Growth Flashcards

Question

History taking for growth: ROS

Answer 1

Energy level, sleep pattern, headaches, visual changes, diarrhea, etc. to evaluate functional capacity of various body systems *Also want to know social history; growth can be affected by stress (ex: psychosocial dwarfism)

Answer 2

Looks at face, hands, and feet

Answer 3

1. Obese children are taller 2. With endocrinopathies, height is impaired (they will be shorter) 3. If the child's height is at or greater than mid-parental height, an endocrine cause of the obesity is likely 4. Obese children go into puberty earlier and as a result end up being shorter

Answer 4

1. Upward to downward movement towards mid-parental range | 2. Usually accomplished by 12-15 months

Answer 5

1. Family history 2. The child is healthy, growing below but parallel to the 3rd percentile line 3. Between 6-24 months, the linear growth and weight track downward to the 3rd percentile * Linear growth slows and they wind up with growth spurts that are lower than normal 4. Slow growth rate between 12-30 months 5. Delayed onset of puberty and growth spurt and usually end up with heights in lower half of the normal range 6. Bone age that is delayed by 2 or more years

Answer 6

1. Infrequent measurement opportunities 2. Normal prepubertal growth deceleration 3. Effects of medications for common disorders (ADHD, asthma, depression) 4. Normal variation in onset of puberty

Answer 7

1. Birth length and weight (SGA vs. prematurity) 2. Mid parental height 3. Family growth and pubertal history 4. Growth rate-normal for age? 5. Bone age (Left wrist)-contributions of delayed vs genetic/intrinsic growth disturbance 6. Health history – effects of disease on growth

Answer 8

Bone age is a measure of skeletal maturity. A conventional X-ray of the left hand and wrist to evaluate bone age may be obtained at the initial visit to assess skeletal maturation, and may be repeated over time if needed

Answer 9

1. Occurs under the influence of estrogen, thyroid hormone, androgen and growth hormones 2. Bone age is generally more than 2 years in advance of chronologic age in longstanding precocious puberty because of the action of sex hormones

Answer 10

Males: size of the testes and length of the penis Females: breast development and pubic hair development

Answer 11

1. Continually increases in girls during most of the second decade, while boys tend to decrease fat after age 14. 2. In the lower ranges, BMI-for-age tends to increase more slowly in both adolescent boys and girls. 3. At the 5th percentile, BMI-for-age increases at the rate of about 0.5 unit/year during most of the second decade.

Answer 12

The appearance of breasts in girls; the earliest signs of pubertal development in 85%

Answer 13

Pubic hair growth in females; the initial pubertal sign in 15% of girls

Answer 14

1. Menarche occurs an average of 2 years after thelarche * Range 1-5 years 2. Peak height velocity is reached at l2 years in girls immediately prior to menarche 3. Usually if you start to see feet growing, breast budding is coming 4. Tanner II stage girls develop body fat and need cholesterol for estrogen to cause breast buds to occur; should be a little rounder/chubby 5. Between the age of 12 and 13, girls at the 5th percentile gain less than 8 lbs. while those at the 95th percentile gain more than 13 lbs.

Answer 15

1. Slow their accumulation of total body fat, but during their peak height velocity they accelerate their accumulation of fat and lean body tissue, leading to an increase in weight that peaks just prior to menarche. 2. After that time, the rate at which weight is added slows, with an inflection point around 13 years of age.

Answer 16

Tanner I: non Tanner II: Breast bud diameter = areola width Tanner III: Breast diameter > areolar with; beyond breast budding Tanner IV: Mounding of areola above plane of breast Tanner V: adult

Answer 17

Tanner 1: None Tanner 2: Slightly pigmented over mons or labia Tanner 3: Dark, course on mons Tanner 4: Adult in character, confined to mons Tanner 5: Adult spread to medial thigh

Answer 18

1. In boys, testicular size should be measured by a "Prader orchidometer" 2. A testicular volume of >/=4mL in boys indicates puberty is starting 3. Prepubescent boys testicle equals 2.5cm in length 4. The increase in stature in males is due to androgen produced by the testes, so the growth spurt in stature is preceded by an increase in the size of the testes 5. Androgens also cause the penis to lengthen and widen

