Paediatric Endocrine Review Questions

Abdulmoein Eid Al-Agha, MBBS, DCH, CABP, FRCPCH

Associate Professor of Pediatric Endocrinology, King Abdulaziz University Hospital

Pediatric Department

MCQ # 1

• A 2-year-old boy was referred for further assessment of his increasingly bow legs. His mother was known to have rickets. X-rays show bowing of both tibial shafts. The following blood measurements were obtained: calcium 2.37mmol/L, phosphate 0.13mmol/L , alkaline phosphatase 805IU/L, PTH 1.3pmol/L. Which one of the following statements is true?

A. This boy has a 25% chance of inheriting rickets from his mother

B. With this inherited form, he would be expected to be less severely affected than his mother

C. A simultaneous blood and urine sample should be obtained for the measurement of phosphate and creatinine so that the renal threshold phosphate concentration can be calculated

D. 1,25 dihydroxy vitamin D3 is usually normal or high

MCQ # 2

• A -5-year-old girl presents with breast enlargement and slight vaginal discharge, together with moodiness and body odor. There is no relevant past history and she is well with no headaches, visual disturbance or polydipsia. Mother and two elder sisters had early menarche at 10–11 years. On examination, her height is on the 90th centile and mid-parental height 50th centile. Examination shows Tanner stage B3, P2, A1. What is the most important diagnostic tool for this girl?

A. Observation of further progression of pubertal signs

B. Confirm advancing bone age

C. MRI pituitary to look for any CNS tumors

D. Basal &LHRH stimulation test if needed

MCQ # 3

Two- year old girl, brought by her mother because of bilateral breast enlargement and spotty vaginal discharges. On examination (see photo). Which is the most important confirmatory investigation you will order?

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A. Basal LH/FSH and estrogen

B. HCG

C. Thyroid function test

D. GnRH stimulation test

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MCQ # 4

Which one of the following is not a cause of Hirsutism in females?

A. Congenital adrenal hyperplasia

B. Cushing’s syndrome

C. Androgen-producing ovarian tumor

D. Androgen insensitivity syndrome

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MCQ # 5

Three years old boy presented with goiter, short stature, deafness and symptoms suggestive of mild hypothyroidism. On examination, was having normal mentality, diffuse goiter, deaf and mute with normal CNS examination apart from sluggish reflexes. His bone age was retarded and has raised level of circulating TSH, fT4 and fT3

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Among which of the following is most likely diagnosis?

A. Generalized resistance to thyroid hormone (GRTH)

B. Pituitary resistance to thyroid hormone (PRTH)

C. Pendred's syndrome

D. TSH secreting Adenoma

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MCQ # 6

• A 13-year-old girl presented at clinic having been diagnosed as having hypothyroidism by her family doctor who had confirmed the diagnosis with thyroid function tests. She also had a 2-year history of a limp in her left leg. On examination she was short and obese with a goiter and other signs of hypothyroidism. She had limitation of movement of her left hip and a limp. What is the most likely diagnosis?

A. Slipped capital femoral epiphysis (SCFE)

B. Chronic osteomyelitis

C. Vitamin D deficiency

D. Monoarticular rheumatoid arthritis

Which one of the following statement is true regarding Graves’ ophthalmopathy?

A. Graves’ disease is the least common cause of hyperthyroidism in childhood

B. It results from antibodies that block the thyroid-stimulating hormone (TSH) receptor.

C. Exophthalmos occurs in only one third of children.

D. Ophthalmopathy is more severe in children and teens with Graves’ disease than it is in adults

MCQ # 8

Eleven year old young boy who had presented to the clinic because of short stature. Height was much below 3rd. percentile and weight was on 75th. percentile. Which is the following is important in your initial evaluation?

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A. Measure parents height and calculate mid-parental height

B. Assure him that his short stature is not pathological

C. Admit immediately to do growth hormone stimulation test

D. Start short trial of growth hormone and see the response.

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MCQ # 9

A 12-year-old girl was referred with growth failure and delayed puberty. On examination her height was below the 0.4th centile and her weight was on the 25th centile. Her height velocity was 1.8 cm/year. What is the most important initial diagnostic approach?

