Endocrinology MCQ Flashcards by Chidera Nwaroh

4-year-old with bone age of 3 years. Growth charts provided. Weight is tracking. Height started at 3rd percentile and now is below the 3rd percentile.

Constitutional PL

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A 3-year-old girl presents with breast development. She has been otherwise well apart from recent growth spurt. On exam, she has Tanner 2 breast and pubic hair development and mucoid vaginal discharge. Growth chart shows increase from 50th to 85th percentile. What do you do?

MRI Brain

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15yo M with well-controlled T1DM. He complains of fatigue. He eats a varied diet, has a normal BMI and otherwise asymptomatic. He is found to have a microcytic anemia. TSH, creatinine, and UA are all normal. What is your next investigation?

TTG and IgA for celiac disease

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15y F presents to your clinic with a history of nausea, vomiting, and abdominal pain. She was also found to have postural tachycardia and hyperpigmentation underneath her tongue. Which of the following test would BEST identify her condition:

ACTH Stimulation Test

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6-year old who has grown to the 85th percentile and has increased to the 95th percentile. He has multiple cafe au lait macules. He has evidence of precocious puberty with testicular enlargement. What lesion would you most likely find on MRI?

Optic nerve glioma

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Neurofibromatosis 1 Diagnostic Criteria

C: > 6 or more Café-au-lait macules
>5mm pre-pubertal, >15mm post-pubertal
R: Affected 1st degree Relative
O: Optic nerve glioma
Importantly, they can also cause precocious puberty, as these tumors may affect the hypothalamic-pituitary-gonadal axis.
P: Pseudoarthrosis (distinctive osseous lesions can be sphenoid dysplasia or tibial pseudoarthrosis)
L: > 2 or more Lisch nodules
A: Axillary or inguinal freckling
N: > 2 neurofibromas OR 1 plexiform neurofibroma
Cutaneous neurofibromas are soft, benign tumors that develop on or under the skin
Plexiform neurofibromas can grow along nerve pathways and can be more complicated, sometimes causing deformities or functional impairment
D: Dysplasia of the sphenoid

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Indication for MRI in NF1

Symptomatic OPGs - proptosis, visual loss, and precocious puberty resulting from hypothalamic encroachment

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You are seeing a 15 year old female. She has had irregular menstrual periods in the three years since menarche. She has moderate to severe acne and hirsuitism. There is maybe an aunt with infertility? Which test is indicated as part of screening in her condition?

Serum lipids

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5 year old girl weighing 99 percentile, height 50th percentile, bmi 99th percentile, maternal grandfather died of MI at age 40. Labs show elevated total cholesterol, elevated ldl , low hdl elevated triglycerides. Normal exam. What is the best management

Start high fibre low fat diet

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10 yo female, enlarged thyroid, firm, non-tender. Assessment otherwise unremarkable. Labs are T4 6.6 (normal), TSH >50 (elevated). Next step:

Start levothyroxine

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A 10-year-old child assigned female at birth has always preferred boy clothes and wanted to be referred to as a boy. The onset of puberty has been very distressing. What is the PRIMARY reason to start GnRH agonists in this child?

Prevent the development of secondary sex characteristics after onset of puberty

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3 day old noted to have persistent hypoglycemia. Weight is at the 15th percentile and there was no maternal gestational diabetes or administration of antihypertensives during pregnancy. On exam noted to have a micropenis but otherwise his exam is normal. What would you most likely find on MRI brain?

Absent septum pellucidum

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16-year-old female with primary amenorrhea. She has SMR5 breasts and SMR1 pubic hair. What is the underlying etiology?

complete androgen insensitivity

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A 14 year old is worried that he hasn’t started puberty yet. He is growing 5cm/year along the 3% and weight is the 10%. His parents are 50%. On exam he has no auxiliary or pubic hair. Testicles are 4 and 5cm. What do you think is the most likely diagnosis?

Constitutional Delay

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4y male presents with muscle cramping. He has a history of mucocutaneous candidiasis as an infant, but he is otherwise healthy. He was found to have a Calcium of 0.8 (low with normative range given) and phosphate of 2.8 (high with normative range given). What labs will most likely give you the diagnosis?

Parathyroid hormone

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Baby presents on day 3 of life with ambiguous genetalia what is the most likely abnormality:

Elevated K

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Girl in DKA, has been started on insulin infusion. Initial labs had pH 7.16 with normal sodium and k. Chloride was 113? Eight hours later she is doing well. PH now is7.19 with sodium 147 K 3.8 chloride 133.
What is the cause of her persistent acidosis?

