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Pediatric EOR exam > Developmental Assessment and Growth Abnormalities > Flashcards

Developmental Assessment and Growth Abnormalities Flashcards

1
Q

what is developmental surveillance

A

skilled individual monitors development over time as part of providing routine care and helps recognize children at risk for developmental disorder

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2
Q

what are the key elements of developmental surveillance

A
  • listen to parent concerns
  • obtain developmental history
  • make careful observations
  • periodically screen all infants and children
  • refer children who fail screenings
  • recognize conditions that put children at risk for delays
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3
Q

t/f developmental assessment should occur at all well child visits

A

true

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4
Q

what is a developmental delay

A

circumstance in which a child has not demonstrated a developmental skill by an age at while the vast majority of normally developing children have accomplished this task

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5
Q

what are developmental therapies

A
  • speech language
  • birth to 3
  • 3 and up services through school
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6
Q

M-CHAT

A

Modified checklist for autism in toddlers

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7
Q

At what age do you screen toddlers to assess the risk of autism spectrum disorder

A

18-30 months

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8
Q

what are the 1st vs the 2nd portions of the M-CHAT

A
  • 1st: 20 item yes/no parent report questionnaire
  • 2nd: structures fu questions administered by a healthcare provider
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9
Q

what is the denver developmental screening tool II

A
  • 125 performance based and parent reposted items are used to screen functioning in 4 areas
  • personal-social
  • gross motor
  • language
  • fine motor adaptive
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10
Q

how do you interpret denver developmental screening tool II

A
  • normal: no delays and a maximum of one caution
  • suspect: 2 or more cautions and/or one or more delays. re-screen in 1-2 weeks
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11
Q

what are the drawbacks of denver

A
  • validity is low
  • small sample size of normal
  • does not require an advanced degree
  • studies show only 50% with developmental needs are identified
  • length of time it takes to complete and score
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12
Q

what is the ages and stages questionnaire

A

19 age specific surveys that asks parents about developmental skills that are common in daily life

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13
Q

what are the ages that are completed in the ages and stages questionnare?

A

1 month - 5.5 years

2 and 4 months
4 month intervals up to 24 months
6 month intervals until the child reaches 5 years old

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14
Q

what is tested in age and stages questionnaire ?

A
  • language
  • personal social
  • fine motor
  • gross motor
  • problem solving
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15
Q

cutoff for age and stages questionnaire is ______below the mean

A

2 standard deviations

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16
Q

what is the interpretation of the age and stages

A
  • if below cutoff in one or more areas: diagnostic referral indicated
  • if close to cutoff, provide follow up activities to practice specific skills, then re-screen in 4-6 months
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17
Q

what are the developmental milestones at 1-2 months

A
  • holds head erect and lifts head
  • follows objects through visual field
  • becomes alert in response to voices
  • recognizes parents
  • cooing
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18
Q

what are the developmental milestones at 3-5 months

A
  • reached for and brings objects to mouth
  • raspberry sound
  • sits with support
  • laughs
  • puppy prop
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19
Q

what are the developmental milestones at 6-8 months

A
  • babbling
  • sits along for short period
  • imitates “bye bye”
  • cans start to feed self with puffs or cheerios
  • commando crawl
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20
Q

what are the developmental milestones at 9-11 months

A
  • crawls
  • can stand alone for short period
  • imitates patty cake or peek-a-boo
  • neat pincer grasp
  • follows 1 step commands
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21
Q

what are the developmental milestones at 1 year

A
  • can start to walk independently
  • mama and dada
  • perfects neat pincer grasp
  • points to desired objects
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22
Q

what are developmental milestones at 18 months

A
  • throws a ball
  • can walk up and down stairs with help
  • can say 4-20 words
  • can feed self with spoon
  • protodeclarative pointing
  • protoimperative pointing
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23
Q

what is protodeclarative vs protoimperative pointing

A
  • protodeclarative: something interesting happens and they try to direct you to the event
  • protoimperative: sees an object and looks at you and directs your attention to that object bc they want it
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24
Q

what are the developmental milestones at 2 years

A
  • around 50 word vocabulary
  • kicks ball on request
  • points to named objects or pictures
  • plays with mimicry
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25
Q

