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*Diabetes & Endocrinology > Growth and Development > Flashcards

Growth and Development Flashcards

(Paediatric endocrinology and diabetes)

1
Q

Name some protocols for accurate height measurement of a child

A
  • Shoes n socks off
  • Heels together, legs straight, shoulders released
  • Heels, buttocks, scapulae against wall
  • ‘breathe in and stand tall’
  • Height to last complete mm
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2
Q

How is height measured in children under 2 years, or when something is preventing you from measuring height?

A

Length is measured instead

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3
Q

When is sitting height measured?

A

When the body is disproportionate e.g. in people with skeletal dysplasia

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4
Q

Who is head circumference measuring routine in?

A

Children <2 years

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5
Q

How is head circumference measured?

A

Tape round forehead and occipital prominence

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6
Q

What does ‘make every contact count’ refer to?

A

Every time a child visits the GP or hospital, they should be measured; important to track growth to flag up any problems

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7
Q

Name a few different growth charts

A

Mid-parental height and target height
Condition-specific charts e.g. for Downs, Turners
BMI

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8
Q

How is bone age measured?

A

Radiographs usually of left wrist, hand and fingers

Measured from epiphyseal plates

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9
Q

Name the 5 components of puberty staging in the Tanner method

A 
B = 1 to 5
G = 1 to 5
PH = 1 to 5
AH = 1 to 3
T = 2ml to 20ml
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10
Q

What do the stages of the Tanner method roughly mean in relation to stages of puberty?

A

Stage 1 = prepubertal
Stage 3 = early puberty
Stage 5 = adult

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11
Q

What is the tool used for testicular maturation measurement?

A

Prader orchidometer

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12
Q

Name 6 features of history and further examination when investigating growth and development

A
  • birth weight + gestation
  • PMH
  • fam history/social history/schooling
  • systematic enquiry
  • dysmorphic features
  • systemic examination
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13
Q

What factors influence height?

A 
Age
Sex
Race
Nutrition 
Parental heights
Puberty 
Skeletal maturity (Bone age)
General health 
Chronic disease
Specific growth disorders
Socio-economic status
Emotional well-being
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14
Q

Which gender enters puberty earlier?

A

Female

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15
Q

For which gender does puberty last longer?

A

Male

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16
Q

What is the earliest objective sign of puberty in females?

A

Breast budding (Tanner stage B2)

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17
Q

What is the earliest objective sign of puberty in males?

A

Testicular enlargement (Tanner stage G2 + T3-4ml)

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18
Q

Give 6 indications for referral about a possible growth disorder

A
  • extreme short/tall stature (off centiles)
  • height below target height
  • abnormal height velocity (crossing centiles)
  • history of chronic disease
  • obvious dysmorphic syndrome
  • early/late puberty
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19
Q

What is the common link between obesity and growth?

A

Obese children are generally taller; short obese children are worrying

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20
Q

Give 3 common causes for short stature

A

Familial
Constitutional
SGA/IUGR

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21
Q

Give some pathological causes for short stature (6)?

A 
Undernutrition 
Chronic illness (JCA, IBD, Coeliac)
Iatrogenic (steroids)
Psychological + social
Hormonal (GHD, hypothyroidism)
Syndromes (Turner, P-W, Noonans, achondroplasia)
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22
Q

What is considered early and late puberty in boys?

A

EARLY < 9 yrs

LATE > 14 yrs

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23
Q

What is considered early and late puberty in girls?

A

EARLY < 8 yrs

LATE > 13 yrs

24
Q

What is CDGP?

A

Constitutional Delay of Growth and Puberty

25
Q

Who is CDGP most common in?

A

Boys; fam history in dad or brothers; bone age delay (need to exclude organic disease)

26
Q

Give 4 causes of delayed puberty

A

Gonadal dysgenesis (Turner, Klinefelter)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
Peripheral (cryptorchidism, testicular irradiation)

27
Q

What is central precocious puberty?

A

Early pubertal development; breast development in girls and testicular enlargement in boys

28
Q

Give a couple more features of CPP

A

Growth spurt

Advanced bone age

29
Q

What is the cause of CPP in girls?

