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WorksheetsExam 3 (Peds) - Endocrine/Musculoskeletal
Total questions: 115
Worksheet time: 3570secs
What does Growth Hormone Deficiency (GHD) inhibit?
somatic growth
organ growth
nerve growth
hair growth
Where does the primary site of dysfunction appear to be in Growth Hormone Deficiency (GHD)?
Pituitary gland
Hypothalamus
Thyroid gland
Adrenal gland
SATA: Growth hormone (GH) is crucial for which of the following?
Muscle development
Bone development
Metabolism regulation
Vision improvement
Blood production
A definitive diagnosis of GHD is acquired with which test?
radioimmunoassay of plasma GH levels
ultrasound of the brainstem
MRI of the brainstem and cerebellum
A combination of CBC, BMP, and type+screen
SATA: Acquired GHD may result from which of the following?
Brain injuries
Brain surgeries
Cancer treatments
Viral infections
Heart surgeries
What is the main management option for GHD?
Biosynthetic growth hormone injections
Cadaver growth hormone injections
There is no effective management for GHD
Synthetic osteoclast and osteoblast injections
GH replacement is successful in what percentage of affected children?
80%
30%
50%
95%
What is the typical growth rate per year before and after treatment for GHD?
1.5-2 cm before, 3-4 cm after
3.5-4 cm before, 8-9 cm after
5.5-6 cm before, 10-12 cm after
2.5-3 cm before, 5-6 cm after
What rare neurodegenerative condition has been reported in some patients after receiving GH from cadavers?
Creutzfeldt-Jakob Disease
Guillen-Barre Disease
Myelomeningocele
Spastic Cerebral Palsy
Does Creutzfeldt-Jakob Disease occur with biosynthetic GH?
No
Yes
Only in children
Only with animal-derived GH
Will blood banks accept donations from former human GH recipients? Why or why not?
No, because of the risk of CJD infection.
Yes, because GH recipients are considered healthy.
Yes, as long as the recipient is over 18 years old.
No, because of myelomeningocele.
When are injections given for best results in GH therapy?
At bedtime
In the morning
After meals
Before exercise
What is the approximate yearly cost of GH therapy?
20k-30k per year
5k-10k per year
50k-60k per year
100k-120k per year
Excess GH BEFORE closure of epiphyseal shafts results in what?
Overgrowth of long bones
Dwarfism
Osteoporosis
Acromegaly
Overgrowth of short bones
Excess GH AFTER epiphyseal closure is known as what?
Acromegaly
Gigantism
Dwarfism
Cretinism
New guidelines define puberty as precocious if it occurs in Caucasian girls younger than __ and African-American girls younger than __.
7; 6
8; 7
6; 5
9; 8
What staging is used to identify the stage of puberty?
Tanner staging
Duke staging
Ann Arbor staging
Child-Pugh staging
Which of the following is NOT a potential cause of precocious puberty?
Disorder of the gonads
Adrenal gland disorder
Hypothalamic-pituitary-gonadal axis disorder
Growth hormone deficiency
In what percentage of girls with precocious puberty is no causative factor found?
80-90%
10-20%
30-40%
50-60%
Which of the options below is NOT a type of precocious puberty?
Central
Peripheral
Incomplete
Delayed
In males with precocious puberty, what should the RN also check for?
benign prostate hypertrophy
cardiac abnormalities
renal and hepatic defects
brain tumors
What does a GnRHa histrelin implant do to treat precocious puberty?
increases serum luteinizing hormone
decreases serum luteinizing hormone
increases serum luteinizing hormone and testosterone
decreases serum luteinizing hormone and testosterone
Which of the following is NOT an early manifestation of hypothyroidism?
Cold intolerance
Receding hairline
Apathy
Thickened skin
Name one skin-related symptom of early hypothyroidism.
Dry and scaly skin
Oily skin with acne
Increased sweating
Blistering rash
Which of the following is a late manifestation of hypothyroidism?
Heat intolerance
Cardiac complications
Fine straight hair
Bulging eyes
Which symptom is associated with hyperthyroidism?
Bradycardia
Weight gain
Bulging eyes
Dull/blank expression
SATA: ________ is a treatment for hyperthyroidism.
Ablation with radioiodine
Thyroidectomy
Methimazole therapy
Beta-blocker therapy
Climate therapy
Which of the following are NOT manifestations of hypothyroidism?
Anorexia, brittle hair and nails
Fine straight hair, tachycardia
Facial and eyelid edema
Dull/blank expression, slow speech
Congenital adrenal hyperplasia is a(n) ____________ disorder.
autosomal recessive
autosomal dominant
X-linked disorder
Y-linked disorder
What is congenital adrenal hyperplasia?