Hyperchloremia

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5 year old female with 2 episodes of vaginal bleeding. On exam, she has Tanner ?3 breasts, Tanner 1 pubic hair, and several cafe au lait macules. Her height is on the 97th percentile and her weight on the 50th (?). What is her underlying condition.

McCune Albright

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McCune Albright Triad

triad of café au lait macules, fibrous dysplasia and PPP (from estrogen secreting ovarian cysts)

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“Coast of Maine” café au lait lesions

McCune Albright - also cross midline

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“Coast of California” café au lait lesions

Neurofibromatosis 1

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7-year-old patient with type 1 diabetes mellitus. Has had 1 day of abdominal pain and vomiting. Has recently transitioned to an insulin pump 2 weeks ago. Patient has very high glucose with ketones. What is your immediate next step?

Present to the emergency department for assessment

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15 year old girl with T1DM, diagnosed at the age of 7 years old. Presents with 2kg weight loss. HbA1c is 9.7%. What is the most likely cause of her weight loss?

Nonadherence

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5 year old boy with lethargy associated with being ill. Labs show hypoglycemia around 2.1 with urinary ketones. Lytes, liver enzymes, all normal. Child has had previous episodes of mild lethargy with illnesses this year. What do you recommend

Avoid fasting and pay attention to nutrition during illness until 8-9 years old

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A 14yo girl presents with restlessness and a mass in her neck. TSH low. FT4 and T3 both clearly elevated. How do you treat?

Methimazole

A 12 year old girl has been gaining weight for 3 years. Her BMI is 33. She has appropriate caloric intake and activity levels for her age. Her height was tracking along the 25th % but is now tracking along the 10th%. She has abdominal obesity and wide abdominal straie (no color mentioned) as well as mild acne. Her blood pressure is 140/80s. What is the most likely cause?

Cushing's syndrome

Girl on risperidone presents with amenorrhea and galactorrhea. What is the mechanism of action?

Dopamine antagonist

8yo boy with increase in height, deepening of voice, some pubic hair and testes 3 mL. What is the most likely cause?

Adrenal carcinoma

Child with congenital adrenal hyperplasia is having elective tonsillectomy. What do you order for her post-operatively?

30mg/m2 divided TID

A 13 year old female has an LDL of 6.82. Her HDL and triglycerides were normal. Her BMI is above the 97th percentile. Her TSH is 4.9. Her father is obese and had a MI at age 42. What is the most likely diagnosis?

Familial hypercholesterolemia

Child presents in DKA. pH 6.9, BG 30, looked unwell, tachycardic, and GCS 13. What do you do next?

Bolus 10mL/Kg NS

7yo boy with autism is referred to your office for obesity. He was hypotonic as an infant and parents report he snacks constantly and his weight is now above the 97th percentile with length at the 75th percentile. He has pale abdominal striae on exam and a dorsocervical fat pad. What is the best diagnostic test?

DNA methylation studies

A 1-year-old girl is referred to you for breast development. Previous history non-contributory, and she has not had a recent growth spurt. She is well appearing and general exam is normal except for Tanner Stage 2 breasts. What is the best next step?

Reassure and reassess in 6 months

A school-aged girl has a growth velocity of 2cm/year. Did not mention anything about a bone age nor was this one of the options. What should you do next?

TSH

Male teen with gynecomastia, Tanner Stage 5. He is extremely distressed.

Refer to plastic surgery

Obese boy without dev delay, rapid weight gain, pale abdominal striae, what diagnosis?

Prader-Willi syndrome

An 8 year-old boy presents with 3 weeks of polydipsia, polyuria, and fatigue. He presents to ED with a BG of 22. His blood gas is normal. He is started on subcutaneous insulin and was discharged the next day. At home, he is having frequent episodes of hypoglycemia despite dramatically reducing his insulin dose. What is the most likely cause?

Honeymoon period of diabetes

An 8-year-old girl is referred to you because of breast development. She has Tanner Stage 3 breasts but no other signs of puberty. On dermatological exam she has axillary freckling and 7 large cafe au lait macules. What is the cause of her symptoms?

Optic glioma

A one-week-old infant presents to the ED with a seizure. They were born at term after an uncomplicated pregnancy with a birth weight of 4.8kg. They are normally formula fed every 1-2 hours, but parents let him go a bit longer between feeds and found him unresponsive and jerking. He is hypoglycemic with a BG of 1.8. After stopping the seizure and drawing a clinical sample, he is admitted to hospital. Besides IV fluids, what other medical management would you initiate?

Glucagon

A 16-year-old gymnast has had irregular periods since menarche. She also has upper lip hair and moderate acne on her forehead and back. BMI 15. What is she most likely to also have?

