Chronic Pediatric Conditions
Help Questions
USMLE Step 3 › Chronic Pediatric Conditions
- A 15-year-old girl with type 1 diabetes has A1c 8.9% and reports intentionally underdosing insulin to avoid weight gain. She skips breakfast, eats large dinners, and has frequent hyperglycemia but denies DKA. She has irregular menses and expresses body dissatisfaction. Exam: normal vitals, BMI at 60th percentile; mild parotid enlargement is absent; no acanthosis. Labs: normal electrolytes, negative ketones today. She is medically stable but at risk for complications. Which interdisciplinary team member should be consulted for this aspect of the patient's care?
Which interdisciplinary team member should be consulted for this aspect of the patient's care?
Orthopedic surgeon to evaluate for diabetic neuropathy causing appetite changes
Otolaryngologist to evaluate for sinus disease as the cause of hyperglycemia
Nephrologist to initiate dialysis to improve glycemic control
Child and adolescent mental health specialist for disordered eating and insulin omission
Explanation
This question tests the management of chronic pediatric conditions, specifically focusing on long-term care strategies and coordination with interdisciplinary teams. Chronic conditions like type 1 diabetes in teens can involve psychosocial issues like disordered eating, requiring mental health support. In this vignette, intentional insulin omission for weight control signals an eating disorder risk needing specialized intervention. Choice A is correct because consulting a mental health specialist addresses diabulimia per ADA recommendations. Choice B is incorrect because orthopedic evaluation isn't indicated without neuropathy evidence. To help students: Emphasize screening for psychosocial complications in diabetes. Practice identifying red flags for referral in adolescent care.
- A 15-year-old with type 1 diabetes is transitioning to greater self-management. He frequently forgets to bring supplies to school and has had repeated episodes of hyperglycemia during exams. Family conflict is increasing around diabetes tasks. He has stable housing and no substance use. A1c is 9.3%. He asks for help “staying on track” without constant parental reminders. Which interdisciplinary team member should be consulted for this aspect of the patient's care?
Which interdisciplinary team member should be consulted for this aspect of the patient's care?
Radiologist to perform abdominal imaging to identify cause of hyperglycemia
Dermatologist to treat acne as primary driver of poor glycemic control
Certified diabetes care and education specialist to build routines, problem-solve barriers, and coach transition
Cardiothoracic surgeon to evaluate for autonomic dysfunction causing missed doses
Explanation
This question tests the management of chronic pediatric conditions, specifically focusing on long-term care strategies and coordination with interdisciplinary teams. Chronic conditions like type 1 diabetes in teens involve building self-management skills through education and support. In this vignette, forgetting supplies and family conflict highlight transition barriers needing coaching. Choice A is correct because a diabetes educator provides routines and problem-solving per ADA. Choice B is incorrect because no autonomic issues are evident. To help students: Emphasize transition planning in adolescents. Practice identifying educational needs.