Decreased enzyme activity required for cortisol production in the adrenal cortex.
Increased insulin secretion from the pancreas.
Overproduction of thyroid hormones in the thyroid gland.
Deficiency of growth hormone in the pituitary gland.
More than 90% of cases of Congenital Adrenal Hyperplasia (CAH) are due to which enzyme deficiency? (I'll be furious if I see this on the exam.)
21-hydroxylase deficiency
11β-hydroxylase deficiency
17α-hydroxylase deficiency
3β-hydroxysteroid dehydrogenase deficiency
What is the inheritance pattern of Congenital Adrenal Hyperplasia (CAH)?
Autosomal recessive
Autosomal dominant
X-linked recessive
Mitochondrial
Overproduction of adrenal androgens in CAH results in what effect on the female fetus?
Virilization of the female fetus
Delayed puberty in the female fetus
Increased risk of ovarian cysts
Development of Turner syndrome
Which of the following is a manifestation of CAH in males?
Precocious genital development
Ambiguous genitalia
Enlarged clitoris
Fused labia
Which of the following is NOT a manifestation of CAH in females?
A) Enlarged clitoris appears as a small phallus
B) Fused labia produce a saclike structure without testes
C) Internal female sex organs remain intact
D) Testes are present
Which of the below is the preferred diagnostic imaging method is used to visualize pelvic organs in congenital adrenal hyperplasia?
U/S
ECG
CT
EEG
MRI
What is measured in newborn screening for CAH?
Measurement of cortisol precursor
Measurement of blood glucose
Measurement of thyroid hormone
Measurement of bilirubin
What medication is used to suppress abnormally high secretion of ACTH in CAH treatment?
Cortisone
Desmopressin
Thyroxine
Metformin
What is the defect in Phenylketonuria (PKU)?
Defect in hydroxylation of phenylalanine to form tyrosine
Defect in hydroxylation of tyrosine to form phenylalanine
Defect in cortisol production
Defect in androgen production
What is the hallmark sign of urine in PKU (Phenylketonuria)?
Musty odor
Fruity odor
Fishy odor
Burnt sugar odor
Generalized stank
SATA: Select some clinical manifestations of PKU.
cognitive defects
convulsions
ataxia
musty odor
skin rash
Babies are tested for PKU a minimum of how many hours after beginning milk feeds (both breastmilk and formula)?
24 hours
6 hours
12 hours
48 hours
How many days after the initial PKU test should babies be retested to catch earlier false negatives?
7-10 days
1-2 days
14-21 days
30 days
Which of the following should a mom COMPLETELY avoid if her baby has PKU?
Chips, crackers, cookies
Dry beans, nuts, and eggs
Cereal, fruits, and vegetables
All of the above
SATA: Select the clinical manifestations of galactosemia.
liver failure
renal tubular defects
cataracts
brain damage
myocardial infarction
What is the treatment for galactosemia?
Restriction of galactose and lactose for life
High protein diet with dairy products
Supplementation with galactose
Increased intake of glucose and fructose
Restriction of galactose and lactose for 3-5 years after diagnosis
Which of the following is NOT a manifestation of galactosemia?
A) Brain damage
B) Cataracts
C) Jaundice
D) Musty odor urine
If a galactosemic infant is given milk, what happens to unmetabolized milk sugars?
They build up and damage the liver, eyes, kidneys, and brain
They become stuck in the kidney's excretion system
They are converted into harmful proteins in the body
They turn the infant's urine into pure milk
Maple Syrup Urine Disease is caused by a deficiency of which enzyme, which causes amino acid degradation?
Decarboxylase
Phenylalanine hydroxylase
Tyrosinase
Homogentisate oxidase
What is the weakest point of long bones?
The cartilage growth plate
The diaphysis
The periosteum
The bone marrow cavity
Which site is a frequent site of damage during trauma in long bones?
The epiphyseal plate
The periosteum
The diaphyseal shaft
The articular cartilage
Epiphyseal injuries may affect future bone growth.
True
False
Which of the following may be included in the treatment of epiphyseal injuries to prevent growth disturbances?
Open reduction and internal fixation
Bionic replacement
Pins and epiphyseal fusion
Amputation
Fractures are _____ in infants.
Common
Rare
Constant
Impossible
Which bone is most frequently broken in children?
Wrist
Femur
Clavicle
Skull
Methods of treatment for fractures are the same in pediatrics and older adult populations.
True
False
Which of the following is NOT a type of fracture?
Complete
Incomplete
Simple
Dislocated
What type of fracture occurs when bone fragments have damaged other organs or tissues?
Complicated fracture
Simple fracture
Greenstick fracture
Comminuted fracture
What is a greenstick fracture?
