Chapter 45 - Endocrine Test ques

The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? a. Congenital adrenal hyperplasia causing breast development b. Precocious puberty needing endocrinology management c. Premature adrenarche which will lead to pubic hair onset d. Premature thelarche which will resolve over time

Premature thelarche which will resolve over time Infant & toddler girls may have isolated breast development (premature thelarche) which usually resolves over time and rarely progresses to true precocious puberty Precocious puberty invovles the early onset of multiple features of puberty & not just breast development

A 6-year-old female has had a recent growth spurt and an exam reveals breast and pubic hair deverlopment. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?

Refer the child to a pediatric endocrinologist for management Children w/ early puberty should always be referred to a pediatric endocrinologist for evaluation and management Thyroid function tests are performed for isolated menarche

The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order? a. Free serum T4 and TSH levels b. Serum levothyroxine level c. Total T4 and free T4 levels d. TSH and total T4 levels

The infant is showing s/sx of hypothyroidism - Free serum T4 will be low & TSH will be high in central hypothyroidism (should be monitored to determine whether doses of levothyroxine are adequate) Total T4 is used to diagnose TBG deficiency

The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely? a. Constitutional growth delay b. Growth hormone deficiency c. Idiopathic short stature d. Klinefelter syndrome

a. Constitutional growth delay - constitutional growth delay = delay in bone age but growth patterns consistent w/ bone age - growth hormone deficiency = delay in both bone age and growth - idiopathic short stature = bone age consistent with chronological age - klinefelter syndrome = an overgrowth syndrome

The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a school-age child whose HbA is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy? a. Continuous glucose monitoring b. Continuous subcutaneous insulin infusion c. Self-monitoring of blood glucose d. Use of a long-acting insulin analogue

a. Continuous glucose monitoring

What is an initial key part of management of a child suspected of having an inborn error of metabolism(IEM)? a. consulting a metabolic specialist. b. obtaining a complete family history. c. ordering metabolic screening tests. d. referring the family to a dietician.

a. consulting a metabolic specialist.

The primary care pediatric nurse practitioner is performing a well child examination on a 5-year-old girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child? a. 5'11" tall b. 5'7" tall c. 5'8" tall d. 6' tall

b. 5'7" tall Calculation of expected adult height for a girl is: [(Father s height - 5 in.) + (Mother s height)]/2, so [(71" - 5") + 68"]/2 = 134/2 = 67" or 5'7". A calculation of boy s expected height: [(Mother s height + 5 in.) + (Father s height)]/2 would be 6' tall.

The primary care pediatric nurse practitioner diagnoses an 8-year-old child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child's weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct? a. Admit the child to the hospital for initial insulin management. b. Begin insulin and refer the child to a children's diabetes center. c. Order a fasting serum glucose and a dipstick UA in the morning. d. Send the child to the emergency department for fluids and IV insulin.

b. Begin insulin and refer the child to a children's diabetes center.

The primary care pediatric nurse practitioner prescribes metformin for a 15-year-old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner NOT include when teaching the adolescent about this drug? a. That insulin therapy will be necessary in the future b. The importance of checking blood glucose 3 or 4 times daily c. To consume a diet with foods that are high in vitamin B d. To use a stool softener to prevent gastrointestinal side effects

b. The importance of checking blood glucose 3 or 4 times daily - pts on metformin should increase foods high in vitamin B12 - blood sugar should be checked only twice daily (once before breakfast and again 2 hours after dinner, b/c metformin does not cause hypoglycemia) - GI side effects are mild & self-limiting

The primary care pediatric nurse practitioner evaluates children's growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening? a. Measuring supine length in children over the age of 2 years b. Obtaining serial measurements to assess patterns over time c. Using the CDC growth chart for children under age 2 years d. Using the WHO growth chart for children over age 2 years

b. obtaining serial measurements to assess patterns over time - supine length is measured in children under 2 yoa - CDC growth charts should be used in children > 2 yoa - WHO charts in children < 2 yoa

The primary care pediatric nurse practitioner is performing a well child examination on a 12-year-old child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? a. Annual lipid profile evaluation b. Annual screening for microalbuminuria c. Comprehensive ophthalmologic exam d. Hypothyroidism screening every 5 years

c. Comprehensive ophthalmologic exam CHildren who have been diagnosed for 3-5 years and who are over age 10 should be referred for annual comprehensive ophthalmologic exams Child w/ a previous normal lipid profile needs to be evalulated q 5 years, not annually Annual screening for microalbuminuria begins at 5 years after onset Hypothyroidism screening should be done annually

13. A 13-year-old Native American female has a body mass index (BMI) at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet-like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will take what action? a. Counsel the child to lose weight to prevent type 2 diabetes. b. Diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL. c. Order a fasting blood sample for a metabolic screen for type 2 diabetes. d. Refer the child to a pediatric endocrinologist.

c. Order a fasting blood sample for a metabolic screen for type 2 diabetes. 3 risk factors for type 2 diabetes: 1. native american ethnicity 2. overweight 3. acanthosis nigricans Diagnosis is based on a randome glucose > 200 mg/dL

A 12-year-old child has a recent history of increased thirst and frequent urination. The child's weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child? a. Fasting plasma glucose b. Hemoglobin A1C levels c. Pancreatic autoantibodies d. Thyroid function tests

c. Pancreatic autoantibodies - fasting plasma glucose may be elevated in both types - hgbA1C does not distinguish among types

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2-week checkup. What will the nurse practitioner suspect? a. Galactosemia b. Glucose-6-phosphatase deficiency c. Phenylketonuria d. Urea cycle disorder

c. Phenylketonuria - Children w/ PKU have a musty odor - Galactosemia causes poor weight gain, lethargy & jaundice after milk feeding has begun - G6PD deficiency causes cardiomegaly & seizure - Urea cycle disorders are characterized by vomiting & lethargy

A 7-year-old female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition? a. Adrenal tumor b. Congenital adrenal hyperplasia c. Polycystic ovary syndrome d. Type 1 diabetes mellitus

c. Polycystic ovary syndrome Children w/ idiopathic premature adrenarche are at increased risk for PCOS & metabolic syndrome -Adrenal tumor & CAH are both possible causes of premature adrenarche, but these have been ruled out to make a diagnosis of idiopathic premature adrenarche - Type 2 diabetes is related to metabolic syndrome, not type 1

A 16-year-old adolescent female whose body mass index (BMI) is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? a. Dyslipidemia b. Hypothyroidism c. Nonalcoholic steatohepatitis d. Polycystic ovary syndrome

d. Polycystic ovary syndrome - PCOS sx: irregular menses, acne, hirsutism - PCOS is associated w/ obesity - dyslipidemia, hypothyrpidism & nonalcholic steatohepatitis are all possible conditions associated w/ obesity but do not have the sx described in the scenario

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and mild dehydration. Which action is correct? a. Administer an intramuscular stress dose of hydrocortisone succinate. b. Administer intravenous fluids in the clinic and reassess hydration status. c. Prescribe an oral hydrocortisone in a replacement dose of 8 to 10 mg/M . d. Refer the infant to the emergency department for fluids, dextrose, and steroids.

d. Refer the infant to the emergency department for fluids, dextrose, and steroids. s/sx of adrenal crisis ED managment is required for IV dextrose, NS & stress doses of hydrocortisone B/c of dehydration, the infant requires IVF but must be sent to the ED b/c of the risk of worsening crisis Oral hydrocortisone in replacement doses is given as part of routine management, not as treatment for adrenal crisis