A. Celiac antibody screening B. Bone age C. Chromosomal analysis D. Thyroid function test

10 MCQ # 20 days old, baby boy was seen in a pediatric

clinic for hypoglycemia . He had dysmorphic features, cleft lip and palate with a small mid-face. Both testes were palpable, but the penis was rather small. length was below the 3rd centile, weight on the 10th centile. What is your next best approach in order to reach diagnosis?

A. Look for other dysmorphic features B. Admit and do critical sample during his

hypoglycemia attack C. Do GH stimulation test D. Do MRI brain

MCQ # 11

Which one of the following is an absolute contraindication for growth hormone replacement therapy in children?

A. Active malignancy

B. Proliferative retinopathy in a child with diabetes and growth hormone deficiency

C. Scoliosis

D. Within six months of post surgical removal of pituitary tumor

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MCQ # 12

Which one of the following is not proven adverse effect of growth hormone replacement?

1) Carpal tunnel syndrome

2) Arthralgia and myalgia

3) Benign intracranial hypertension

4) Increase incidence and recurrences of brain tumor

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MCQ # 13

Six-year-old girl was referred with growth failure, poor appetite, recurrent abdominal pain, ‘thick custard’ stools and vomiting. What is the most diagnostic tool?

A. Bone age

B. Anti-tissue transglutaminase antibody

C. Jejunal biopsy

D. Serum iron and ferritin

MCQ # 14

• A 9-year-old girl was referred because of tall stature. She has on & off headache. On examination there were no dysmorphic features. Her height was just above the 99th centile and her parents’ heights were on the 50th and 75th centile. Pubertal development was: breast, stage 2; pubic hair, stage 3; and no menarche. Bone age was 12.4 years and final height prediction was 188 cm. Which one of the following statement is most appropriate?

A. Most likely familial and need to observe growth velocity

B. Need to do basal and stimulated GH test

C. Need to do IGF -1

D. Need to do an oral glucose tolerance test for GH suppression

MCQ # 15

Six month old male infant presented with failure to thrive, constipation. His mother was complaining of too many diaper change and urine was leaking out of diapers most of the time. On examination he was having moderate to severe dehydration. His initial sodium was high 175 mmol/l., very low urine osmolality. Which one of the following is least common cause in the differential diagnosis of this infant?

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MCQ # 15

A. Langerhans cell histiocytosis

B. X-linked recessive form of nephrogenic diabetes insipidus

C. DIDMOAD syndrome

D. Psychological polydipsia

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MCQ # 16

Which one of the following is first line treatment of acute hypercalcemia?

A. Calcitonin

B. Diuretics

C. Intravenous hydration

D. Bisphosphonate therapy

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MCQ # 17

Which one of the following is not a cause of Hirsutism in females?

A. Congenital adrenal hyperplasia

B. Cushing’s syndrome

C. Androgen-producing ovarian tumor

D. Androgen insensitivity syndrome

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MCQ # 18

Which one of the following is commonest cause of 46 XX DSD?

A. Partial AIS.

B. CAH (21- OH deficiency).

C. Virilizing ovarian or adrenal tumors

D. Placental Aromatase enzyme deficiency

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MCQ # 19

• Which one of the following is commonest cause of 46 XY DSD?

A. Testicular Aplasia / Hypoplasia.

B. Partial AIS

C. Testosterone biosynthesis defects.

D. 5 - Reductase deficiency

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MCQ # 20

The following is true regarding primary adrenal failure? A. Is least commonly due to autoimmune damage to the

adrenal gland B. Hemorrhage into adrenal gland due to meningococcal

infection (Waterhouse-Frederickson syndrome is common cause

C. The long and short synacthen tests are useful diagnostic tools in primary adrenal failure

D. Management is usually by lifelong hydrocortisone administered orally at night.

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GOOD LUCK

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