Developmental Assessment

Question 1

At what age does puberty normally stop/aka at what age do you stop growing?

Answer 1

16-18 years

Question 2

Is it abnormal to stop growing at age 13?

Answer 2

Not necessarily - may have started and then stopped puberty earlier

Question 3

When do girls have their most rapid growth during puberty?

Answer 3

Age 12-13

Question 4

When do boys have their most rapid growth during puberty?

Answer 4

Age 14-15

Question 5

Which part of the bone is open during puberty and then closes, preventing growth?

Answer 5

The epiphysis

Question 6

How do we measure growth?

Answer 6

Height

Head circumference

Question 7

What difference between chronological age and bone age is a cause for concern?

Answer 7

Greater than 2 years either side

Question 8

What is the major reason for an older bone age than chronological age?

Answer 8

Precocious puberty

Question 9

How do you calculate height velocity?

Answer 9

height difference / time difference

Question 10

What are the causes of short stature? (6)

Answer 10

1. Inherited/familial
2. Chromosomal - consider Turner’s, achondroplasia
3. Nutrition
4. Hormonal (growth hormone deficiency)
5. Inflammatory (chronic illness)
6. Psychological and emotional

Question 11

What are the endocrine abnormalities that can lead to short statute?

Answer 11

1. Hypothyroidism
2. Growth hormone deficiency
3. Cushing’s disease (ACTH secreting pit adenoma)
4. Diabetes - if poorly controlled
5. Delayed/precocious puberty

Question 12

Which is more worrying - short and fat or tall and fat?

Answer 12

Short and fat - pathological obesity

Question 13

If a child is short and thin (not in keeping with parents height/weight), what is a possible cause?

Answer 13

Chronic disease

Question 14

How does puberty present in a girl?

Answer 14

Breast budding aka thelarche

Question 15

What is the sequence of puberty in a girl?

Answer 15

Breast budding –> pubic and axillary hair development –> menarche at end of puberty

Question 16

What is the sequence of puberty in a boy?

Answer 16

Increase in testicular volume –> pubic and axillary hair development and deepening voice –> voice broken, facial hair, increase in penis size

Question 17

At wha age is precocious puberty (early onset of secondary sexual characteristics)?

Answer 17

In girls before the age of 8 and in boys before the age of 9

Question 18

What is the term given to central precocious puberty?

Answer 18

Concordant

Question 19

What is the term given to the source of sex steroids not under gonadotrophin control (testes develop on their own)?

Answer 19

Discordant

Question 20

What is virilisation?

Answer 20

Increased adrenal androgen secretion

Question 21

What is premature thelarche?

Answer 21

Isolated breast development

Question 22

What are the possible investigations for precocious puberty? (6)

Answer 22

1. Bone age
2. TFTs
3. Oestrodiol/testosterone
4. Pituitary function tests
5. Scan pelvis and adrenals
6. MRI

Question 23

What is classed as delayed puberty in girls and boys?

Answer 23

In girls - no sign of puberty by age 13, and menarche after 15 years
In boys - no signs of puberty by age 14

Question 24

What are the possible investigations for delayed puberty? (7)

Answer 24

1. Bone age
2. Karyotype
3. Coeliac disease
4. TFTs
5. FBC, U&Es
6. LH/FSH/oestrogen/testosterone
7. Consider imaging: MRI/pelvic USS

Question 25

Why it is important to look out for pubertal arrest?

Answer 25

It can be a sign of CNS tumour - prolactinoma

Question 26

In suspected Turner’s syndrome, what tests need to be performed due to associations with Turner’s syndrome?

Answer 26

Echo - aortic problems associated

USS kidney + U&Es - kidney problems associated