what are developmental milestones at 30 months

A
  • walks backwards
  • hops on 1 foot
  • refers to self as 1
  • can carry on conversation
  • holds crayon with fist
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26
Q

what are the developmental milestones at 3 years

A
  • gives 1st and last name
  • can dress with supervision
  • hold crayon with fingers
  • rule of 3s (3 numbers, 3 letters, 3 colors, 3 shapes, 3 wheels)
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27
Q

what are the developmental milestones at 3-4 years

A
  • climbs stairs with alternating feet
  • knows own sex
  • gives full name
  • feeds self at mealtime
  • takes off shoes and jacket
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28
Q

what are the developmental milestones at 4-5 years

A
  • draws a stick person
  • knows days of week
  • knows answers to questions like what to do when you’re cold or hungry
  • self care at toilet
  • dresses self
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29
Q

what are the developmental milestones at 5-6 years

A
  • can catch ball
  • tells age
  • knows right and left hand
  • does simple chores at home
  • little awareness of dangers
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30
Q

what are the developmental milestones 6-7 years

A
  • knows morning or afternoon
  • reads several one syllable printed words
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31
Q

what are the developmental milestones at 7-8 years

A
  • ties shoes
  • adds and subtracts 1 digit numbers
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32
Q

what are developmental red flags

A
  • not sitting by 9 months
  • persistence of moro past 6 months
  • not walking independently by 18 months
  • hand dominance before 18 months
  • no babbling, pointing, gesturing by 12 months
  • failure of 2 and 3 word sentences by 24 and 36 months respectively
  • failure to smile or show joyful expressions by 6 months
  • any regression of speech, language, or social skills
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33
Q

failure to address language impairment can lead to impaction of what

A

social and developmental behavior

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33
Q

what is the most predictive marker of cognition and school achievement

A

language developement

more predictive than any other milestone

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34
Q

when should weight be doubled by after birth? tripled?

A
  • doubled by 6 months
  • tripled by 1 year
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35
Q

what are the projected weight gain and growth for children by age

A
  • 1-4 months: should gain approx 1.5-2lbs each month while growing 1-1.5 inches per months
  • 4-7 months: gain another 1-1.5 lbs per months while growing another 2-3 inches total
  • 8-12 months: grow .5-1 inch per month
  • 8 months: average boy weighs 14.5-17.5 lbs while girls weigh about a half pound less
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36
Q

what is plotted on a growth chart

A

height, weight and head circumference

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37
Q

most kids fall between what percentiles

A

3rd and 97th

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38
Q

what is a type 1 growth abnormality

A

head circumference is preserved and the weight is depressed more than the height

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39
Q

what does a type 1 growth abnormality result from?

A
  • inadequate caloric intake
  • excessive loss of calories
  • inability to use calories peripherally
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40
Q

what is a type 2 growth abnormality

A

normal head circumference with proportionate diminution of height and weight

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41
Q

what are type 2 growth abnormalities associated with

A
  • genetically short stature
  • endocrinopathies
  • constitutional growth delay
  • heart or renal disease
  • skeletal dysplasias
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42
Q

what are type 3 growth abnormalities

A

all 3 parameters of growth are lower than normal

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43
Q

what are type 3 growth abnormalities are associated with

A
  • CNS abnormalities
  • chromosomal defects
  • in utero or perinatal insults
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44
Q

what is SGA

A

infants below the 10th percentile

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45
Q

what are causes of IUGR

A
  • results of poor maternal environment
  • intrinsic fetal abnormalities
  • congenital infections
  • fetal malnutrition
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46
Q

what is symmetrical vs asymmetrical growth abnormalities

A
  • symmetrical: weight, length, and head circumference all <10%
  • asymmetrical: only weight is <10%
47
Q

what is a symmetrical growth abnormality indicative of? what about asymmetrical?

A
  • event early in pregnancy
  • event late in pregnancy
48
Q

LGA babies are MC seen in…..

A

diabetic mothers

49
Q

LGA babies are at risk for what

A

birth trauma

50
Q

what is failure to thrive?