Low LH and FSH *** PL***

Girl with very high T4 and high T3. TSH <0.02 (low). Has maternal aunt with hypothyroidism. What will you use to treat?

Methimazole

6 year old obese boy. Having behavioural and learning difficulties. Weight is > 99.9th percentile, height is 15th percentile. Daytime somnolence. Mild hypotonia.

Cytogenetic testing

Term newborn noted to be hypotonic after birth. Required CPAP for 48 hours. He is stlll requiring NG feeds. He is noted to have bilateral undescended testes. What investigations is most likely to give you the diagnosis?

DNA methylation studies

9 year old female presenting in DKA Initial bloodwork: Blood glucose 27, pH 7.12, HCO3 5, sodium was normal, K 4.9 She was started on IV normal saline + 40 meq/L KCl and Insulin 0.1 units/kg/hr. 2 hours later: BG 15, pH 7.19, HCO3 9, sodium still normal, K 3.7, Anion gap calculated at 15 (did yourself) What do you do next?

Add dextrose to the IV

12 yo F w recent anorexia, abdominal pain, fatigue, malaise. Labs with increased PTH and mildly elevated serum calcium (3.43). Mother with recent diagnosis of prolactinoma. Family history of a few uncles with kidney stones. What is the diagnosis?

MEN 1

MEN 1 Diagnosis

2 classic endocrine tumor types (parathyroid, pit, pancreas) or presence of one of these tumors in 1st degree relative of a patient with known MEN1

What is the best test for Vit D deficiency

Serum 25OHD

2 year old boy 3 days of vomiting and diarrhea. Lethargic. Glucose low (2.4?). Ketones 2+. Most likely diagnosis?

Idiopathic ketotic hypoglycaemia

A healthy 16 year old male has noticed breast tissue increase over the last 2 years. His BMI is at the 85th percentile. He has adult sized testes, SMR 5 pubic hair and SMR 4 breast tissue. He is extremely distressed about the breast tissue. Other than healthy active living, what will be included in your management?

Plastic surgery referral

Familial hypercholesterolemia

Child with vomiting, lethargy, fatigue. Labs given. Hyponatremia, hyperkalemia, low chloride, normal glucose. Sosm > Uosm. What is the diagnosis?

Adrenal insufficiency

14 yo girl who is treated with levothyroxine for Hypothyroidism. She has been on it for 2 weeks but still has fatigue and a 5 kg weight loss. She has a borderline low blood pressure. Her lab work reveals: Na 127, K 5.8, Glucose 3.4. TSH 90. What is the next best step:

IV hydrocortisone

12yo female with menarche 1yr ago periods every 3mos for 5d and mild dysmenorrhea. Upper lip hair and some on lower abdomen. BMI 20. Maternal aunt infertility. Best management?

Start OCP

A baby is born to a mom with Graves disease. Mom had positive TRABs. Baby is now 36 hours old and “ready for discharge.” What is the next step in management?

Check thyroid function at 3-5 days

Girl who is non-symptomatic, with firm diffuse enlarged thyroid, with normal skin and hair, no cold intolerance, normal school, normal growth, normal TSH (4.6); what to do?

thyroid ultrasound

13mo female presents to the emergency room with convulsions. She is found to have an ionized calcium of 0.81. She has been exclusively breast fed. Her physical exam shows widened wrists and ankles. What other laboratory abnormalities are likely to be present?

High ALP

Maternal risk factors for Rickets (5)

1. Low intake of VitD rich foods (consuming <2cups/day of milk or fortified soy beverage, low consumption of fish and sea mammals) 2. Lack of Vit D supplementation during pregnancy 3. Use of certain medications (ex: some antiretrovirals and antiepileptics 4. Multiple pregnancies 5. Smoking

Infant Risk Factors for Rickets (1)

Mother not ingesting sufficient Vit D supplements or otherwise at risk for for Vit D deficiency (regardless of infant feeding mode)

Child risk factors for Rickets (3)

1. Low intake of Vit D rich foods 2. Mother has risk factors for VitD deficiency 3. Lack of Vit D supplementation during infancy

General Risk Factors for Rickets (7)

1. Darker skin pigmentation 2. Food insecurity 3. Obesity 4. Living in communities North of 55* latitude (Edmonton is 53) 5. Living i area where Vit D deficiency is prevalent 6. Extensive use of sun block or skin coverage by clothing or lack of exposure to outdoors 7. Low socio-economic status

A 6 year old girl presents with one breast that is SMR 2 and one that is SMR 3. Exam otherwise normal. What is the most likely cause?

