ATI RN
Endocrine System Pediatric Questions
Question 1 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.
Question 2 of 5
Hypoglycemia may be a manifestation of child abuse or Munchausen syndrome by proxy induced by exogenous administration of insulin (i.e., factitious hyperinsulinemia). Of the following, the MOST reliable test that confirms the diagnosis of factitious hyperinsulinemia is
Correct Answer: A
Rationale: Factitious hyperinsulinemia from exogenous insulin shows high insulin levels with low C-peptide (produced by endogenous insulin), distinguishing it from endogenous causes. Low glucose (B) and ketones (C, D) are nonspecific, and high insulin (E) alone is insufficient.
Question 3 of 5
A 15-year-old boy is brought to clinic by his parents because of delayed puberty. His growth chart reveals a height just below but parallel to the 5th centile. Examination is unremarkable. Bone age is consistent with a 12 year chronological age. Lab investigations including hormonal study are normal. Of the following, the MOST likely diagnosis is
Correct Answer: D
Rationale: Constitutional growth delay involves delayed puberty and growth with normal labs and a delayed bone age, matching this case. Hypothyroidism (A), Klinefelter (B), hypogonadism (C), and craniopharyngioma (D) typically show abnormal labs or physical findings.
Question 4 of 5
An adolescent female develops fever, palpitation and disorientation. Examination shows exophthalmos, goiter, tachycardia and elevated blood pressure. Lab tests reveal elevated T4 and T3 with low TSH. Of the following, the BEST initial treatment is
Correct Answer: A
Rationale: Thyroid storm requires immediate symptom control; beta blockers (e.g., propranolol) rapidly manage tachycardia and palpitations, making them the best initial treatment before antithyroid drugs (B, C), radioiodine (D), or surgery (E).
Question 5 of 5
A 3-week-old neonate develops repeated vomiting and dehydration. Examination reveals ambiguous genitalia with fusion of the anterior portion of the labioscrotal folds. Ultrasonography reveals presence of uterus, ovaries, and fallopian tubes. Of the following, the MOST valuable test to establish the diagnosis is
Correct Answer: A
Rationale: Elevated 17-hydroxyprogesterone confirms congenital adrenal hyperplasia (e.g., 21-hydroxylase deficiency), common in 46,XX neonates with ambiguous genitalia and salt-wasting, as seen here. Other tests (B, C, D, E) are less diagnostic initially.