A

abnormal pattern of weight gain

51
Q

t/f a single observation of a child is enough to make a FTT diagnosis

A

false

52
Q

what is the criteria of FTT

A
  • weight consistently less than 80% of the median for the age
  • weight that has fallen across two major percentiles on the growth chart
53
Q

four fundamental constituents that ensure growth of a child

A
  • oxygen
  • substrate
  • hormones
  • love
54
Q

What hormone deficits can result in failure to thrive

A
  • growth hormone
  • insulin like growth factor
  • glucocorticoids
  • thyroid hormone
55
Q

what can cause an energy imbalance

A
  • increase in energy needs
  • decrease in energy supplies
56
Q

What are conditions that increase energy usage

A
  • chronic heart disease
  • chronic lung disease
  • chronic anemia
  • chronic infections
  • malignancy
57
Q

what conditions can lead to decrease in energy supply

A
  • poor caloric intake
  • neuromuscular disorders
  • GI disorders
58
Q

what organ systems reflect evidence of malnutrition

A
  • mucous membranes
  • hair
  • nails
  • skin
59
Q

what is the treatment of mild-moderate FTT

A
  • consultation from dietician
  • alert CPS is suspected cases of abuse/neglect
60
Q

what are the goals of management of mild-moderate FTT

A
  • nutritional rehab
  • parental education
  • behavioral intervention
61
Q

why should you attempt to overfeed malnourished infants at the outset

A

vigorous refeeding may induce malabsorption and diarrhea

62
Q

what is the 3 phase regimen for FTT treatment

A
  • phase 1: begins with provision of 100% of the daily age-adjusted energy and protein requirements on day 1
  • phase 2: intake is increased to provide adequate nutrition to achieve catch-up growth
  • phase 3: varied diet is offered ad libitum as the child gradually approaches ideal body weight
63
Q

what is the management of severe FTT

A
  • hospitalization
  • multidisciplinary team of sub-specialists
64
Q

what is mild-moderate vs severe FTT

A
  • mild-moderate: greater than 80% of ideal body weight for age
  • severe: less than 60% of ideal body weight for height
65
Q

how often do you follow up for FTT

A

initially weekly visits for progress

66
Q

what are the MC problems evaluated by pediatric endocrinologists

A

growth disturbances

67
Q

what is the most critical parameter in evaluation of a child’s growth

A

height velocity

68
Q

it is more difficult to distinguish normal from abnormal growth in what ages

A

first 2 years of life

69
Q

growth and height potential are determined by what

A

genetic factors

70
Q

how do you calculate target height of a child

A

mean parental height plus 6.5cm for boys and subtract 6.5cm for girls

71
Q

how do you assess skeletal maturation

A

xray of the left hand and wrist

72
Q

normal variants of growth

A
  • familial short stature
  • constitutional growth delay
73
Q

pathologic short stature is more likely in children with what abnormality

A

growth velocity abnormality

74
Q

what are chronic illness/nutritional deficiencies vs endocrine causes of short stature

A
  • chronic illness/nutritional deficiencies: poor linear growth associated with poor weight gain
  • endocrine: associated with normal or excessive weight gain
75
Q

what is familial short stature

A
  • typically have normal birth weight and length
  • first 2 years of life their linear growth velocity decelerates
  • once target percentile is reached, the child resumes normal linear growth parallel to the growth curve
76
Q

what is a constitutional growth delay

A
  • delayed onset of puberty and growth spurt
  • growth continues beyond the time the average child stops growing
77
Q

what is the pattern of GH secretion? and what is GH secreted in response to?

A
  • pulsatile pattern
  • secreted in response to sleep, exercise, and hypoglycemia
78
Q

GHD is characterized by what

A

decreased growth velocity and delayed skeletal maturation in the absence of other explanations

79
Q

what are the early s/s of GHD

A
  • normal birth weight with only slightly reduced length
  • hypoglycemia
  • micropenis
  • truncal adiposity
80
Q

what do you do when results of GH tests are ambiguous

A

trial of GH treatment can help determine whether an abnormally short child will benefit from GH

81
Q

what is the treatment of GHD

A

subcutaneous recombinant GH 7 days per week

82
Q

what are the SE of GH replacement

A
  • benign intracranial hypertension
  • slipped capital femoral epiphysis
83
Q

recombinant IGF-1 is used to treat children with what

A
  • GH resistance
  • IGF-1 deficiency
84
Q

what is psychosocial short stature associated with

A

emotional deprivation and undernutrition

85
Q

what are the s/s of Prader-Willi Syndrome

A
  • hypotonia at birth
  • almond shaped eyes
  • strabismus
  • short stature
  • obesity
  • hypogenitalism
  • small hands and feet with tapering fingers
  • deficient GH
  • obsessive hyperphagia noticed at 3-4 years
86
Q

