Development Flashcards
FAILURE TO THRIVE
i) what is it? what is faltering growth? what is a centile space?
ii) name five causes of fail to thrive?
iii) name four parameters that should be recorded in the examination? which two outcomes suggest inadequate nutrition or a growth disorder?
iv) which two special tests can be done?
i) poor physical growth/development in a child
faltering growth - fall in weight across centile spaces
centile space - space between two centile lines
ii) inadequate nutrition,difficulty feeding, malabs, increased energy req, inability to proess nutrition
iii) preg/birth hx, feeding hx, observe feeding, mum physical/mental heaalth, height/weight/BMI, mid parental height centile (height of mum and dad /2)
inad nut or growth disorder if height more than 2 centile spaces below mid parental height centile
BMI below the 2nd centile
iv) urine dip, coeliac screen
SHORT STATURE
i) what is it defined as? how can predicted height be calculated for girls and boys?
ii) name five causes
iii) what is constitutional delay in growth and puberty? what is a key feature?
iv) how is a dx of CDGP made? what imaging can support it? what should be done?
i) height more than 2SD below average for age and sex (below 2nd centile)
predicted height calc based on parents height
boys ( mum+dad+14cm)/2
girls (mum+dad-14cm)/2
ii) familial short stature, CDGP, malnut, chronic diseases (IBD, coeliac, CHD), endocrine (hypothyroid), genetic (DS), skeletal dysplasoa eg achondroplasia
iii) CDGP is a normal variation on development
key deature is delayed bone age (bones mature slower)
iv) dx is made on hx and exam
do an x-ray of hand and wrist to assess bone age and shape of growth plates
reassure parents and monitor over time
DEVELOPMENTAL DELAY
i) what does global dev delay referr to? name four possible underlying causes?
ii) what are gross motor skills? name four causes of gross motor delay?
iii) what are fine motor skills? name four causes of delay?
iv) name four causes of language delay? name three people the child may be referrred to?
v) name three causes of personal/social delay
i) global - delay in all domains
DS, fragile X, fetal alcohol syndrome, Rett syndrome, metabolic disorders
ii) gross motor - walking, crawling, posture
delay due to ceb palsy, ataxia, myopathy, spina bifida, visual impairment
iii) fine motor - precise movement, hand eye co-ord
delay - dyspraxia, ceb palsy, musc dystrophy, visual impair, congenital ataxia
iv) language delay - social circumstances eg languages, hearing impair, learning disability, neglect, autism, ceb palsy
refer to SALT, audiology, health visitor
v) emotional/social neglect, parenting, autism
LEARNING DISABILITY
i) what is dyslexia? what is dysgraphia? what is dyspraxia?
ii) what is the severity of LD based on? what is classified as profound LD?
iii) what may increase the risk of LD? name two enviro factors?
iv) name four conditions associated with LD?
v) what four things show ability to demonstrate capacity
i) dyslexia - difficulty in reading, writing, spelling
dysgraphia - difficulty in writing
dyspraxia - dev co-ord disorder - physical co-ord is difficult (clumsy)
ii) based on IQ - below 25 is profound
iii) FH can increase the risk
enviro - abuse, neglect, psych trauma
iv) genetic disorders eg DS, fetal alcohol, birth problems eg hypox isch enceph, meningitis in early childhood, autism, epilepsy
v) capacity - understand, retaim, weigh up, communicate decision
NORMAL PUBERTY
i) between what ages does puberty usually start in boys and girls? how long does it last?
ii) what happens first for girls? what then happens? what happens about 2 years in?
iii) what happens first for boys? then what? (4)
iv) which staging system is used to determine the pubertal stage?
i) usually starts 8-14 in girls and 9-15 in boys
lasts 4 yeaaars
ii) girls - first dev breast buds then pubic hair then mens periods 2 years in
iii) boys first get enlarged testicles, then penis, then darkening of scrotum, then dev pubic hair then deepen voice
iv) tanner staging based on findings of sex characs
DELAYED PUBERTY
i) what is hypogonadism? what is hypogonadotrophic HG? what is hypergonadotrophic HG?
ii) what is malfunc in hypogonadotrophic HG? name four potential causes
iii) what causes hypergonadotrophic HG? name four potential causes
iv) what is kallman syndrome? what type of HG does it cause? what other symptom can it be assoc with?
i) HG = lack of sex hormones oes and testos > delay in puberty
hypogonadotrophic = deficiency of LH and FSH
hypergonadotrophic = lack of response to LH and FSH
ii) hypo - LH/FSH defic > oes and testos defic
caaused by abnormal hypothal or pit gland functioning
caused by damage to PG/HT eg RT or surgery, GH deficiency, hypothyroid, hyperPRL, chronic conds eg CF, IBD, CDGP, kallman syndrome
iii) hyper - gonads fail to respond to LH and FSH
no negative fb from gonads (as no oes /testos) so PG produces lots of LH/FSH (high gonadotrophins)
caused by abnormal gonad function - previous damage eg torsion, cancer, infection eg mumps, congential absence of testes/ovaries, klienfelter XXY, turners XO
iv) kallman syndrome is a genetic cond causing hypogonadotrophic HG (lack of response) resulting in failure to staart puberty
can also be assoc with reduced or absent smell
DELAYED PUBERTY MX
i) what is the threshold for initiating investigation? name three initial ix that may be done?
ii) when should LH/FSH be looked aat? whaat will they be in hypo aand hyper HG? name three other hormones to look at
iii) which two genetic conditions may be implicated?
iv) what can xray of wrist be useful for? what may MRI of brain look for?
i) no evidence of pubertal change in aged 13 girls or 14 boys
do FBC/ferritin for anaemia, U&E for CKD, anti TTG/EMA for coeliac
ii) early morning serum LH and FSH
hypo = low and hyper = high
also look at TFTs, GH, IGF, serum PRL
iii) kleinfelter XXY, tuner XO
iv) wrist xray to assess bone age and dx constitutional delay
pelvic US to look at ovaries/pelvic organs
brain MRI to look for PG pathology/olfactory bulb assesment in kallman syndrome
