A mother and her 14½-year-old daughter come to you because the girl has not begun to menstruate. Findings on her medical history and complete physical examination are normal. Breast development and pubic hair have been present for 18 months and are normal. Which would be the most appropriate?

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Endocrine System Pediatric Questions

Question 1 of 5

A mother and her 14½-year-old daughter come to you because the girl has not begun to menstruate. Findings on her medical history and complete physical examination are normal. Breast development and pubic hair have been present for 18 months and are normal. Which would be the most appropriate?

Correct Answer: A

Rationale: Normal puberty with Tanner stage progression suggests menstruation will likely start soon; reassurance is appropriate.

Question 2 of 5

A 6-year-old female presents with breast enlargement and pubic hair development. Otherwise, she is asymptomatic. Her serum LH level is elevated. The most likely diagnosis is

Correct Answer: D

Rationale: Elevated LH with puberty signs at age 6 indicates central precocious puberty (gonadotropin-dependent).

Question 3 of 5

The evaluation of the child in the previous question is best accomplished by determining

Correct Answer: A

Rationale: Serum TSH is the most sensitive test for diagnosing hypothyroidism, elevated in primary cases.

Question 4 of 5

A 6-year-old has a chronic rash involving all of the nails of the fingers and toes. Last year she had a seizure and was noted to have a low serum ionized calcium. Currently she has weakness and hypotension, and she presents with a hypoglycemic seizure. The most likely diagnosis causing this seizure is

Correct Answer: D

Rationale: Addison disease causes hypoglycemia, hypotension, and weakness due to adrenal insufficiency, fitting this presentation.

Question 5 of 5

Hyperkalemia in severe diabetic ketoacidosis is due to

Correct Answer: D

Rationale: Acidosis in DKA shifts potassium extracellularly, causing hyperkalemia despite total body depletion.

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