A fracture where the compressed side of bone bends, but the tension side of bone breaks
A fracture where the bone breaks into multiple pieces and scatters bone shrapnel throughout the body
A fracture that occurs only in infants due to congenital early-onset osteoporosis
A fracture where the bone is completely displaced from its original position
What is the typical bone healing and remodeling time for a fracture in the neonatal period?
1-2 weeks
2-3 weeks
4-5 weeks
6-8 weeks
Fill in the blank: The typical bone healing and remodeling time for a fracture in early childhood is _____
4 weeks
2 weeks
8 weeks
12 weeks
Which of the following is NOT a clinical manifestation of fracture?
Generalized swelling
Pain and/or tenderness
Complete loss of sensation
Diminished functional use
List the 5 Ps used in the assessment of fracture.
Pain, Pulse, Pallor, Paresthesia, Paralysis
Pain, Pressure, Pulse, Pallor, Perspiration
Pain, Pulse, Pallor, Pruritus, Paralysis
Pain, Pulse, Pallor, Paresthesia, Pruritus
What is the most useful diagnostic tool for fractures?
X-ray
Ultrasound
MRI
CT scan
Which of the following is assessed to monitor circulation, movement, and sensation (CMS) in a child with a fracture?
Pulses
Capillary refill
Skin color and temperature
All of the above
Palpation of cast for hot spots is part of fracture management in children.
True
False
What is the purpose of using a cast in a child with a fracture?
Immobilization to promote healing and ensure proper alignment
To reduce swelling by applying pressure
To provide warmth and comfort to the injured area
To allow the child to move the limb freely
Which type of injury would require a child to be put in traction?
Minor injuries
Severe injuries
Chronic injuries
None of the above
The RN can release a child from traction autonomously.
True
False
What is the correct position for a child in Bryant's Traction?
Supine with feet held upwards
Supine with legs anchored to the foot of the bed
Prone with feet held upwards
Prone with legs anchored to the foot of the bed
What is the correct position for a child in Buck's Traction?
Supine with feet held upwards
Supine with legs anchored to the foot of the bed
Prone with feet held upwards
Prone with legs anchored to the foot of the bed
Fill in the blank: In the TRACTION Care Guide for Traction, the FIRST 'T' stands for ________ (assess for infection of extremity).
temperature
tenderness
tension
tone
Fill in the blank: In the TRACTION Care Guide for Traction, 'R' stands for ________.
ropes hang freely
rest regularly
raise the limb
remove traction daily
Fill in the blank: In the TRACTION Care Guide for Traction, 'A' stands for ________.
alignment
assessment
airway
antibiotics
Fill in the blank: In the TRACTION Care Guide for Traction, 'C' stands for ________.
circulation check
compression
cast care
cleanliness
Fill in the blank: In the TRACTION Care Guide for Traction, the SECOND 'T' stands for ________.
type and location of fracture
traction weight
treatment plan
tissue integrity
Fill in the blank: In the TRACTION Care Guide for Traction, 'I' stands for ________.
increase fluid intake
inspect the weights
initiate traction
immobilize the limb
Fill in the blank: In the TRACTION Care Guide for Traction, 'O' stands for ________.
overhead trapeze
oxygen therapy
oral care
observation
Fill in the blank: In the Care Guide for Traction, 'N' stands for ________.
no weights on bed or floor
nurse only to adjust traction
never remove traction
night checks required
Stress fractures occur as a result of ________.
repeated muscle contraction
sudden impact injuries
bacterial infections
genetic disorders
Stress fractures are often seen in ________ weight-bearing sports (ex: running, gymnastics, basketball).
repetitive
occasional
sedentary
random
What is another name for Torticollis?
Wry Neck
Frozen Shoulder
Tennis Elbow
Carpal Tunnel Syndrome
Torticollis is characterized by congenital or acquired limited neck motion with the neck flexed to one side.
True
False
Kyphosis is defined as abnormally increased convex angulation in the curvature of which part of the spine?
Thoracic spine
Cervical spine
Lumbar spine
Sacral spine
The most common form of Kyphosis is:
Congenital
Postural
Traumatic
Idiopathic
Kyphosis can result from which of the following?
Tuberculosis (TB)
Arthritis
Osteodystrophy
Compression fracture
All of the above
In CAH (congenital adrenal hyperplasia), females may be born with varying degrees of "ambiguous" genitalia. When this occurs, what happens to the structure of their actual female sex organs?
They are destroyed by CAH
They fuse with the deformities
They remain intact
They turn into testes
Maple Syrup Urine disease is a _____, ___________ disorder.
common, autosomal dominant
common, autosomal recessive
rare, autosomal dominant
rare, autosomal recessive
Which type of fracture is a red flag for possible abuse in pediatric patients?
