Growth

Question 1

A mother brings her 7 year old son to see you because he is overweight. He is doing very well at school academically but does not like playing sport. His appetite is said to be large but he never eats overnight or seeks food inappropriately. On examination he weighs 46kg (well above the 97th centile), height is 128 cm (90th centile) and head circumference is 54 cm (75th centile). He has a blood pressure of 125 (>99th centile) / 80 (95th-99th centile). He is prepubertal and has white/pink striae on his hips.

What is the most likely cause of this child’s excessive weight?

Answer 1

Idiopathic obesity

Endocrine - usually short too. Prader-Willi has short stature + foodseek

Question 2

A 6-year-old boy is evaluated for short stature. He is otherwise well and has been growing just below the 3rd centile. His growth velocity over the past year is 5.3 cm. There are no abnormal findings on examination. The bone age equals his actual age. The mid-parental height is 162 cm.

What is the likely cause for his short stature?

Question 2Select one:

a.
Growth hormone deficiency

b.
Hypothyroidism

c.
Constitutional delay in maturation

d.
Familial short stature

Answer 2

Familial short stature

Constitutional has delayed bone age

Question 3

What is the most likely reason a boy of 14 years old would be seen by a doctor because of a concern about short stature?

Question 3Select one:

a.
Familial short stature

b.
Hypogonadotrophic hypogonadism

c.
Growth hormone deficiency

d.
Constitutional delay in growth

Answer 3

Constitutional delay in growth

familial may or may not seek, others occur earlier than 14

Question 4

A 7-year-old girl is seen in outpatients because of short stature. She is otherwise well. Her height is just below the 3rd centile and weight is on the 25th centile. Her growth velocity is 4 cm over the past year. What is the normal growth velocity at this age?

Question 4Select one:

a.
11-13 cm/year

b.
2-4 cm/year

c.
8-10 cm/year

d.
5-7 cm/year

Answer 4

5-7 cm/year

~9 at 3 years, slowing until puberty where it peaks at ~8

Question 5

A 3 year old boy is diagnosed with Klinefelter syndrome (XXY) after a cytogenetic screen was performed for slow speech development and undescended testicles.

What can you tell his parents about the average adult stature (height) in people with Klinefelter syndrome compared to the average adult? Compared to average adult males, adult males with Klinefelter syndrome are:

Question 5Select one:

a.
Between 6cm and 10cm taller

b.
Between 2cm and 5cm taller

c.
Between 2cm and 5cm shorter

d.
Same average height as others

Answer 5

Between 2cm and 5cm taller

testosterone normally stops long bone growth

Question 6

A 14 year old boy, Sam, has been diagnosed with constitutional delay in growth and puberty. He was on the 50th percentile for height before puberty but is now on the 10th percentile. Until recently he had been planning on joining the army when he left school, but is now re-considering because he is short. He has early signs of puberty. What would his predicted final adult height percentile be?

Question 6Select one:

a.
90-97th%ile

b.
25-75th%ile

c.
3-10th %ile

d.
<3rd%ile

Answer 6

25-75th%ile

Question 7

A 13 year old girl presents to your surgery because of concerns about her being the shortest in class, and not showing any signs of puberty. You check the following features and fine:

Her height is below the 3rd centile;
Growth velocity is 5 cm/year;
Mid-parental height expected range is from 25th-90th percentile;
Bone age is compatible with that of a girl of 8-10 years old.
After examining her, which starting investigation would be the most important?

Question 7Select one:

a.
Thyroid function

b.
Ovarian hormones

c.
Simple karyotype

d.
Growth hormone

Answer 7

Simple karyotype

Turner Syndrome common cause