A

Usually idiopathic; do pituitary imaging

30
Q

What is the cause of CPP in boys?

A

Look for underlying cause e.g. brain tumour, genetics

31
Q

What is the treatment for CPP?

A

GnRH agonist (Gonadatrophin-releasing hormone agonist)

32
Q

What is different between precocious pseudopuberty and CPP?

A

PP is gonadotrophin independent (low/prepubertal levels of LH and FSH)

33
Q

Give some features of precocious pseudopuberty

A

Abnormal sex steroid hormone secretion
Virilasing/feminasing
Secondary sexual characteristics

34
Q

What is the management for a newborn with ambiguous genitalia?

A

Do NOT guess sex of baby
MDT approach
Exam: USS? gonads/internal organs
Karyotype

35
Q

What is it important to exclude in newborns with ambiguous genitalia?

A

Congenital Adrenal Hyperplasia (risk of adrenal crisis in first 2 weeks)

36
Q

Give 2 causes of congenital hypothyroidism

A
  • Athyreosis/hypoplastic/ectopic

- Dyshormonogenic

37
Q

When should treatment of congenital hypothyroidism commence?

A

Within first 2 weeks

38
Q

What is the most common cause of acquire hypothyroidism?

A

Autoimmune (Hashimoto’s) thyroiditis

39
Q

What is the expected history in someone with acquired hypothyroidism?

A

Fam history of thyroid/autoimmune disorders

Childhood issues like lack of height gain, pubertal delay, poor school performance

40
Q

What percentage of children aged 2-15 are overweight/obese?

A

31%

41
Q

What centile is considered overweight?

A

BMI >85th centile

42
Q

What centile is considered obese?

A

BMI >97.5th centile

43
Q

What is important to keep in mind when looking at an obese child?

A

Obese + short = abnormal

44
Q

Name a few complications of obesity

A 
Metabolic syndrome
Fatty liver disease
Gallstones 
Thromboembolic disease
Pancreatitis
GRD
Stress incontinence
Orthopaedic problems
Left ventricular hypertrophy
RSHF
etc
45
Q

Name 5 causes of obesity

A 
SIMPLE OBESITY (99%)
Drugs
Syndromes
Endocrine disorders
Hypothalamic damage
46
Q

Name 4 drugs that can cause obesity

A

Insulin
Steroids
Anti-thyroid drugs
Sodium valproate

47
Q

Name 4 syndromes that can cause obesity

A 
Prader Willi syndrome
Laurence-Moon-Biedl syndrome
Pseudohypoparathyroidism type 1
Down's syndrome
(there will be obvious pointers towards syndrome anyway)
48
Q

Name some treatments for obesity

A

Diet
Exercise
Psychological input
Drugs (??)

49
Q

What is the most common form of diabetes in children?

A

Type 1

50
Q

Why is it important to diagnose children with diabetes early?

A

To prevent DKA (diabetic ketoacidosis) occurring

51
Q

What are the THINK symptoms of diabetes (4 Ts)?

A

Thirsty
Thinner
Tired
Using the toilet more

52
Q

What is the immediate test for diabetes?

A

Finger prick capillary glucose test (result >11mol)

53
Q

What is a ‘red flag’ symptoms of diabetes?

A

A return to bedwetting or day-wetting in a previously dry child

54
Q

What are some other symptoms of diabetes in children under 5?

A
  • heavier than usual nappies
  • blurred vision
  • candidiasis (oral, vulval)
  • constipation
  • recurring skin infections
  • irritability, behaviour change
55
Q

What are some symptoms of DKA?

A 
Nausea + vomiting
Abdominal pain 
Sweet smelling, 'ketotic' breath
Drowsiness
Rapid, deep 'sighing' respiration 
Coma
56
Q

What do you NOT request to diagnose DKA?

A

Returned urine specimen
Fasting blood glucose
Oral glucose tolerance test
DO NOT WAIT for lab results

*Diabetes & Endocrinology (24 decks)

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