Module 15 - Endocrine Flashcards
A 16-year-old boy weighing 50 kg was diagnosed with type 1 diabetes at age 7. He is managed on basal-bolus insulin therapy. For the last six months, he has complained of fatigue, cold intolerance, and constipation. The exam reveals mild thyromegaly and mild abdominal distention. What is the most appropriate lab test to confirm his diagnosis?
A. Tissue transglutaminase (TTG), IgA
B. Thyroid-stimulating hormone (TSH) and free thyroxine (free T4)
C. Rheumatoid factor
D. AM cortisol
B. Thyroid-stimulating hormone (TSH) and free thyroxine (free T4)
A 16-year-old girl presents for a well-child check. She is obese with BMI in the 95th percentile for age. She has never been screened for diabetes mellitus (DM). She denies any symptoms. Laboratory tests are ordered to screen for diabetes mellitus. Which of the following would be diagnostic of diabetes in this patient?
A. Hemoglobin A1c 6.0%
B. Blood sugar 150 mg/dL 2 hours after ingestion of a glucose load
C. Random blood sugar 200 mg/dL
D. Fasting plasma glucose 130 mg/dL
D. Fasting plasma glucose 130 mg/dL
- A1C of 6.5% or higher is diagnostic of diabetes.
- 2-hour postprandial glucose of 200 mg/dL is considered positive for DM.
- Random blood glucose of 200 mg/dl or higher in the setting of classic symptoms of polyuria, polydipsia, and weight loss is diagnostic.
- A fasting plasma glucose greater than 126 mg/dl is diagnostic of DM.
An 18-year-old girl presents to your office for an annual well-check. The patient’s father was recently diagnosed with type 2 diabetes mellitus. The patient denies polydipsia, polyuria, or recent weight loss. Her fasting blood glucose is 184 mg/dL, her HbA1c is 6.7%, and she has elevated C-peptide levels. Lifestyle modification consisting of diet changes and exercise is recommended. On a three-month follow-up, the patient’s HbA1c was 7.1%. What is the best next step in the management of this patient?
A. Metformin
B. Repaglinide
C. Insulin
D. Semaglutide
A. Metformin
Insulin and Metformin
- Insulin and metformin are the only two approved treatments for T2DM in children!!!!!!!!!!!!!!
- Body responds to metformin by making more insulin, enough to take care of daily metabolic needs!!!!!!!!
Hyperthyroidism
- Complain of problems with clamminess, hand tremor, pulse changes, sleeping difficulty, nervousness and fear of impending doom, diarrhea, weight loss
- Thyroid workup what studies and why?
A 16-year-old male presents with delayed puberty. He denies any changes in his ability to smell. He was diagnosed with cryptorchidism at birth. On physical examination, he is at Tanner stage 1, and testicular volume is < 3mL. Stretched penile length is < 3.5 cm. Laboratory tests show decreased serum calcium. Which of the following laboratory findings are likely?
A. Decreased follicle-stimulating hormone (FSH), decreased luteinizing hormone (LH), decreased testosterone, and increased thyroid-stimulating hormone (TSH)
B. Decreased FSH, decreased LH, decreased testosterone, and normal TSH
C. Increased FSH, decreased LH, increased testosterone, and decreased TSH
D. Decreased FSH, increased LH, increased testosterone, and normal TSH
B. Decreased FSH, decreased LH, decreased testosterone, and normal TSH
A 14-year-old boy presents to the clinic with his mother, concerned about his height and a possible delay in puberty. He is on a soccer team, where most of his teammates are much taller than him. The patient has developed body odor and some facial acne. Mom does report that the patient’s older brother and father were both “late bloomers.” The child’s growth curve reveals that his height is slightly under the 3rd percentile but has been growing along the curve. Physical exam reveals a testicular volume of 3 ml and Tanner stage 1 findings. What is the next best step in evaluating this patient?
A. Brain MRI
B. Left hand and wrist x-ray
C. Growth hormone levels
D. Trial of low-dose testosterone for 2 weeks
B. Left hand and wrist x-ray
Evaluating bone age is next best step
A 15-year-old female is brought to the clinic for evaluation of primary amenorrhea. Her mother states that the patient started pubertal changes at age 11 but did not seem to progress. Her rate of growth has been low normal for age and there has been no menarche. Physical examination shows Tanner stage III breast development and Tanner III-IV pubic hair. There are no dysmorphic features on physical exam. Upon review of systems, the patient states that she has had some headaches. What is the next best step in the management of this patient?
A. Order brain MRI
B. Order blood chromosomes for karyotype
C. Order pituitary function tests including thyroid and prolactin
D. Reassure parent that everything is fine and follow up in six months
C. Order pituitary function tests including thyroid and prolactin
A 5-month-old boy presents with developmental delay, poor head control, and dry skin. Physical examination reveals a goiter, coarse face, and umbilical hernia. Which of the following is the chief cause of this condition?
A. Growth hormone deficiency
B. Iodine deficiency
C. Pituitary tumor
D. Enzymatic defect
B. Iodine deficiency
A 30-year-old woman presents with preterm premature rupture of membranes. The patient gives birth at 32 weeks of pregnancy. The neonate is lethargic and has delayed reflexes on examination. Laboratory evaluation reveals findings suggestive of transient hypothyroxinemia of prematurity. Which of the following laboratory findings are associated with this patient’s condition?
A. Decreased free T4 and normal TSH
B. Elevated free T4 and normal TSH
C. Decreased free T4 and TSH
D. Elevated free T4 and TSH
A. Decreased free T4 and normal TSH
A 4-year-old male is brought to the healthcare provider with a profound intellectual disability. He has a coarse face, an umbilical hernia, a large tongue, and dry skin on the physical exam. The patient’s condition is most likely caused by which of the following deficiencies?
A. Iron deficiency
B. Iodine deficiency
C. Sodium deficiency
D. Thiamine deficiency
B. Iodine deficiency
congenital hypothyroidism, clinical manifestations
protruding tongue, thick coarse hair, umbilical hernia
