Growth and Development And Endocrine Problems in Childhood

Question 1

What would be measured when assessing normal growth in children?

Answer 1

Height
Length
Sitting Height
Head circumference

Question 2

What staging Is used for the staging of puberty?

Answer 2

Tanner

Question 3

What is involved in the Tanner staging of puberty?

Answer 3

B 1 - 5 = breast development
G 1-5 = genital development
PH 1-5 = pubic hair 
AH 1-3 = axillary hair
T 2ml - 20ml

Question 4

What is used to assess testicular maturation?

Answer 4

Prader Orchidometer

Question 5

Factors influencing height

Answer 5

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

Question 6

What in the tanner staging shows the earliest objective signs of puberty?

Answer 6

Breast budding - tanner stage 2 in a girl

Testicular enlargement - tanner stage T 3-4ml in a boy

Question 7

Indications for referral for a growth disorder

Answer 7

Extreme tall or short stature (off centiles)
Height below target height
Abnormal height velocity (crossing centiles)
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty

Question 8

Pathological causes of short stature

Answer 8

Undernutrition 
Chronic illness (JCA, IBD, coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal (GHD, hypothyrodisim)
Syndromes e.g. PW, Turners, noonans

Question 9

Whats classified as early puberty in boys and how common is this?

Answer 9

< 9 years old

Rare

Question 10

Whats classified as delayed puberty in boys and how common is this?

Answer 10

> 14 y/o

Common, especially CDGP

Question 11

Whats classified as early puberty in girls?

Answer 11

< 8 years

Question 12

Whats classified as delayed puberty in girls and how common is this?

Answer 12

> 13 years (rare)

Question 13

Who is constitutional delay of growth and puberty (CDGP) seen in mainly and what is common with it?

Answer 13

Boys mainly
FH in dads or brothers (difficult to obtain)
Bone age delay

Question 14

Causes of delayed puberty

Answer 14

CDGP
Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
Chronic disease (chrons, asthma)
Impaired HPG axis (e.g. kallmans syndrome)
Peripheral (e.g. cryptorchidism, testicular irridation)

Question 15

Treatment of central precocious puberty

Answer 15

GnRH agonist

Question 16

Presentation of precocious pseudopuberty

Answer 16

Secondary sexual characteristics

Question 17

When should treatment be started with congenital hypothyroidism?

Answer 17

Within first 2 weeks

Question 18

What is the most common cause of acquired hypothyroidism ?

Answer 18

Autoimmune (Hashimoto’s) thyroiditis

Question 19

Childhood issues who have acquired hypothyroidism

Answer 19

Lack of height gain
Pubertal delay (or precocity)
Poor school performance (but work steadily)

Question 20

What BMI centile is classed as overweight?

Answer 20

BMI >85th centile

Question 21

What BMI centile is classified as obese?

Answer 21

BMI > 97.5th centile

Question 22

Complications of obesity in children

Answer 22

Metabolic syndrome
Fatty liver disease (non alcoholic steatohepatitis)
Gallstones
Reproductive dysfunction (e.g. PCOS)
Nutritional deficiencies 
Thromboembolic disease
Pancreatitis
Central hypoventilation Obstructive sleep apnoea
Gastroesophageal reflux disease
Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
Stress incontinence
Injuries
Psychological 
Left ventricular hypertrophy 
Atherosclerotic cardiovascular disease
Right sided heart failure

Question 23

Drugs that cause obesity

Answer 23

Insulin
Steriods
Antithyroid drugs
Sodium valproate

Question 24

Syndromes that cause obesity

Answer 24

Prader willi syndrome
Pseudohypoparathyroidsm type 1
Downs syndrome

Question 25

Endocrine disorders that cause obesity

Answer 25

``` Hypothyroidism GH definciency Hypothalamic lesion (tumour/trauma/infection) Androgen excess Insulinoma Insulin resistance syndromes Leptin deficiency ```

Question 26

The 4 Ts of symptoms of diabetes in children

Answer 26

Thirsty Thinner Tired using the Toilet more

Question 27

If you suspect diabetes mellitus in a child, what test would you do?

Answer 27

Finger prick capillary glucose test

Question 28

What would indicate DM in a child after a finger prick capillary glucose test?

Answer 28

>11 mmol/l

Question 29

What is a RED FLAG symptom for diabetes in children?

Answer 29

Return to bedwetting or day wetting in a previously dry child

Question 30

Symptoms of diabetes in children < 5 y/o

Answer 30

``` Heavier than usual nappies Blurred vision Candidiasis (oral, vulval) Constipation Recurring skin infections Irritability, behaviour change ```

Question 31

Symptoms of diabetic ketoacidosis

Answer 31

``` Nausea and vomiting Abdominal pain Sweet smelling, "ketotic breath" Drowsiness Rapid, deep "sighing" respiration Coma ```