Growth Flashcards
1
Q
Embryonic stage:
A
The first 8 weeks.
2
Q
Fetal stage:
A
9th to the 40th weeks
3
Q
Includes maximum rate of growth
A
Fetal stage:
4
Q
Factors affecting fetal stage
A
Maternal and placental health and fetal insulin.
5
Q
Neonates stage
A
first 4 weeks of life (28 days of life)
6
Q
first 4 weeks of life (28 days of life)
A
neonates stage
7
Q
Infancy stage
A
from one month to 2 years
8
Q
Factors affecting the infacy stage
A
Nutrition, good health, thyroid hormone, happiness
9
Q
factors affecting childhood
A
genes, growth hormone, thyroid hormone,
nutrition, good health and happiness,
10
Q
Factors affecting Adolescence
A
Testosterone/Estrogen, growth hormone
11
Q
Factors affecting physical growth
A
- Race:
- Family genes: Height and body frame are inherited from parents
- Sex: Girls grow faster from the 7th month to 4 years and start puberty at a younger age.
- Chromosomal disorders: (as Down syndrome): usually show retarded growth.
- Socioeconomic factors: Poor housing and hygiene and poor health
can delay growth. - Nutritional status: Under nutrition delays growth while over nutrition can lead to obesity.
- Chronic illness: Renal, liver, chest diseases, cardiac and GIT.
- Developmental anomalies: as cleft palate, pyloric stenosis and renal anomalies.
- Chronic infection: e.g. Tuberculosis and brucellosis.
- Endocrinal factors: Growth hormone, Thyroid hormone, androgens, adrenal cortisol, excess steroids
4 مليش دعوه بيهم
4 امراض
2 nutrition
12
Q
Growth hormone: deficiency causes
A
proportionate — short stature, normal mentality and characteristic features
13
Q
Thyroid hormone deficiency causes……
A
disproportionate short stature, mental retardation and coarse face in infants and children with congenital hypothyroidism (Cretinism).
14
Q
acquired hypothyrodism causes
A
Proportionate short stature in children
15
Q
effect of androgen on physical activity
A
Excess androgens cause tall stature as a child but proportionate short stature later as an adult.
16
Q
Adrenal cortisol: deficiency causes
A
failure to thrive and asthenia
17
Q
Excess steroids whether endogenous or exogenous causes
A
short stature with characteristic obesity (Cushing syndrome).
18
Q
normal birth weight
A
3 Kg (Normal from 2.5 to 4 Kg).
19
Q
W at 4 months
A
6 Kg
20
Q
W at 8 moths
A
8
21
Q
W at 12 months
A
9 Kg
22
Q
W at 2 years
A
12 Kg
23
Q
W at 6 years
A
20Kg
24
Q
w at 10 years
A
30 Kg
25
Length at Birth
50 cm
26
length at 1 year
75 cm
27
length at 4 years
100 cm
28
Head circumference at birth
35 cm
29
Head circumference 1 year
47 cm
30
Head circumference 12 years
53 cm
31
Anterior Fontanelle at birth
3 fingers
32
Anterior Fontanelle 6 months
2 fingers
33
Anterior Fontanelle 1 year
1 finger
34
Anterior Fontanelle closed at
1.5 years
35
motor dev
3m: head support
6m: sits without support
9m: crawling
12m: walks
36
head support
3m
37
sits without support
6m
38
crawling
9 month
39
walks unsteady
12
40
rolling over
8 months
41
pushing with feet
4 months
42
walks steady
15 months
43
stands
11 months
44
turn head from side to side
at birth
45
Ascends stairs in an adult manner
3 years
46
can pedal tricycle
3 years
47
Descends stairs in an adult manner
4 years
48
Can hop on one feet
5 years
49
Ascends stairs in a child manner
18 m
50
runs stiffly
18m
51
Descends stairs in a child manner
2 years
52
runs well
2 years
53
palmer grasp
6 months
54
transfer objects
7 months
55
Immature pincer grasp
10 months
56
mature pincer grasp
12 months
57
tower of 3
tower of 6
tower of 8
18 mon
2 years
2.5 years
58
Follows moving objects or light
1 month
59
Smiles on social contact
2 months
60
Recognizes his mother
4 months
61
draw a shape and its age
line 2 years
cicrle 3 years
square 4 years
triangle 5 years
62
Follows moving objects or light
1 month
63
Laughs and prefers social contact
6 months
64
babbling
8 months
65
Responds to own name
9 months
66
Says Mama, Dada
9 months
67
Waves bye — bye
12 months
68
Says only 2-3 words
1 year
68
Says about 10 words
1.5 years
69
Knows about 100 words
2 years
70
Shows 2 parts of the body
1.5 years
71
says 3 words sentence (telegraphic)
2 yyears
72
Gives full name, age and sex
3 years
72
tells story — counts up to 10
4 years
73
Clear and fluent speech
5 years
74
Can draw a man with all features
6 years
75
enumerate causes of short stature
Normal Variants:
1. Familial (genetic) short stature
2. Constitutional delay of growth and puberty
Pathological Variants:
1. Genetic and chromosomal disorders
= Down syndrome.
