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WorksheetsPre test Endokrin - Alergi
Total questions: 20
Worksheet time: 20mins
A 12‑day‑old term neonate has persistent jaundice since day 3, constipation, axial hypotonia, a relatively wide anterior fontanelle, dry skin, and macroglossia. Newborn screening on day 3 reported very high TSH; venous confirmation on day 11 shows TSH 85 mIU/L and free T4 0.5 ng/dL. Birth weight is appropriate for gestational age, hemodynamically stable with adequate suck and no signs of sepsis. Pregnancy history is negative for antithyroid drug exposure and there is no family history of thyroid disorders. The most appropriate action now is…
Repeat screening at 1 month before starting medication
Start levothyroxine immediately
Wait for thyroid ultrasound to determine the etiology before deciding on therapy
Begin low‑dose liothyronine (T3) while assessing response
Observe without treatment for two weeks because the infant is clinically stable
A newborn is diagnosed with congenital hypothyroidism by screening and venous confirmation. Birth weight 3.2 kg, no comorbidities, no cholestasis. Therapeutic targets are rapid normalization of free T4 and age‑appropriate TSH. The most recommended initial levothyroxine dose is…
3–5 μg/kg/day
5–8 μg/kg/day
10–15 μg/kg/day
15–20 μg/kg/day
20–25 μg/kg/day
A 10‑year‑old with primary hypothyroidism has just had levothyroxine dose adjusted due to a prior TSH of 7 mIU/L. The child is asymptomatic with normal heart rate and blood pressure. The best timing for repeat TSH and free T4 after a dose change is…
1 week
2 weeks
4-6 weeks
8 weeks
12 weeks
A 7‑year‑old’s height is below the 3rd percentile with an annual growth velocity of 5.5 cm over the last 12 months. Weight is normal, dietary intake is adequate, and there is no chronic illness. Mid‑parental target height is low; bone age equals chronological age. These findings are most consistent with…
Failure to thrive due to subtle malnutrition
Definite growth hormone deficiency
Subclinical hypothyroidism
Familial short stature
Constitutional delay of growth and puberty (CDGP)
An 11‑year‑old has height below the 3rd percentile and slowed growth velocity at 3.5 cm/year with no pubertal signs. The mother had delayed puberty. Hemoglobin and thyroid function are normal. The most helpful test to differentiate constitutional delay of growth and puberty (CDGP) from endocrine pathology is…
IGF‑1 alone
Serial free T4
Left hand bone age
Ferritin
Serum calcium and phosphate
A 24‑month‑old toddler’s height tracks near the 3rd percentile with a stable growth curve over six months. Energy intake meets recommendations and there are no recurrent infections. The recommended interval for height monitoring to assess growth velocity consistency is…
Every 1 month
Every 2 months
Every 3 months
Every 6 months
Every 12 months
A 3‑week‑old neonate presents with recurrent vomiting, lethargy, poor peripheral perfusion, sodium 121 mmol/L, potassium 6.8 mmol/L, glucose 45 mg/dL, and a history of ambiguous genitalia. Blood pressure is low with decreased skin turgor. The most appropriate initial management is…
High‑dose IV dexamethasone and 3% saline bolus
IV hydrocortisone with 0.9% saline bolus plus correction of hypoglycemia
Immediate oral fludrocortisone without fluid resuscitation
Insulin plus glucose to lower potassium as the first step
Fluid restriction to avoid cerebral edema
An infant with the salt‑wasting form is clinically stable after crisis, but sodium trends low and plasma renin is elevated on follow‑up. The maintenance therapy aimed at maintaining sodium/potassium balance and suppressing renin is…
Spironolactone
Fludrocortisone
Eplerenone
Hydrocortisone alone without mineralocorticoid
Night‑time dexamethasone alone
A 7‑year‑old girl has progressive breast development over four months, accelerated linear growth, bone age advanced by two years, and pelvic ultrasound shows no ovarian cysts. The hormonal test most helpful to confirm central precocious puberty is…
High basal estradiol
Luteal‑phase progesterone
Prolactin
DHEA‑S
Basal/ GnRH‑stimulated LH
An 8‑year‑old boy has rapidly progressive puberty, increased testicular volume, markedly advanced bone age, and a falling predicted adult height. Long‑acting GnRH agonist is planned. The main goal of this intervention is…
Increase IGF‑1 to accelerate linear growth
