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D&E Physiology > Growth and Development > Flashcards

Growth and Development Flashcards

1
Q

Give a generic list of growth measurement techniques?

A 
Height/Sitting height
Length (<2yrs)
Head circumference 
Comparison with parent height
BMI
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2
Q

Why might sitting height be useful?

A

Spinal radiotherapy - causes spine to not grow properly

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3
Q

What age is head circumference measured and how?

A

<2yrs

Forehead and occipital prominence

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4
Q

Which growth chart is used in the uk?

A

RCPCH UK 2-18
WHO standards <4
UK90 >4

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5
Q

What is bone age measuring?

A

Looking at long bones and round bones of hand for distortion/growth

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6
Q

Outline the Tanner method for puberty staging?

A 
B 1-5 (breast)
G 1-5 (genitals)
PH 1-5 (pubic hair)
AH 1-3 (axillary hair)
T 2ml-20ml
SO
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7
Q

What is testicular maturation?

A

Measuring testicle size with a Prader Orchidometer

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8
Q

How is a testicular orchidometer used?

A

Black beads for pre-pubertal size

15+ for post-pubertal size

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9
Q

What history is taken for growth?

A 
Birth weight/gestation
PMH
FH/SH/Schooling
Systematic enquiry 
Dysmorphic features
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10
Q

What assessment tools are used for growth?

A 
Height/length/growth
Growth charts
MPH + Target centiles
Growth velocity 
Bone age
Pubertal assessment
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11
Q

What factors influence height?

A 
Age/Sex/Race
Nutrition
Parent height
Puberty + skeletal maturity
Health/disease/disorders
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12
Q

What are the 3 stages of normal growth?

A

Infantile
Childhood
Pubertal

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13
Q

What is the pattern of infantile growth?

A

Starts very fast and slows down rapidly towards childhood

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14
Q

What is the pattern of childhood growth?

A

Starts moderately fast from 4+ and slows down to 11-14

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15
Q

What is the pattern of pubertal growth?

A

Sharp rapid burst at puberty which then drops down to standstill at ~20yrs

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16
Q

When does testicular growth take place in puberty?

A

Right at the start

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17
Q

When does penile growth take place in puberty?

A

Just after the start before maximum growth

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18
Q

When does advanced growth take place in puberty?

A

At the peak of growth rate

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19
Q

When does facial hair growth take place in puberty?

A

Towards the end of puberty

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20
Q

When does breast budding take place in puberty?

A

Start of puberty

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21
Q

When does early breast development take place in puberty?

A

At the peak of growth rate

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22
Q

When does menarche take place in puberty?

A

Towards the end of puberty

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23
Q

What are the most important stages of puberty?

A

Breast budding
Testicular enlargement
(earliest signs of puberty)

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24
Q

At what Tanner stage does breast budding take place?

A

Tanner Stage B2

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25
Q

At what Tanner stage does testicular enlargement take place?

A

Tanner stage G2 - T3-4ml

26
Q

What effect does obesity have on pubertal development in girls?

A

Taller, earlier (end height the same)

27
Q

What signs are indicative of growth disorders and referral?

A 
Extreme short/tall
Height below target height
Abnormal height velocity
Hx chronic disease
Obvious dysmorphia
Early/late puberty
28
Q

How is abnormal height velocity detected?

A

Crossing of centiles on charts

29
Q

What are the common causes of short stature?

A

Familial
Constitutional (delay of growth and puberty)
SGA/IUGR

30
Q

Pathological causes of short stature?

A 
Chronic illness (JCA/IBD/Coeliac)
Undernutrition
Iatrogenic (steroids)
Psychosocial
Hormonal (GHD,hypothyroidism)
Syndromes
31
Q

Which syndromes can cause short stature?

A

Turner syndrome
Prader-Willi syndrome
Noonan’s syndrome
Achondroplasia

32
Q

When is puberty early and late in a boy?

A

Early <9yrs

Delayed >14yrs

33
Q

When is puberty early and late in a girl?