Answer 19

Tanner 1: Pre-pubertal testes (3cm, volume =6-8mL Tanner 4: Further development of glans and penis, DARKENING OF SCROTAL SAC, further increase ins ize *Testes >4cm, volume=10-15mL Tanner 5: Adult; testes >5cm, volume >15mL

Answer 20

Tanner 1: Preadolescent: Testes, scrotum, and penis about same size and proportion as in early childhood Tanner 2: Enlargement of scrotum and testes, skin of scrotum reddens and changes in texture; little or no enlargement of penis Tanner 3: Enlargement of penis first mainly in length; further growth of testes and scrotum (11.5-14) Tanner 4: Increased size of penis with growth in breadth and development of glans further enlargement of testes and scrotum and increased darkening of scrotal skin Tanner 5: Genitalia adult in size and shape

Answer 21

1. With rapid bone growth, alkaline phosphatase levels increase 2. Peaks at about the peak height velocity in males and females so occurs earlier in females. * Alkaline phosphatase is elevated in growing children

Answer 22

Absence or incomplete development of 2nd sexual characteristics by an age at which 95% of children of that sex and culture have initiated sexual maturation. The upper 95th % in the U.S. for age is: Boys 14 years of age Girls 12 years of age

Answer 23

1. Any sign of puberty in girl less than 8 2. Boys less than 9 3. With increases to tanner 3 within a 6-12 month period in a 6-8 year old 4. Menarche before age 10 years 5. Pubic Hair White: Before age 7 years Black: Before age 6 years

Answer 24

Increased adrenal androgen secretion 1. Occurs between ages 6 to 8 years 2. Transient growth spurt 3. Some children develop axillary and pubic 4. No sexual development occurs

Answer 25

Release of GnRH In Boys: LH stimulates Testosterone production, FSH stimulates sperm maturation In Girls: FSH stimulates Estrogen and follicle formation, LH stimulates corpus luteum after ovulation

Answer 26

A.A.: 12.2 y/o C: 12.9 y/o

Answer 27

Any sign of secondary sexual maturation before 8 | years in girls and 9 years in boys.

Answer 28

1. Virilization (development of male physical characteristics) - clitoris enlargement, acne. voice deepening, increase in muscle mass 2. Extensive pubic hair growth (would be a peripheral cause) 3. Menarche without breast bud development 4. Rapid enlargement in breast development through tanner III in an 8 year old or less 5. Documented growth acceleration in a child over 6-12 months in a girl less than 8

Answer 29

1. Feminization in boys - gynecomastia 2. Penis enlarges without scrotal development (peripheral cause); enlargement of penis without enlargement of testicles 3. Precocious puberty in boys is 50% pathological 4. Documented growth acceleration in a child over 6-12 months in a boy less than 9 5. Any virilization signs such as clitoris enlargement, voice deepening or increase in muscle mass.

Answer 30

Some of the changes of puberty are present, but appearance is isolated or out of normal sequence

Answer 31

When changes of puberty are consistent with gender | when they are discordant with gender, it is heterosexual puberty

Answer 32

1. Early pubertal changes 2. Normal progression in order of breasts, pubic hair development, growth spurt 3. For females, menstruation

Answer 33

Development of breast buds, usually 1-4 years of age. *Usually benign if not associated with the onset of other pubertal events

Answer 34

1. Breast, nipple and areolar development reach tanner 3 2. Linear growth accelerates 3. Androgenization with pubic and/or axillary hair

Answer 35

1. Incidence: 6 months-2 years 2. Breasts: usually Tanner 2 or early 3 3. No pubic hair 4. No axillary hair 5. No apocrine odor 6. No menses 7. No accelerated growth 8. No advanced bone age Outcome: considered benign!

