A 15-year-old boy is concerned about his lack of pubic hair, deep voice, and muscl

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1.A 15-year-old boy is concerned about his lack of pubic hair, deep voice, and muscle growth. On physical examination you conﬁrm that his testicles have not enlarged and he lacks pubic hair. Which of the following statements about this situation is correct?
(A) The patient will most likely progress through pu
berty without intervention
(B) Testosterone should be administered (C) Growth hormone should be given
(D) A hormonally active adrenal tumor is likely (E) Prednisone will result in an amelioration of the
symptoms
2.A 75-year-old widower who lives alone is brought to
his primary care physician by his daughter because she
feels that he has been confused over the past few days.
Prior to this he was quite independent and cognitively intact. The patient has a history of hypertension and is on hydrochlorothiazide. He is due for bilateral cataract ex
traction in 2 months. Of note, he reports a fall in his living room about two weeks earlier, at which time he sustained a hip bruise and bumped his head.
At this time his general physical examination is unremarkable; his neurologic examination is normal except for the mental status component, which discloses defects in
short-term memory. Which of the following diagnostic studies is most likely to explain this patient’s condition?
(A) Neuropsychiatric battery
(B) CT scan of head
(C) Electroencephalogram
(D) Serum chemistry panel
(E) Urinary screen for toxic substances
3.An 80-year-old woman with severe osteoarthritis is
wheelchair-bound. She develops a pressure ulcer on her
right buttock that involves the dermis; however, subcu
taneous tissues and deeper structures do not appear to be involved.
In addition to efforts to increase mobility and to relieve pressure, the most appropriate therapy is
(A) surgical debridement
(B) dry dressings
(C) wet dressings changed when dry
(D) wet dressings changed when wet
(E) topical antibiotics

Anil Tuladhar · 08:57 AM

Being a paediatrician, I would dare to answer only the first question.

I would like to know bit more in the history ie, parents age of onset of puberty. Even without considering the history, answers c, d and e can be easily discarded.

The commonest reason for the problem is Constitutional Delay in Growth and Puberty (CDGP).

Approximately 15% of patients of short stature referred for endocrinologic evaluation have CDGP. Individuals with CDGP superimposed upon familial short stature represent another 23%. The frequency of CDGP may be underestimated because individuals with milder delays and those who are not psychologically stressed may not be seen by subspecialists.

Most of them do well, gain puberty and attain final predicted height, if we wait and watch for a year or two.

Testosterone may (not should) be given in some cases to kick start the pubertal process if there is excessive delay and if the child is experiencing psychological distress.

My answer will be A.

Please look at this very useful link: Constitutional Delay in Growth and Puberty

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where is the answer?