Suppress testosterone only at night
Treat physiologic pubertal gynecomastia
Arrest pubertal progression and improve predicted adult height
Reduce the need for calcium supplementation
A 12‑year‑old has sneezing, clear rhinorrhea, nasal obstruction, and itch almost every day for six weeks, with sleep disturbance and poor school concentration. There is no fever and the discharge is not purulent. Examination reveals hyperemic turbinates and mucosal edema. According to ARIA, the classification is…
Intermittent mild
Intermittent moderate–severe
Persistent mild
Persistent very severe, non‑specific
Persistent moderate–severe
A 10‑year‑old with persistent moderate–severe allergic rhinitis has received counseling on allergen avoidance. The most recommended first‑line pharmacotherapy for daily symptom control is…
First‑generation oral antihistamine monotherapy
Daily oral decongestant
Leukotriene receptor antagonist as initial monotherapy
Seven‑day antibiotic course because discharge is clear
Intranasal corticosteroid
Symptoms persist with suspected household dust exposure and environmental control is suboptimal. There is no asthma and no acute infection. The most appropriate indication for skin‑prick testing or specific IgE is…
All patients with seasonal rhinorrhea
Severe/persistent symptoms or unclear triggers to plan exposure control
During acute viral upper respiratory infection
Only when asthma is present
To grade the degree of nasal obstruction
A 13‑year‑old weighing 40 kg develops generalized urticaria, wheeze, and hypotension minutes after eating peanuts. Peripheral perfusion is cool and oxygen saturation is 92% on room air. The most appropriate initial intervention is…
Intramuscular adrenaline 0.01 mg/kg (max 0.3 mg) to the anterolateral thigh
1 mg IV adrenaline bolus
0.5 mg subcutaneous adrenaline
IV antihistamine followed by observation
Salbutamol nebulization without adrenaline
After a single intramuscular dose of adrenaline, respiratory and hemodynamic symptoms improve within 10 minutes. There is no history of severe asthma and no need for vasopressor infusion. The most appropriate observation policy is…
Observe for 1 hour
Observe for 4–6 hours to anticipate biphasic reactions
Admit all cases for 72 hours
Discharge immediately because symptoms resolved
Mandatory 24‑hour observation regardless of severity
A 5‑month‑old exclusively breast‑fed infant has moderate atopic dermatitis and recurrent occult blood in stool. There is consistent improvement after the mother eliminates cow’s milk for two weeks and relapse after controlled re‑challenge. The most appropriate diagnostic consideration is…
Primary lactose intolerance
GERD without immune component
Bacterial enteric infection
cow’s milk protein allergy
Functional infantile colic
A 4‑month‑old not receiving breast milk is suspected of having mild–moderate cow’s milk protein allergy, without failure to thrive and without anaphylaxis. The recommended initial formula choice is…
Partial hydrolysate (pHF)
Lactose‑free cow’s milk formula
Amino acid formula (AAF)
Soy formula for all infants regardless of age
Extensively hydrolyzed formula (eHF)
A 13‑year‑old girl has a malar rash, photosensitivity, arthralgia, mild proteinuria, and high‑titer ANA without major organ involvement. The foundational therapy recommended for nearly all pediatric SLE patients unless contraindicated is…
Long‑term prednisone
Routine methotrexate for all
Hydroxychloroquine
Cyclophosphamide as first‑line
Long‑term antibiotic prophylaxis
An 8‑year‑old has swelling and pain of the right knee for more than six weeks with morning stiffness >1 hour, no fever, no psoriasis, no enthesitis, and all other joints are normal. The most appropriate JIA category is…
Systemic
Persistent oligoarticular
RF‑positive polyarticular
Psoriatic arthritis
Enthesitis‑related arthritis
In the case above, inflammatory markers are moderately elevated with oligoarticular involvement persisting. Therapeutic goals are pain relief, inflammation control, and functional preservation. The most appropriate initial management is…
Long‑term oral glucocorticoid monotherapy
Ten‑day antibiotic course due to suspected septic arthritis risk
Scheduled NSAIDs plus physiotherapy; consider intra‑articular corticosteroid injection
Immediate anti‑TNF for all oligo cases without prior trial
Mandatory hydroxychloroquine as first‑line monotherapy
