Evaluation of Worrisome Growth

Question 1

CDC growth charts are based on _____

Answer 1

US population,

Question 2

WHO growth charts are based on _____

Answer 2

world‐ wide population.

Question 3

Short stature is defined as:

Answer 3

Height below -2 SD (3% is – 1.9 SD) for age and gender
or, a better option is
Height more than 3.5 inches below the midparental target height
*

Question 4

_____ of children will fall within 3.5 inches of midparental target height

Answer 4

97%

Question 5

How is Bone age measured ?

Answer 5

By comparing an X-ray of the left hand and wrist to standardized pictures of X-rays in a reference book.

Question 6

children who have short parents are not necessarily born small, they will have a decrease in their growth rate between ______ of age to establish a new
trajectory

Answer 6

6 and 18 months

Question 7

what is Constitutional Growth Delay?

Answer 7

(“Late Bloomer”)characterized by growth deceleration during the first 2 years of life, followed by normal
growth paralleling the lower percentile curve and shorter than expected for parental heights. Skeletal
maturation is delayed and catch-up growth is achieved by late puberty and delayed fusion of the
growth plates

Question 8

what is the Definition of failure to thrive (FTT)

Answer 8

infant or toddler (< 2 years of age) with deceleration of weight gain to a point <3%, or a fall in weight across 2 or more major percentiles

Question 9

what are Hormonal Causes of Worrisome Growth

Generally, weight is spared

Answer 9

 Hypothyroidism
 Growth hormone/IGF-1 deficiency
 Cushing Syndrome
 Rickets

Question 10

Labs for Primary hypothyroidism should be ____

is straightforward

Answer 10

increased TSH, low T4

Question 11

Labs for Central hypothyroidism

Answer 11

low T4, normal TSH

Question 12

In primary hypothyroidism, pt will have a ___ bone age and __ face

Answer 12

delayed,

puffy (edematous)

Question 13

Clinical findings in growth hormone deficiency:

Answer 13

Decreased muscle build
Increased subcutaneous fat, especially around trunk
Face immature for age
Prominent forehead, depressed midface
In males, small phallus

Question 14

How to Evaluate for growth hormone deficiency:

Answer 14

1) Bone age (if child older than age 3 years)
2) IGF-1 can be helpful but has limitations:(May be reduced in malnutrition regardless of GH status,
IGFBP-3 is less affected by nutrition and may be a better test in very young children)
3)Stimulation testing – clonidine, arginine, glucagon, L-dopa (ruled out with any value >10 ng/ml)

Random, single GH value not useful, due to pulsatile secretion

Question 15

The _____ gene is responsible for skeletal and growth abnormalities in turner syndrome

Answer 15

SHOX

Question 16

Clinical findings of Turner syndrome

Answer 16

Cardiac abnormalities: bicuspid aortic valve, aortic coarctation
 Renal – horseshoe kidney
 Ovarian insufficiency
 Hypothyroidism/celiac disease
 Otitis media
 Sensory-neural hearing loss
 Non-verbal learning disability

Question 17

Side effects of GH treatment include ______

Answer 17

1) Slipped capital femoral epiphysis (fracture through the growth plate (physis), which results in slippage of the overlying end of the femur, )
2) Pseudotumor cerebri (idiopathic increase in ICP)