Answer 36

1. Incidence: 5-8 years old 2. Breasts: Tanner 2-5 3. Pubic hair or axillary hair + breasts 4. Apocrine odor and axillary hair present 5. Menses occurs 6. Accelerated growth and advanced bone age Outcome: early puberty, short stature

Answer 37

The growth of axillary hair stimulated by androgen 1. Look for androgen exposure 2. Family history (partial forms of adrenal hyperplasia) 3. Look at breasts for female 4. Testicular enlargement for male 5. Axillary hair is only finding, check in 3-4 months 6. Acne 7. Enlargement of the clitoris

Answer 38

1. Pubertal signs 2. Age of onset 3. Rate of progression 4. Growth patterns 5. PMH: CNS insults? environmental sex hormones? illnesses? symptoms? 6. Family history of sexual precocious 7. siblings with ambiguous genitalia? Family may consider precocious puberty normal...

Answer 39

1. Plot height, weight and head circumference (if less than 3); will be rapid if CPP or pseudoisosexual precocious puberty * Height will rise to higher growth percentile than occupied previously 2. Check BP: HTN may suggest congenital adrenal hyperplasia due to deficiency of 11-beta hydroxylase 3. Check sexual maturity (breast buds? regression from birth?) 4. Check for signs of systemic disease 5. Look for evidence of CNS mass (optic fundus and visual fields) 6. Look for evidence of androgenic influence 7. Look for evidence of any other mass! (asymmetrical testicular enlargement, hepatomegaly, abdominal mass)

Answer 40

1. Acne 2. Facial and axillary hair 3. Increased muscle bulk 4. Extent of pubic hair 5. Penile elongation 6. Scrotal rugation increased with thinning 7. Clitoris enlargement

Answer 41

1. Café au lait spots 2. Myxedematous face 3. Thyroid enlargement 4. Abnormal visual field 5. Abnormal neurologic findings

Answer 42

1. Size of breast tissue 2. Must distinguish breast from soft smooth consistency of increased fat 3. Reddish, less moist vaginal mucosa in prepubertal girl 4. Pale moist appearance of pubertal vaginal mucosa, elongated clitoris 5. Labia minor more visible as puberty progress

Answer 43

1. Measure phallic and testicular dimension: testicles must be equal 2. Without testicular enlargement, penis enlargement, adrenal pathology 3. Testicular volume is greater than phallic size in normal puberty, CPP, and Primary hypothyroidism

Answer 44

Penile dimensions are disproportionately greater than testicular size

Answer 45

1. Check nutrition 2. CBC 3. Erythrocyte sedimentation rate 4. Liver function tets 5. Thyroid tests (TSH, free T4) 6. If growth abnormality is found, do a bone age of left wrist! 7. Hormonal evaluation of LH and FSH, estradiol (females, testosterone (males)

Answer 46

Because of very early epiphyseal closure; paradoxically the tall child will be a short adult *Linear growth is accelerated during childhood, often with markedly advanced bone maturation

Answer 47

1. Normal head circumference, normal height and decreased weight initially and eventually decelerating height and head as well (infants and children

Answer 48

1. Normal head circumference, disproportionate height and almost normal weight in infants and children under 3 * Near proportional retardation of weight and height with normal head circumference 2. Can lead to: constitutional growth delay, genetic short stature, endocrinopathies, structural dwarfs

Answer 49

1. Small head circumference and decreased weight and height * Concomitant retardation of weight height and head circumference 2. Suggests - SGA: In utero and perinatal insult - Chromosomal aberrations - CNS abnormalities - Rarely familial

Answer 50

1. Upper segment head to symphysis pubis to lower segment (type 2) 2. US to LS in infants is 1.7 to 1.8 to 1 3. As child approaches adolescent .9 to l.0:1 4. Upper: lower segment ratio is low in Marfan syndrome 5. Abnormal in bony dysplasia 6. After spinal irradiation

Answer 51

1. Growth hormone deficiency 2. Hypothyroidism 3. Glucocorticoid excess (causes Cushing's)

Answer 52

1. Malnutrition | 2. Systemic illness

Answer 53

Chromosomal abnormality (Trisomy 21 or Turner's) or other specific syndrome

Answer 54

Skeletal dysplasia or metabolic bone disease

Answer 55

1. Careful physical examination 2. Free T4, TSH 3. ESR 4. Electrolytes, BUN creatinine, UA, LFT 5. Bone age of left hand and wrist 6. Markedly delayed bone age suggestive of endocrinopathy * * Refer to endocrine

