Tall stature evaluation — MCQs

A 15-year-old girl comes to the physician with her father for evaluation of her tall stature. She is concerned because she is taller than all of her friends. Her birth weight and height were within normal limits. Her father is 174 cm (5 ft 7 in) tall; her mother is 162 cm (5 ft 3 in) tall. She is at the 98th percentile for height and 90th percentile for BMI. She has not had her menstrual period yet. Her mother has Graves disease. Vital signs are within normal limits. Examination shows a tall stature with broad hands and feet. There is frontal bossing and protrusion of the mandible. Finger perimetry is normal. The remainder of the examinations shows no abnormalities. Serum studies show a fasting serum glucose of 144 mg/dL. An x-ray of the left hand and wrist shows a bone age of 15 years. Which of the following is the most appropriate definitive treatment for this patient's condition?

A 3-year-old male presents with his parents to a pediatrician for a new patient visit. The child was recently adopted and little is known about his prior medical or family history. The parents report that the child seems to be doing well, but they are concerned because the patient is much larger than any of the other 3-year-olds in his preschool class. They report that he eats a varied diet at home, and that they limit juice and snack foods. On physical exam, the patient is in the 73rd percentile for weight, 99th percentile for height, and 86th percentile for head circumference. He appears mildly developmentally delayed. He has a fair complexion and tall stature with a prominent sternum. The patient also has joint hypermobility and hyperelastic skin. He appears to have poor visual acuity and is referred to an ophthalmologist, who diagnoses upward lens subluxation of the right eye. This child is most likely to develop which of the following complications?

A 15-year-old girl comes to the physician with her father for evaluation of short stature. She feels well overall but is concerned because all of her friends are taller than her. Her birth weight was normal. Menarche has not yet occurred. Her father says he also had short stature and late puberty. The girl is at the 5th percentile for height and 35th percentile for weight. Breast development is Tanner stage 2. Pubic and axillary hair is absent. An x-ray of the left hand and wrist shows a bone age of 12 years. Further evaluation of this patient is most likely to show which of the following sets of laboratory findings?

A 14-year-old boy is brought to the physician because of blurry vision. He is at the 97th percentile for height and 25th percentile for weight. He has long, slender fingers and toes that are hyperflexible. Examination of the oropharynx shows a high-arched palate. Slit lamp examination shows bilateral lens subluxation in the superotemporal direction. The patient's older sister is also tall and has hyperflexible joints. However, she does not have lens subluxation or an arched palate. Which of the following genetic principles accounts for the phenotypical differences seen in this pair of siblings?

A 14-year-old boy is brought to the physician by his parents for a well-child visit. The patient was born at 38 weeks' gestation via vaginal delivery and has been healthy. He attends a junior high school and is having difficulties keeping up with his classmates in many classes. He is at the 97th percentile for height and 50th percentile for weight. Vital signs are within normal limits. Cardiac examination shows a high-frequency midsystolic click that is best heard at the left fifth intercostal space. The patient has long extremities along with excess breast tissue bilaterally. He has no axillary hair. Genital examination shows reduced scrotal size and a normal sized penis. Which of the following tests is the most likely to diagnose the patient's underlying disorder?

A 15-year-old boy is brought to the physician by his mother for a well-child examination. He recently stopped attending his swim classes. The patient is at the 97th percentile for height and the 50th percentile for weight. Examination shows decreased facial hair, bilateral breast enlargement, and long extremities. Genital examination shows scant pubic hair, small testes, and a normal-sized penis. Further evaluation is most likely to show which of the following karyotypes?

A 15-year-old boy is brought to the clinic by his father for difficulty in school. He reports that his son has been suspended several times over his high school career for instigating fights. Per the patient, he has always had trouble controlling his anger and would feel especially frustrated at school since he has difficulty “keeping up.” His past medical history is unremarkable and he is up-to-date on all his vaccinations. A physical examination demonstrates a 6-foot tall teenage boy with severe acne vulgaris throughout his face and back. He is later worked up to have a chromosomal abnormality. What is the most likely explanation for this patient’s presentation?

A 6-year-old girl is brought to the pediatrician by her father for an annual physical examination. The father reports that the patient is a happy and healthy child, but he sometimes worries about her weight. He says that she is a “picky” eater and only wants chicken nuggets and French fries. He also notes some mild acne on her cheeks and forehead but thinks it’s because she “doesn’t like baths.” The father says she has met all her pediatric milestones. She has recently started kindergarten, can tell time, and is beginning to read. Her teacher says she gets along with her classmates well. The patient was born at 38 weeks gestation. She has no chronic medical conditions and takes only a multivitamin. Height and weight are above the 95th percentile. Physical examination reveals scattered comedones on the patient’s forehead and bilateral cheeks. There is palpable breast tissue bilaterally with raised and enlarged areolae. Scant axillary hair and coarse pubic hair are also noted. A radiograph of the left hand shows a bone age of 9 years. Serum follicular stimulating hormone (FSH) level is 9.6 mU/mL (normal range 0.7-5.3 mU/mL) and luteinizing hormone (LH) level is 6.4 mU/mL (normal range < 0.26 mU/mL). Which of the following is the most appropriate diagnostic test?

A 7-year-old boy is brought to the physician because his parents are concerned about his early sexual development. He has no history of serious illness and takes no medications. His brother was diagnosed with testicular cancer 5 years ago and underwent a radical orchiectomy. The patient is at the 85th percentile for height and 70th percentile for weight. Examination shows greasy facial skin. There is coarse axillary hair. Pubic hair development is at Tanner stage 3 and testicular development is at Tanner stage 2. The remainder of the examination shows no abnormalities. An x-ray of the wrist shows a bone age of 10 years. Basal serum luteinizing hormone and follicle-stimulating hormone are elevated. An MRI of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?

A 7-year-old girl is brought to the physician because of vaginal bleeding for 2 days. There is no personal or family history of serious illness. She is at the 95th percentile for height and at the 90th percentile for weight. Examination shows enlarged breasts, and the areola and papilla have formed a secondary mound. There is coarse pubic hair that does not extend to the inner thigh. The remainder of the examination show no abnormalities. An x-ray of the left hand and wrist shows a bone age of 11 years. Her serum luteinizing hormone concentration is 0.1 mIU/mL (N < 0.2 mIU/mL). Which of the following is the most appropriate next step in management?