= Turner syndrome
= Mucopolysaccharidosis.
= Skeletal dysplasia: Achonroplasia
= Russel Silver syndrome.
2. Endocrinal causes:
= Growth hormone deficiency
Panhypopituitarism e.g. craniopharngioma
Isolated growth hormone deficiency.
Insulin growth factor 1(IGF1) deficiency (Laron syndrome)
= Hypothyroidism : congenital /autoimmune thyroiditis
=Hypoparathyroidism Cushing
=Hypogonadism
= Adrenal hormones
-Cushing syndrome.
-Adrenal insufficiency.
-Corticosteroid therapy
4. 3. Severe systemic diseases in infancy and childhood
= Chronic diseases (chronic kidney disease - cystic fibrosis - liver cell failure
malabsorption- hemolytic anemia).
= Chronic infections: Tuberculosis-bilharziasis.
4. Nutritional starvation (malnutrition)
6. 5. Social short stature
= Psychological deprivation: disturbed child-mother or family relation reduces growth hormone release
76
genetic and chromosomal disoders causing short stature
= Down syndrome.
= Turner syndrome
= Mucopolysaccharidosis.
= Skeletal dysplasia: Achonroplasia
= Russel Silver syndrome.
77
Endocrinal causes of short stature
2. Endocrinal causes:
= Growth hormone deficiency
Panhypopituitarism e.g. craniopharngioma
Isolated growth hormone deficiency.
Insulin growth factor 1(IGF1) deficiency (Laron syndrome)
= Hypothyroidism : congenital /autoimmune thyroiditis
=Hypoparathyroidism Cushing
=Hypogonadism
= Adrenal hormones
-Cushing syndrome.
-Adrenal insufficiency.
-Corticosteroid therapy
78
Investigations for short stature
1. Bone age assessment: x-ray of the left hand and wrist will diagnose the normal variant (familial/constitutional)
2. Karyotyping in short females to exclude Turner syndrome (45 XO).
4. 3. Anti-tissue transglutaminase (positive in case of Celiac disease).
5. Skeletal survey if skeletal dysplasia is suspected (e.g. Achondroplasia). Rickets also should not be missed as a cause.
5. If bone age is markedly delayed: Endocrinal assessment is warranted including: Thyroid profile - Growth hormone stimulation tests - Steroids and ACTH if clinically suspected.
6. If pituitary hormonal deficiency is diagnosed (Isolated GH deficiency or
Panhypopituitarism): MRI to detect craniopharyngioma or brain anomalies.
liver cell function and kidney cell function
CBC
tuberculin for tuberculosis
78
list the causes of the macrocephaly
1. Cranial causes
Familial large head.
Chronic hemolytic anemia.
Rickets.
Achonroplasia and mucopolysaccharidosis
2. Intracranial (increased intracranial tension)
Hydrocephalus.
Subdural hematoma and Subdural effusion.
Brain tumors.
Neurofibromatosis
Cerebral gigantism (Sotos syndrome)
CNS storage disease e.g. mucopolysaccharidosis (Hurler’s syndrom
79
Etiology of microcephaly
A. True microcephaly
Primary (genetic)
1. Familial ( autosomal recessive)
2. Autosomal dominant
3. Syndromes (Down: trisomy 21) — (Edwards: trisomy 18)-( Cri du chat:5p)
Secondary (non- genetic or acquired)
1. Prenatal causes
Congenital infections e.g. Cytomegalovirus, Rubella
Irradiation
Drugs e.g. — fetal alcohol syndrome.
2. Perinatal causes
Hypoxic ischemic injury.
Intracranial hemorrhage.
3. Post- natal causes
Kernicterus
CNS infections: meningitis -encephalitis.
Intracranial hemorrhage.
B. Craniostenosis ( craniosynostosis)
80
carnial causes of macrocephaly
1. familial large head
2. chronic hemolytic disease
3. Rickets
4. Anchodroplasia and mucopolysaccharidosis
81
intracranial causes of macrocephaly
Hydrocephalus.
Subdural hematoma and Subdural effusion.
Brain tumors.
Neurofibromatosis
Cerebral gigantism (Sotos syndrome)
CNS storage disease e.g. mucopolysaccharidosis (Hurler’s syndrome)
82
Causes of the precocoious pubery
1. Normal variant
Premature thelarche in girls
Gynecomastia in boys
Premature adrenarche (premature pubarche)
2. True precocious puberty(
Idiopathic(mainly in girls): the commonest
Secondary (commoner in boys)
Brain tumors- hydrocephalus.
Trauma and radiotherapy.
3. Pseudo precocious puberty
Girls: ovarian tumors or excess Estrogen
Boys: testicular tumors or excess androgens
83
Definition of Precocious puberty
Onset of puberty before 8 years in girls or before 9 years in boys