Premature thelarche

A 7 yo boy has difficulties with attention and has become ataxic over the last few months, gradually worsening. He still has tan lines and it’s March. What test would you order?

VLCFA (Very Long Chain Fatty Acids test) for X-linked adrenoleukodystrophy

2 year old boy with FTT, polyuria, polydipsia. He has a large liver. Investigations show normal anion gap metabolic acidosis. He has glucosuria with normal serum glucose. What will give you the diagnosis?

urine organic acids

4y male with SMR3 pubic hair, enlarged penis but prepubertal testes. Next step?

11 yr old girl complains she is the shortest in her class. with school difficulties, esp math. Has had many AOMs and unilateral SNHL. Has bicuspid aortic valve. What is the diagnosis?

2yo with 1 day of vomiting and diarrhea in the ER is lethargic. Blood glucose 2.0. Gets better after IV glucose. What will support your diagnosis?

elevated urine ketones

2 ½ month-old with Prader Willi Syndrome comes to your office for a weight check. Currently feeds 120mL of 20kcal/30mL formula q3h. Weight is 3.1kg. He has gained 12g/day over the last week. What do you recommend for his feeds?

Increase caloric density of feeds

Teen girl with acne, hirsutism, purple striae on abdomen and legs. BP 140/90. What is the BEST test for diagnosis?

Dexamethasone suppression test

You are trying to diagnose complete diabetes insipidus. Which of the following would you expect post-water deprivation test?

Drop in urine osmolarity ***PL***

15 year old gymnast with menarche at age 11 and presenting with periods q2-3months. BMI at the 25th percentile. She has hirsutism and Grade III acne. She has mildly elevated LH and testosterone. FSH, DHEAS and prolactin are normal. What is the diagnosis?

PCOS

An amenorrheic teenage girl has SMR 5 breasts and SMR1 pubic hair. What is the most likely diagnosis?

Complete Androgen Insensitivity Syndrome

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?

7.5%

A neonate’s newborn screen shows a TSH of 45. What is the NEXT step in management?

Order a TSH + free T4

6 yo 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 3 cm/year and her bone age is 4 years. What is the most likely diagnosis?

Growth hormone deficiency

A boy (? 5y) has pubic hair but testes < 2ml. What is the most likely reason for this?

Normal variant

A boy is growing along the 3rd % for height. His parents are 175cm (dad) and 155cm (mom). What do you do?

Do TSH

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:

non compliance with insulin

A child is noted to be drinking ++ water and has very dilute urine. What is the most likely diagnosis?

Diabetes

A 5 month old boy who has been unwell for 48 hours (not feeding, lethargic) presents 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?

Fatty acid oxidation disorder ***PL***

6-day old baby girl with elevated 17-OHP on newborn screening, which of the following is most likely?

Clitoramegaly

11 yo male 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?

lifestyle modification and low-fat diet

Diabetic girl with weight loss. T1DM, straight A student fell of curve from 25% to 5% for weight. HbA1C 8%. Which is the most likely cause of her weight loss?

Diabetic with weight loss and diarrhea and bullous itchy rash on extensors and over trunk. Abdominal pain that’s nonspecific. No hematochezia.

Celiac

When do you give insulin to give in DKA?

After fluid resucitation

Mid parental height 155cm and 175cm of mom and dad for a male child.

171

What investigation to do in a male child whose height is on 3rd percentile, with parents having heights of 155cm mom, 175cm dad

Bone age

Child has autoimmune thyroiditis, want to monitor therapeutic treatment of levo, how do you do this?

TSH

DM2 and obese. Age 12. Parents want to know what appropriate next step is

14 yo girl, tanner 1, normal BA, Normal weight, 3Rd percentile height…what is the diagnosis

Turner Syndrome

Boy on risperidone with gynecomastia. What would we look for before switching?

Prolactin

10 y.o with metabolic syndrome. What is the best measure of adiposity to follow?

Kid w SIADH, what happens?

Urine osmol is more than serum osmol

2 year old kid with thelarche; bone age & stature age is 3 years; what do you tell parents?

Fast Progression to puberty

3y boy with rickets. Which test is most helpful in establishing the diagnosis?

25 OHD

Newborn with ambiguous genitalia. What will help most with your differential diagnosis?

Palpable gonads

14 year old girl. Tanner 1 for breast and pubic hair. Height 5%ile for age.Absent menses. Bone age is equal to chronologic age. What is her most likely diagnosis?

Turner’s syndrome

The parents of an 8 year old child present to you to ask about screening for Diabetes Mellitus type 2. Both parents have DMII and they would like to know when their child should be screened?

A question describing a baby with ambiguous genitalia, palpable gonads. Which is most likely?

CAH