Answer 56

*Over-nutrition is most common cause 1. Precocious puberty (adrenal or gonadal) 2. Hyperthyroidism 3. Genetic (familial) or syndrome (Klinefelter or Marfan’s) 4. GH excess 5. Development of pubic hair

Answer 57

1. Normal patterns of growth --> familial or constitutional growth delay 2. Primary growth disturbance --> itrauterine growth restriction 3. Systemic illness 4. Genetic disorders (Turner, Down, Noonan, Prader Willi, russel Silver) 5. Disproportionate short stature --> skeletal dysplasia or spinal irradiation

Answer 58

1. Abnormally slow growth rate 2. Downward crossing of percentile channels on the growth chart after the age of 18 months 3. Height below the 3rd percentile 4. Height significantly below genetic potential by 2 standard deviations

Answer 59

1. Do a careful prenatal history with birth weight; IUGR is birth weight less than 10th percentile for gestational age 2. Look at growth points 3. Look at growth velocity 4. Determine parental height, do midparental height 5. For constitutional growth delay, do bone age 6. Look at weight to height ratio

Answer 60

1. Multiple nevi 2. Low posterior hairline 3. Webbed neck 4. Broad chest with wide spaced nipples 5. Short fourth metacarpals 6. Coarctation of the aorta with bicuspid aortic valve 7. Increased carrying angle of arms or CUBITUS VALGUS (can't fully extend arms; hallmark) 8. No menses 9. Lymphadema at birth

Answer 61

1. Hypocaloric (malnutrition, GI, poorly controlled DM) 2. Metabolic (renal, hepatic, cardiac, hematologic, respiratory (CF, severe asthma) chronic infection) 3. Endocrine (hypothyroidism, Cushing's) 4. Growth hormone deficiency

Answer 62

In general, a child whose height differs by more than 2 standard deviations (SD) from the population mean is considered too tall *Few families will seek medical attention for it

Answer 63

1. Child's pattern of growth 2. Medical history 3. Physical exam 4. When dysmorphic features are found, special effort should be made to rule out syndromes that are associated with excessive growth

Answer 64

1. Maternal diabetes (most common cause of LGA) 2. Cerebral gigantism 3. Beckwith-Wiedemann Syndrome

Answer 65

Cerebral Gigantism Infants with cerebral gigantism tend to be large at birth and continue to grow rapidly during the early years of childhood.

Answer 66

1. high forehead 2. frontal bossing 3. hypertelorism 4. prominent jaw 5. high arched palate 6. mental retardation 7. poor coordination 8. adult height is normal in many of these children

Answer 67

1. Macrosomia 2. Visceromegaly 3. Macroglossia 4. Omphalocele 5. Prominent occiput 6. Hypoglycemia with hyperinsulinism

Answer 68

Height is 2 standard deviations above corresponding mean for age and gender

Answer 69

1. Genetic factors play the most important roles in the pathogenesis of familial tall stature. 2. Growth hormone secretion and serum IGF-1 and IGF binding protein-3 concentrations often are in the upper range of normal.

Answer 70

1. These children usually have diminished overall growth hormone production but high normal serum concentrations of growth hormone-binding proteins and IGF-1 * due to leptin increase, may have upper limit TSH and T4 2. They are taller initially, but get very big, hit early puberty, and end up being short 3. Bone age may be advanced and puberty starts early causing premature epiphyseal fusion

Answer 71

Excessive linear growth that occurs with growth hormone (GH) excess when epiphyseal growth plates are open during childhood

Answer 72

1. Growth velocity is the best way to assess a child whose height > 2 SD. 2. Dysmorphic features and developmental delay may suggest a non-endocrine cause of tall stature. 3. Although rare, growth hormone excess should be considered if the growth velocity is accelerated + a family history of multiple endocrine neoplasia 4. Transsphenoidal removal of the pituitary adenoma, when present, offers definitive treatment of growth hormone excess.

Growth Flashcards

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