Treatment of Prader-Willi Syndrome

A

GH replacement

87
Q

what are the s/s of turner syndrome

A
  • webbed neck
  • short stature
  • shield chest
  • amenorrhea
  • coarc of aorta and GU malformations
88
Q

what is the treatment of turner syndrome

A
  • estrogen replacement
  • GH replacement
89
Q

what are the s/s of hypothyroidism

A
  • growth retardation
  • decreased physical activity
  • hypothyroid sx
  • delayed puberty
  • thick tongue
  • large fontanels
  • poor muscle tone
  • hoarseness
  • jaundice
90
Q

if hypothyroidism is untreated, it can lead to

A

neurocognitive impairement

91
Q

what is the cause of most cases of pediatric hypothyroidism

A

hypoplasia or aplasia of the thyroid gland or failure of gland to migrate to its normal anatomic location

92
Q

t/f even when the thyroid gland is completely absent, most newborns with congenital hypothyroidism appear normal at birth and gain weight normally for the first few months

A

true

93
Q

how do you screen for screening for congenital hypothyroidism

A

newborn screening

94
Q

abnormal newborn screening for hypothyroidism should immediately be followed up with what lab

A

FT4 and TSH level

95
Q

what is the treatment of hypothyroidism

A

levothyroxine

96
Q

what is the presentation of congenital hyperthyroidism

A

weight loss despite increased appetite

97
Q

what is the management of hyperthyroidism

A
  • BB to control nervousness and tachycardia
  • PTU or methimazole
  • radiation therapy
  • surgery
98
Q

neonatal graves disease usually occurs in what population

A

children whose mothers also have graves

99
Q

what is neonatal graves disease

A

maternal TSH receptor antibodies cross placenta and stimulate excess thyroid hormone production in fetus and resolves over 1-3 months

100
Q

what is constitutional tall stature

A

child who is taller than his or her peers and is growing at a velocity that is within the normal range for bone age

101
Q

what is growth hormone excess

A

excessive secretion of GH by somatotroph adenomas causes gigantism in the prepubertal child

102
Q

what is the management of growth hormone excess

A

treat the adenoma

103
Q

what is precocious puberty

A
  • pubertal development occurring below the age limit set from normal onset of puberty
  • usually before age 8 in girls and 9 in boys
104
Q

what is central precocious puberty

A
  • activation of GnRH, increase in gonadotropin release, and increase in sex steroids
  • events identical of normal puberty
105
Q

what is peripheral precocious puberty

A
  • exogenous source
  • independent of gonadotropin secretion
  • presents with markedly elevated estrogen levels and rapidly progressive pubertal changes
106
Q

what are the s/s of precocious puberty

A
  • breast development
  • pubic hair growth
  • menarche
  • increased body odor
  • accelerated growth
107
Q

what are the labs for precocious puberty

A
  • xray of left hand and wrist
  • estradiol level to rule out ovarian tumor or cyst
  • LH/FHS levels (normal in central and low in peripheral)
108
Q

what is the treatment of precocious puberty

A

leuprolide

109
Q

what is the MOA of leuprolide

A

GnRH analog that desensitizes and down-regulates pituitary GnRH receptors and thus decreases gonadotropin secretion

110
Q

what is considered delayed puberty

A
  • girls: no pubertal signs by 13 and menarche by 16
  • boys: no secondary sexual characteristics by 14 or if more than 5 years have elapsed since the first signs of puberty
111
Q

what is the MCC of delayed puberty

A

constitutional delay

112
Q

what is the treatment of delayed puberty

A
  • girls: low dose estrogen, later switch to OCPs
  • males: low dose testosterone
113
Q

what are the s/s of galactosemia

A
  • vomiting
  • jaundice
  • hepatomegaly
114
Q

what are the s/s of PKU

A

-MR (mitral regurg??)
-hyperactivity
-seizures
-light complexion
-eczema

Pediatric EOR exam (20 decks)

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