Compound
Transverse
Greenstick
Spiral
Oblique
Which spinal disorder causes accentuation of the cervical or lumbar curvature beyond physiologic limits, creating a "permanently arched back"?
Torticollis
Kyphosis
Lordosis
Scoliosis
In obese children, abdominal fat alters their center of gravity, which commonly causes:
Torticollis
Kyphosis
Lordosis
Scoliosis
What is the most common spinal deformity in children?
Torticollis
Kyphosis
Lordosis
Scoliosis
SATA: Scoliosis is a multiplanar spinal deformity. Which planes of the spine does scoliosis affect?
lateral curvature
spinal rotation (causes rib asymmetry)
thoracic hypokyphosis
convex angulation of the thoracic spine
cervical accentuation
Children with scoliosis often have a primary spinal curve and a compensatory spinal curve which aligns the head with the:
ribcage
cervical spine
thoracic spine
gluteal cleft
Children with scoliosis may have to wear a TLSO brace for 2 years or until their spine reaches maturity. During this time, how many hours per day should the child wear their TLSO brace?
18
24
12
8
2
Developmental dysplasia of hip (DDH) is associated with which type of delivery?
barlow
breech
vertex
caesarian section
DDH: When an infant is supine, and the height of their knees is deemed unequal with their hips and knees flexed, this is known as:
Babinski sign
Galeazzi sign
Barlow sign
Orlotani sign
SATA: What are some treatment options for pediatric developmental dysplasia of hip?
Pavlix harness
Casting
TLSO brace
Traction
Hip replacement
How would a child contract EXOGENOUS osteomyelitis?
infectious agent directly invades wound via wound, fracture, surgical contamination, ect.
A preexisting condition in a completely separate part of the body spreads to the bone.
They receive the infection as an autosomal recessive congenital disorder, usually passed down maternally.
They are a victim of maternal substance abuse while in utero.
How would a child contract HEMATOGENOUS osteomyelitis?
An abscess or a burn directly infects the bone when not properly sterilized in a timely fashion.
An infectious agent directly invades the bone following a wound, fracture, surgical contamination, ect.
A preexisting condition in a completely separate part of the body spreads to the bone.
Osteomyelitis is an autosomal dominant congenital bone infection, usually passed down paternally.
Choose the BEST answer. _________ can cause osteomyelitis.
viruses
bacteria
fungi
archaea
any organism
The signs and symptoms of osteomyelitis begin _______, and resemble the manifestations of both arthritis and ________.
abruptly, leukemia
abruptly, lymphoma
slowly over time, leukemia
slowly over time, lymphoma
Bone scans and x-rays for children in the early stages of osteomyelitis may appear normal.
True
False
In severe cases, the treatment of osteomyelitis can take several months. What is the gold standard treatment for MOST osteomyelitis cases?
PO antibiotics for 1-2 weeks
IV antivirals for 4-6 weeks
PO antifungals for 5-10 weeks
IV antibiotics for 3-4 weeks
IV antivirals for 6-9 weeks
Osteogenesis imperfecta is a group of heterogenous inherited disorders of the connective tissue, characterized by excessive ________ and ________.
bone length, bone defects
bone fragility, bone defects
bone size, bone thickness
bone length, bone circumference
Most disorders that fall under the umbrella of osteogenesis imperfecta are autosomal recessive disorders.
True
False
Osteogenesis imperfecta can cause ________ of ligaments.
snapping
hypoextensibility
hyperextensibility
destruction
SATA: Medication therapy for osteogenesis imperfecta includes bisphosphonate therapy in conjunction with which of the following substances?
pamidronate
olpadronate
neridronate
alendronate
bonixdronate
Pauciarticular onset of juvenile idiopathic arthritis involves _______ joints.
4 or more
4 or less
5 or more
5 or less
Polyarticular onset of juvenile idiopathic arthritis involves _______ joints.
4 or less
4 or more
5 or less
5 or more
SATA: Systemic onset of juvenile idiopathic arthritis involves:
high fever
rash
hepatosplenomegaly
pericarditis
lymphadenopathy
Many children with juvenile idiopathic arthritis have negative serum _________ factor.
osteoclast
intrinsic
ghrelin
rheumatoid
spinal
How would a HCP definitively determine a diagnosis of juvenile idiopathic arthritis?
X-ray
CT
MRI
ECG
There is no definitive diagnostic test
There is a cure for juvenile idiopathic arthritis.
True
False
SATA: Select some medications used to treat juvenile idiopathic arthritis.
NSAIDs
slow acting antirheumatic drugs
disease-modifying antirheumatic drugs
corticosteroids
cytotoxic agents
