Endocrine disorders and Centile charts and assessment of child growth Flashcards
How do you measure the weight of a baby [1] and child older than two? [1]
How do you measure head circumference? [1]
How do you measure baby length? [1]
Baby weight: without any clothes or nappy
Child older than two: vest & pants only
Head circumference: tape measure above ears
Baby length: place head on back and measure; requires two measures as they move
What happens to weight of an infant in first two weeks and why? [2]
There is some degree of weight loss - but 80% recover this in first two weeks
Due to baby using fat reserves that has stored in-utero, milk isn’t making up for deficit
What is the % weight loss of a child who was born by vaginal delivery at 3.5kg and weighs 3.15Kg at 5 days
3.5-3.15 = 350g (0.35kg)
0.35/3.5 = 10%
What weight loss at any stage is a concern and needs assessment? [1]
10%
When do you measure neonatal weight in first year of life? [4]
8, 12 and 16 weeks and 1 year
(same time as immunisations)
( Where do the majority of mistakes occur in paper growth charts? )
Came up in YR2 OSCE!
Plotting months instead of months
How would you describe this child’s centile?
Half way between 9th and 25th centile
What drop in weight (in centiles) would need further assessment of a growth chart? [1]
2 or more centiles
What is important to remember for normal rate of weight gain and growth throughout first year? [2]
Weight often does not follow a particular centile especially in 1st year
Usually tracks within one centile space (gap between 2 centile lines)
What is the first line treatment for osteoporosis? [1]
Bisphosphonates are the first-line treatment for osteoporosis. They work by interfering with osteoclasts and reducing their activity, preventing the reabsorption of bone. There are a few key side effects to remember:
What will a child’s BMI centile be for a child with average weight? [1]
A child whose weight is average for their height will be between the 25th and 75th BMI centile whatever their height centile
How do you predict height of a child from the parents height for boy and girl? [2]
OFTEN ASKED IN EXAMS Qs
Calculated in males by adding 7cm to the mean parental heights
Calculated in females by subtracting 7cm from mean parental heights
Mid parental height (MPH) = (mothers height + fathers height/2) +/- 7cm
How do you go about evaluating a child with short stature? [4]
Height centile vs weight centile
* Failure to thrive or failure to grow
* Compare height vs weight
When it started
* In utero (IUGR. achondroplasia)
* In infancy
* In childhood
* In puberty
Body proportions
* Primary or secondary growth disorders
Presenting signs
* Idiopathic Short Stature (ISS) or a specific diagnosis (e.g. genetic condition / GH deficiency / sex steroids?)
Evaulation of short stature:
After conducting initial 4 steps, what would you investigate? [1]
If growth is proproptionate or disproportionate
Which conditions would create disproportionate short stature? [4]
- Achondroplasia – have shorter secondary limbs which make disproportionate growth
- Hypochondroplasia
- Leri-Weill dyschonrosteosis (LWD)
- Rickets
Evaulation of short stature:
What would you do after investigating if child has proprotional / dissproportional growth? [2]
Calculate Standard Deviaton score:
* Mean would be score of 0
* Below mean: - score
* Above mean: +score
and
Skeletal survey
* Skull
* Spine
* Pelvis
* Upper limb
* Lower limb
Why do all girls with short stature need karyotype analyis? [1]
To investigate for Turner’s syndrome (45X-)
Describe the physiopathology of Leri-Weill dyschonrosteosis (LWD):
- Inheritance pattern? [1]
- Mutation to which gene? [1]
- How do LWD individuals present? [4]
Leri-Weill dyschonrosteosis (LWD):
Autosomal dominant skeletal dysplasia
Short stature homebox gene (SHOX) - found on pseudoautosomal region of X & Y genes
Presentation:
- mesomelic (mid parts) limb shortening
- Bowing of radius
- dorsal dislocation of ulna
- Premature epiphyseal fusion
Describe the madelung deformity of the forearm in LWD [3]
Madelung deformity is characterized by the bowing and shortening of the bones in the forearms (the radius and the ulna) and the dislocation of the ulna, resulting in the abnormal deviation or misalignment of the wrist.
Name two other pathologes that madelung deformity of the forearm is seen in (apart from LWD) [2]
Turners Syndrome
Idiopathic short stature
What is the karyotype of Turner’s syndrome? [1]
45X-
Classical signs of Turner syndrome? [6]
Short stature
Webbed neck
High arching palate
Downward sloping eyes with ptosis
Broad chest with widely spaced nipples
Cubitus valgus (wide carrying angle)
Underdeveloped ovaries with reduced function
Late or incomplete puberty
Most women are infertile
Shortening of the 4th/5th metacarpal
Which systemic disorders could cause proportionate short stature? [3]
GI Diseases (Coealiac Disease / Lactose intolerance)
Chronic renal diseases
Idiopathic short stature
How do you treat idiopathic short stature? [1]
Growth Hormone - will increase overall height
(but expensive)
Name a treatment for Tuner Syndrome growth deficieny [1]
Oxandrolone
What endocrine disorders might you think about for proprionate short stature? [2]
Hypothyroidism
Hypercortisolism
