Deck 26: Endocrine and Metabolic Disorders

Question 1

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

Answer 1

Premature thelarche which will resolve over time

Question 2

The primary care pediatric nurse practitioner diagnoses an 8­year­old 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.

Answer 2

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

Question 3

A 6­year­old female has had a recent growth spurt and an exam reveals breast
and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?
A. Order LH and FSH levels and a long­acting GnRH agonist.
B. Order thyroid function tests to exclude primary hypothyroidism.
C. Reassure the parent that this is most likely idiopathic.
D. Refer the child to a pediatric endocrinologist for management.

Answer 3

Refer the child to a pediatric endocrinologist for management.

Question 4

The primary care pediatric nurse practitioner is performing a well child
examination on a 12­year­old 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

Question 5

An initial key part of management of a child suspected of having an inborn error of metabolism is
A. consulting a metabolic specialist.
B. obtaining a complete family history.
C. ordering metabolic screening tests.
D. referring the family to a dietician.

Question 6

The primary care pediatric nurse practitioner is performing a well child
examination on a 5­year­old 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

Question 7

A 7­year­old 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

Question 8

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/M2.
D. Refer the infant to the emergency department for fluids, dextrose, and steroids.

Question 9

The primary care pediatric nurse practitioner is reviewing lab work and diabetes
management with a school­age child whose HbA1C 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. Self­monitoring of blood glucose
D. Use of a long­acting insulin analogue

Question 10

The primary care pediatric nurse practitioner performs a physical examination on
a 9­month­old 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

Question 11

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2­week checkup. What will the nurse practitioner suspect?
A. Galactosemia
B. Glucose­6­phosphatase deficiency
C. Phenylketonuria
D. Urea cycle disorder

Question 12

The primary care pediatric nurse practitioner prescribes metformin for a 15­year­
old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner 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 B12
D. To use a stool softener to prevent gastrointestinal side effects

Question 13

The primary care pediatric nurse practitioner is providing nutritional counseling for
a 9­year­old female whose weight is at the 95th percentile for her age. What is the goal for this patient?
A. A loss of 10 to 15 pounds in 6 months
B. An average weight loss of 2 pounds per month
C. Maintenance of her current weight
D. Weight loss of 5% of her current body weight

Question 14

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

Question 15

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

Question 16

A 16­year­old adolescent female whose 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

Question 17

The primary care pediatric nurse practitioner is performing a well child
examination on a 2­year­old child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?
A. Consider prescribing growth hormone therapy.
B. Reassure the parent that this is normal for this child.
C. Refer the child to a dietician for dietary supplementation.
D. Refer the child to a pediatric endocrinologist.

Question 18

A 13­year­old Native American female has a BMI at the 90th percentile for age.
The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet­like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will
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.

Question 19

A 12­year­old 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 antibodies
D. Thyroid function tests