones
b) Cortisol
c) Glucagons
d) Pyruvate
A
urine ketones
77
Q
- Mediterranean teen with coarse hair on chest, bum, les, arms. Moderate-severe acne. Most likely diagnosis?
a) CAH
b) PCOS
c) Familial hirsutism
———–
Mediterranean teenage girl who is obese, coarse hair, has upper lip hair, and acne, amenorrhea for 4 months. Diagnosis?
a) PCOS
b) CAH
c) Familial hirsutism
A
PCOS
78
Q
- 5 year old nauseated, confused then seizing 12 hours post-op tonsillectomy. Labs show Na 121 and serum osmolality 260. What finding is most consistent with diagnosis?
a) Urine osmolality is higher than serum osmolality
b) Urine Na < 20
c) Urine osmolality is lower than serum osmolality
d) High urine output
A
Low urine output
High urine osmolality
SIADH
79
Q
- A teenager has been using performance enhancing supplements, presenting with jaundice, gynecomastia. What was the drug?
a) Growth hormone
b) Creatine
c) Anabolic steroids
d) Amphetamines
A
Anabolic steroids
80
Q
- Boy on risperidone with gynecomastia. What would we look for before switching?
Prolactin
A
Prolactin
Risperidone is strong antagonist of dopamine receptor -> block D2 dopamine -> increase prolactin release -> gynecomastia
81
Q
- 9 year old female with menarche, parents want to know about final height; what do you tell them?
a) Expect another 5cm
b) Do bone age
c) Calculate mid parental height
- —————- - 9 year old with menarche. Her parents are concerned about her final height. What is the BEST way to determine her final height.
a) Tell them that she will grow another 5cm
b) Calculate mid parental height
c) Do a karyotype
d) Do a bone age
A
Bone age
82
Q
- 9 year old with menarche. Her parents are concerned about her final height. What would you do?
a) Tell them that she will grow another 2 inches (as per endo)
b) Calculate mid parental height
c) Do a karyotype
d) Do a bone age
A
Do a bone ache
