Puberty and Diabetes

Question 1

John, a 6 year old boy, presents acutely with diabetic ketoacidosis, dehydration, reduced urine output, and reduced level of consciousness. What should be the first step in John’s fluid management?

Question 1Select one:

a.
IV Ringer’s lactate to correct deficit over 12 hours

b.
IV boluses 20 ml/kg normal saline until GCS>12

c.
Oral rehydration fluid to replace deficit over 6 hours

d.
IV normal saline to correct deficit over 48 hours

Answer 1

IV boluses 20 ml/kg normal saline until GCS>12

Question 2

A 3 month old boy is noted at his 3-month vaccination in general practice to have a unilateral undescended testis.

What is the most appropriate GP management at this stage?

Question 2Select one:

a.
Refer to paed surgery outpatients

b.
Refer for urgent orchidopexy

c.
Observe in general practice

d.
Arrange MRI of the scrotum

Answer 2

Refer to paed surgery outpatients

9-12 months best for bring down

Question 3

A 4 year old boy with known type I diabetes presents to ED unwell with clinical signs of dehydration, abdominal pain and vomiting. Gastroenteritis has been going around his day care over the past week. As he wasn’t eating, for the last 24 hours his mother stopped his insulin to avoid hypoglycaemia.

He appears unwell, has a pulse of 130/min, respiratory rate of 30/minute and a central capillary refill time of 3 seconds. He has generalized tenderness to examination of his abdomen.

What is the most likely diagnosis?

Question 3Select one:

a.
Hypernatraemic shock

b.
Acute appendicitis

c.
Diabetic ketoacidosis

d.
Salmonella infection

Answer 3

Diabetic ketoacidosis

Question 4

A 13-year-old girl attends your practice. She and her mother are concerned about her lack of pubertal development, particularly in relation to other girls her age in her school class. She is otherwise well and active.

Physical examination is normal. You note breast tissue 2 cm in diameter. She has no pubic or axillary hair or any body odour.

What is your opinion about her pubertal status?

Question 4Select one:

a.
She has delayed puberty and needs oestrogens.

b.
She is showing signs of normal puberty commencing.

c.
She has precocious puberty and needs investigations.

d.
She is showing no signs of puberty, but this is normal.

Answer 4

She is showing signs of normal puberty commencing.

Breast tissue can be normal up to 14

Question 5

Sarah is a 7-year-old girl with recently diagnosed diabetes mellitus who has just been started on a subcutaneous insulin regime, along with family education.

What important complication of treatment is she at risk from in the next week or two that you should advise her parents about?

Question 5Select one:

a.
Hypokalaemia

b.
Hypoglycaemia

c.
Urinary retention

d.
Ketoacidosis

Answer 5

Hypoglycaemia

The last few islet cells become happier, start to recover. then they die

Question 6

What is usually the first sign of normal puberty in males?

Question 6Select one:

a.
Development of pubic hair

b.
Increased length of the penis

c.
Pigmentation of the scrotum

d.
Increased volume of the testes

Answer 6

Increased volume of the testes