A

Early <8yrs

Delayed >13yrs

34
Q

What is Constitutional delay of growth and puberty?

A

More common in boys
Family history in dad/brothers
Bone age delay
EXCLUDE ORGANIC DISEASE

35
Q

What are the causes of delayed puberty?

A 
CDGP
Gonadal dysgenesis
Chronic disease
Impaired HPG axis
Peripheral
36
Q

What are the causes of early breast development?

A

Infanctile thelarche
Thelarche variant
True central precocious puberty

37
Q

What are the causes of early secondary sexual characteristics?

A

Exaggerated adrenarche

Precocious pseudopuberty

38
Q

What are the causes of early PV bleeding?

A

Premature menarche

39
Q

What is central precocious puberty?

A 
Early puberty 
Growth spurt
Advanced bone age
Idiopathic in girls (pituitary imaging)
Underlying cause in boys
40
Q

What is the treatment for central precocious puberty?

A

GnRH agonist

41
Q

What is Precocious pseudopuberty?

A

Gonadatrophin independent
(Low levels of LH/FSH)
Abnormal sex steroid hormone secretion
Early secondary sexual characteristics

42
Q

How is a birth with ambiguous genitalia managed?

A 
DO NOT GUESS SEX
Multi-disciplinary
Exam of gonads/organs
Karyotype
Exclude Congenital Adrenal Hyperplasia
43
Q

What is congenital hypothyroidism?

A

Athyreosis/hypoplastic/ectopic
Found in newborn screen
1 in 4000

44
Q

What causes acquired hypothyroidism?

A

Autoimmune (Hashimoto’s) thyroiditis

FH of thyroid/autoimmune diseases

45
Q

How does acquired hypothyroidism present?

A

Lack of height gain
Pubertal delay
Poor school performance

46
Q

How is overweight defined?

A

BMI >85th centile

SD >1.04

47
Q

How is obesity defined?

A

BMI >97.5th centile

SD >2

48
Q

How is weight assessed?

A 
Mass + BMI
Height
Waist circumference 
Skin folds
Hx
49
Q

When is obese abnormal?

A

WHEN COMBINED WITH SHORT LOL

50
Q

What symptoms must you be aware in the obese child?

A

Suggestive of Syndromes,
Hypothalamic-pituitary pathology
Endocrine issues
Diabese

51
Q

What are the common causes of obesity?

A 
SIMPLE OBESITY
Drugs
Syndromes
Endocrine disorders
Hypothalamic damage
52
Q

Which drugs increase the risk of obesity?

A

Insulin
Steroids
Antithyroid drugs
Sodium valproate

53
Q

Which syndromes increase the risk of obesity?

A

Prader-Willi
Laurence-Moon-Biedl
Pseudohypoparathyroidism Type 1
Down’s

54
Q

Which endocrine disorders increase the risk of obesity?

A 
Hypothyroidism
Growth hormone deficiency
Glucocorticoid excess
Hypothalamic lesion  (tumour/trauma/infection)
Androgen excess
Insulinoma
Insulin resistance syndromes
Leptin deficiency
55
Q

Endocrine causes of obesity typically present with what?

A

Growth failure

56
Q

Syndromes causing obesity typically present with what?

A

Learning difficulties

57
Q

Hypothalamic causes of obesity typically present with what?

A

Loss of appetite control

58
Q

What are the 4Ts of childhood diabetes?

A

Thirsty
Thinner
Tired
Toileting more

59
Q

How do you respond in suspected childhood diabetes?

A

Prick test
[Glc] > 11mmol/L
REFER

60
Q

What is the red flag symptom for diabetes in a child?

A

Return to bedwetting and day-wetting

61
Q

What other factors are suggestive of diabetes under five?

A 
Nappies heavier than usual
Blurred vision
Candidiasis
Constipation
Recurring skin infections
Irritability
62
Q

What are the symptoms of diabetic ketoacidosis?

A 
N&amp;V
Abdominal pain
Ketotic breath
Drowsiness
Rapid/deep respiration
Coma

D&E Physiology (10 decks)

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