Dow Peds Just the Blue. I'm tired.

Question 1

First two years of growth

Answer 1

common for infants to cross percentiles on their growth curve.

Question 2

what to do for preterm infants

Answer 2

correct for gestational age for at least the first year. (subtract the missing weeks from the chronologic age)

Question 3

pubertal growth spurt typically starts

Answer 3

around 10 for girls

around 12 for boys

Question 4

midparental height calculation

Answer 4

girls - subtract 5 inches or 13 cm from dad and average with mom

boys- add 5 inches to mom and average with dad

Question 5

expected height for kids over 2 years old

Answer 5

extrapolate the child’s growth along the current channel to the 18-20 year mark

Question 6

falling off curve

Answer 6

height-for-age curve has deviated downwards across 2 major height percentile curves

pretty much any child should grow more than 4-5 cm/year, or about 2 in/ year

Question 7

single most important factor in evaluating growth of a child between age 2 and onset of puberty

Answer 7

abnormal growth velocity

Question 8

bone age

Answer 8

radiograph of left hand and wrist

speaks to remaining growth potential

Question 9

short stature

Answer 9

heigh that is below the 2.3rd percentile

gender bias- boys are referred for evaluation more often, at younger ages and for less severe height deficits as compared with girls

Question 10

normal variants of short stature

Answer 10

familial (genetic)
constitutional delay of growth and puberty
small for getsational age, with catch up growth

Question 11

constitutional delay of growth and puerty

Answer 11

family hx positive for delayed growth and/or puberty

bone age delayed

reassure and monitor growth q 6 months

Question 12

1 systemic/ chronic disorder leading to poor growth

Answer 12

malnutrition

Question 13

Turner syndrome presentation

Answer 13

don’t miss this one

short stature and/or delayed puberty may be the only presenting signs

Madelung deformity of the forearm (focal dysplasia of the distal radial physis)- Turner or SHOX mutations

Question 14

endocrine disorder PE findings

Answer 14

most are characterized by increased weight-for-height
abnormal body proportions and characteristics suggesting genetic condition:
- arm span/ heigh ratio
increased with marfan, klinefelter, or if short trunk from vertebral disease
- decreased with untreated hypothyroidism, turner, achondroplasia

midline defects- cleft palate, etc. Note- growth horone deficiency usually is not associated with growth deceleration until after 1 year of age

Back- suprascapular fat pad- Cushings
mild form are seen in simple obesity, but exogenously obese children are often of normal or slightly increased stature.

Question 15

Evaluation

Answer 15

bone age, CBC, ESR, electorlytes, creatinine, TSH…

• IGF-I and insulin-like growth factor binding protein-3– screen for GH deficiency

Karyotype– for Turner esp.

refer for further testing

Question 16

Treatment with growth hormone therapy

Answer 16

super expensive
low risk of adverse effects
- intracranial hypertensions
- glucose intolerance
- slipped capital femoral epiphysis (SCFE)
- increased obesity? risk of cancer?

Indications– SGA w/ failed catch up growth
- idiopathic short stature

Question 17

monitoring of patients with short stature

Answer 17

growth velocity q 6 month intervals to monitor growth if familial or constitutional

works best if therapy initiated at least 5 years prior to the onset of puberty

weather cotreatment with rhGH and a gnrh analog (leuprolide) to inhibit puberty results in greater adult height in patients with classic GHD remains controversial.