March 1st, 2012 Conference Review Questions

SIM Center, Endocrine Meet the Expert with Priya Gopwani and Priya Vaidyanathan, and Constipation with Mel Tavarez

1. A 10 mo F is brought to the ED by EMS after being found unconscious in a house fire. She is brought to the ED intubated, CPR in progress. The decision is made to empirically treat for cyanide poisoning. All of the following is true regarding the diagnosis and treatment of cyanide poisoning EXCEPT:

a) The presence of cyanosis strongly suggests cyanide poisoning in addition to carbon monoxide poisoning
b) Laboratory results suggestive of cyanide poisoning include an anion gap metabolic acidosis
c) Pediatric patients can be treated with 70 mg/kg IV hydroxocobalamin to a maximum of 5 grams
d) The mechanism of action of hydroxocobalamin is through direct binding of cyanide

2. Which of the following patients is most likely to have an elevated TSH level?

a) An infant born to a mother being treated with PTU for Graves Disease
b) An infant born to a mother with untreated Graves Disease
c) An infant with primary hypothyroidism
d) An infant with central hypothyroidism


3. A two week old male infant born to a mother with a history of well-controlled Graves Disease during pregnancy is sent by the PCP for evaluation of failure to thrive- the baby has continued to lose weight since birth and is now almost 15% below birth weight. The baby was born by uncomplicated delivery, had no NICU stay, and had a normal newborn screen. The mom reports that the baby has been feeding well, has been afebrile and is otherwise asymptomatic. You send lab tests, including thyroid function tests. While awaiting results, mom asks you what the likely management will be if her son’s thyroid tests are abnormal. You are most likely to counsel her that:

a) It is very unlikely that the infant’s failure to thrive is related to thyroid abnormalities as mom’s disease was well-controlled during pregnancy
b) If the infant has been affected by maternal Graves’, the condition should resolve within 3-12 weeks
c) Even if the thyroid tests are abnormal, the infant can be discharged with mom as he is asymptomatic
d) It is very unlikely that the infant’s failure to thrive is related to thyroid abnormalities as his newborn screen was normal

4. A 14 year old F with a history of hyperthyroidism is brought in for agitation and anxiety. She was well until the last few days when she developed a febrile flu-like illness, but today acutely worsened with vomiting, diarrhea, and agitation. On exam, she is febrile to 40⁰ with a HR of 140, with warm, moist skin, is extremely agitated and somewhat delirious on exam. Of the following, the best treatment option is:

a) NS bolus and antibiotics
b) Haldol, Benadryl, and ativan
c) Beta blocker, methimazole, iodine and steroids
d) Emergent thyroidectomy


5. A 4 year old M is brought in for evaluation of fever is being discharged with a diagnosis of upper respiratory infection. As you are discussing supportive care, his mother mentions that she is also worried because he tends to have hard stools with straining every 2-3 days. He is not in any discomfort currently, but she was wondering if she could try anything else as the dietary changes recommended by her pediatrician have not been helping. Of the following, you are most likely to prescribe:

a) Daily phosphate sodium enemas for 3 days
b) Daily mineral oil enemas for 3 days
c) Daily polyethylene glycol at 1 to 1.5g/kg/day for 3 days
d) Daily polyethylene glycol at 0.5 g/kg/day

Answers Here