Growth

Question 1

What are the cellular processes to increase size?

Answer 1

Hyperplasia – increase cell number
Hypertrophy – increase cell size
Accretion – increase intercellular substance

Question 2

True or false: lymphoid tissue doubles the amount seen in adult?

Answer 2

True

Question 3

T or F: most of the neural tissue growth takes place in adulthood?

Answer 3

False: childhood

Question 4

T or F: fetal growth rate is the fastest than any other periods in a human lifetime?

Answer 4

True

Question 5

What is the childhood rate of height growth per year?

Answer 5

6 cm

Question 6

Why are females on average shorter than males?

Answer 6

Pubertal linear velocities:

• occur earlier
• have a lower magnitude
• shorter duration of pubertal growth

Question 7

True or False: puberty contributes most to the final adult height?

Answer 7

False: infantile and childhood (puberty 10-15%)

Question 8

What happens to arm span in relation to height throughout lifespan?

Answer 8

pre-puberty: arm span less than height

post-puberty: more than height

Question 9

At approximately what age does the upper segment to lower is lower?

Answer 9

from age 7 and beyond

Question 10

If the upper to lower segment ratio is higher than 1 for a 7 yrs old or older, what would this mean?

Answer 10

genetic syndrome

bone dysplagia

Question 11

What two types of growth charts are used for 2 yrs or less?

Answer 11

head-circumference-for-age

weight-for-length

Question 12

WHO growth charts are made from what?

Answer 12

WHO :
growth standards
growth reference

Question 13

What age dictates at which percentile rate a child will grow?

Answer 13

2 years of age (continue at the same growth channel until puberty and should not deviate from growth channel)

Question 14

What color is bone and cartilage on x-ray?

Answer 14

bone - white

cartilage - black

Question 15

What is the end of the bone called?

Answer 15

epiphysis

Question 16

True or false: the growth plate produces the metaphysis

Answer 16

False: it is the epiphysis

Question 17

What is the material that makes up the growth plate prior to adulthood?

Answer 17

cartilage

Question 18

True or False: Maturation of growth can be reflected in bone age

Answer 18

True

Question 19

What does bone represent and reflect?

Answer 19

• represents secondary ossification

- reflects physiologic growth and maturity

Question 20

What are the broad determinants of growth?

Answer 20

• genetics
• nutrition
• illness/health status (chronic anemia)
• environment (sleep, exercise, seasonality, psychological)
• hormones (proliferation and differentiation of chondrocytes) - insulin, GF, IGF-1, thyroid, estrogen
• -> glucocorticoids stunts growth

Question 21

What is failure to thrive?

Answer 21

Body weight or rate of weight gain much less than expected compared to children of similar age and sex
- usually thin for their length (length and head circum. less affected than length)

Question 22

What are causes of failure to thrive?

Answer 22

• inadequate intake (usually cause of very young)
• inability to use
• excessive utilization of energy

Question 23

What is short stature?

Answer 23

Lower than 3rd% (-2 SD) for age and sex

Question 24

When is short stature pathological?

Answer 24

Linear velocity lower than -2 SD for age
Crossing down more than 2 major growth channel lines
Projected height is lower than -2 SD for mid-parental target height

Question 25

What are causes of short stature?

Answer 25

Improper Growth Measurements Normal variants: Familial short stature (FSS) Constitutional delay of growth and puberty (CDGP) Pathologic causes: Endocrinopathy (ie. hypothyroidism, growth hormone deficiencies, glucocorticoid excess ie. cushings) Systemic Illness or Subclinical Illness (or meds) Genetic Syndrome Bony Dysplasias Intrauterine Growth Retardation (IUGR) (ie. less than 10 percentile that do not catch up by 2 yrs) Psychosocial deprivation (Kaspar Hauser syndrome)

Question 26

What is the difference between FSS and CDGP?

Answer 26

``` for FSS: Parents are short Puberty is not delayed Typically no bone age delay Height-for-age trajectory approximates the mid-parental target height (height-for-bone age in CDGP) ```

Question 27

T or F: for endocrinopathies both weight and height velocities slow down?

Answer 27

False - only height, weight should be unaffected for then most part (unlike systemic disorders)

Question 28

What is tall stature and when is it pathological?

Answer 28

Higher than 97th% (+2 SD) for age and sex. Is potentially pathologic if: Linear velocity higher than +2 SD for age (crossing up percentiles) Projected height is higher than +2 SD for mid-parental target height

Question 29

Causes of Tall Stature:

Answer 29

Normal Variants: Familial Tall Stature Constitutional Obesity ``` Pathologic causes: Endocrinopathy Precocious Puberty GH excess (rare) Hyperthyroidism Genetic syndromes Marfan syndrome Sotos syndrome ```

Question 30

True or False: bone age is greater than chronological age for precocious puberty

Answer 30

True