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Paediatrics SC1 > Growth and Puberty > Flashcards

Growth and Puberty Flashcards

1
Q

What is the birth weight and height influenced by?

A

Intrauterine conditions

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2
Q

Babies small for gestational age (SGA) are below which centile. A concerned mom asks you how it will affect their growth in the future. Will it remain on the same centile line?

A

<10th centile
That is okay as there is usually catchup growth where it is normal for them to go up a centile

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3
Q

A concerned mom asks you how breastfeeding will affect their growth in the future. Will it remain on the same centile line?

A

Breastfed babies initially may drop a centile compared to formula-fed infants = catch down growth. This is only for the first 3 months of life!!

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4
Q

What is the normal growth/year between the ages 0-2.5 years. What is this growth mostly influenced by?

A

0-2.5 years: 25cm/year influenced mostly by nutrition

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5
Q

between the ages 2.5 -3 years. What is this growth mostly influenced by?

A

Nutrition + growth hormone

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6
Q

When is target height measured? How is it calculated?
What age do you measure the target height?

A

Target height is measured between 2.5-3 years
it is the Mid-parental height +/- 10cm
Mid-parental height is calculated by adding the parents heights +12.5 if boy and -12.5 if girl, all divided by 2.

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7
Q

What is the normal growth/year between the ages 2.5 years until puberty . What is this growth mostly influenced by?

A

4-8cm/year
Growth hormone

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8
Q

What is growth during and after puberty mostly influenced by?

A

Sex steroids and growth hormone

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9
Q

When is it best to measure height?

A

In the morning

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10
Q

Height is composed of spine + legs
What is the normal ratio at birth. When does it stabilize by? What is the ratio then?

A

At birth: 1.7:1
10yo: 1:1

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11
Q

You come to measure a patient’s height and notice that their leg length is shorter than their spine length. What do you suspect?

A

SHOX gene deficiency
Achondroplasia/hypochondroplasia

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12
Q

How would you calculate the approximate length of the femur? What is it called?

A

Subischeal length = standing height - sitting height

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13
Q

You suspect someone has scoliosis, how would you quickly confirm your suspicion?

A

Short sitting height indicates scoliosis.

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14
Q

How does puberty start?

A

Hypothalamic pituitary axis: Hypothalamus produces GnRH hormone (gonadotropin releasing hormone) stimulates the release of gonadotropins (LH and FSH) from anterior pituitary which act on the gonads (ovary and testes) to produce sex steroids (estrogen and testosterone) (Gonadarche)

Average age of onset = 11
Premature in girls if <8 and in boys if <9

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15
Q

What is the average age of onset of puberty
What is considered premature onset of puberty in each gender.

A

Average age of onset = 11
Premature in girls if <8 and in boys if <9

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16
Q

What is meant by true puberty?

A

True puberty = Gonadarche = production of sex hormones in the presence of primary sexual characteristics such as breast budding and testicular volume increase

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17
Q

What is used to measure the stages of puberty?
What is Gonadarche? What does that mean for each gender?
What Tanner stage indicates that puberty has begun?

A

Tanner Staging
Gonadarche is the activation of the gonads in producing sex steroids and this is referred to as true puberty. In girls that will show as Breast Budding and in boys it is testicular volume 4ml or more. Both of these represent Tanner stage 2 => start of puberty

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18
Q

How do you measure testicular growth?

A

Orchidometer

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19
Q

What is Pubarche or Adrenarche

A

Adrenarche is the fake puberty which is the production of androgens by the adrenal glands giving rise to secondary sexual characteristics such as pubic hair, body odour, acne, and greasy hair

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20
Q

During what stage is the peak height velocity. Does it occur earlier in boys or girls?

A

During puberty. And like everything related to this, girls have it first

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21
Q

What is the synacthen test used to detect?
How does it work? What is a normal vs abnormal result?

A

Congenital adrenal hyperplasia
Synacthen test assesses the functioning of the adrenal glands. Synacthen is a synthetically made version of ACTH (adrenocorticotropic hormone) which should stimulate cortisol secretion.
In this test, cortisol levels are taken before and after (30 mins and 60 mins) administering synacthen. Normally, cortisol levels should rise significantly
in CAH: low baseline levels (cortisol insufficiency + excess androgens in CAH) and minimal increase in cortisol after administering synacthen.

22
Q

What is the average age of menarche in girls? is this a good marker for measuring puberty?
What is the expected height growth following menarche?

A

Average age of menarche = 12.5 yrs. It is a good marker for puberty but is a late marker. This is shown by the fact that girls usually only grow 4-8 cm after menarche (note this is the normal amount gained /year during childhood until puberty)

23
Q

A mother is concerned about breast tissue in her little boy. He is 13 years old. What do you tell her?

A

Gynecomastia is normal during puberty due to aromatization of testosterone into estrogen. It is normal during this period and is associated with being overweight. It is important to control their child’s obesity during this period due to the increased sensitivity of the breast tissue

24
Q

Boys have a very wide range of PHV (peak height velocity). This leads to confused parents asking why their boy is shorter than most of their peers. What does this lead to? What influences this?
What is important to exclude in cases of constitutional delay?

What should the testicular volume be during this peak velocity in boys?

A

This leads to constitutional delay in boys or “late bloomers”. It usually follows the same pattern as that of their dads and uncles. The vast majority will eventually end up at normal height so reassure the parents. It is associated with
In these cases, the short stature may mask malnutrition, malabsorption, hypothyroidism, renal failure, hypogonadism, or growth hormone deficiency.
During Peak height velocity, the testicular volume should be between 10-12mls (or Tanner stage 3)

25
What is the relation between onset of puberty and magnitude of growth spurt
the magnitude of growth spurt is inversely related to the age of the peak height velocity in both sexes. => early onset of puberty will grow for longer but does not mean they will be taller
26
What is considered the completion of puberty? What is it influenced by?
Fusion of the epiphysial plates or growth plates It is influenced by both sex steroids but mostly estrogen
27
What is the first sign of puberty in a girl (not referring to breast budding, im referring to something that ends with arche)
Telarche
28
What is Precocious puberty? This often has severe psychological impacts on the child. In these cases what is very important to rule out? How would you do that? Assume it was ruled out. To avoid the psychological impact, how would you treat the patient presenting with early breast budding?
It is the onset of Gonadarche <8 in girls and <9 in boys and NOT the same as premature adrenarche. => the presence of breast budding or testicular volume 4 or more and not secondary sex characteristics It is important to rule out a brain tumor via MRI. All boys with gonadarche <9 will have an MRI scan. for girls it is clinical experience or if very early tx = GnRH analogue to delay puberty
29
What is defined as premature adrenarche? It is more common in girls or boys? What are the RFs for premature adrenarche?
Puberty of the adrenal gland => presence of pubic/axillary hair <8 in girls and <9 in boys More common in girls RFs: Premature birth, low birth weight, central adiposity (hypothyroidism), and family history of PCOS (polycystic ovary syndrome)
30
An 8 year old boy presents to you with a chest infection. On examination, you notice the presence of axillary hair. What are you suspecting (2)? What investigations would you carry out?
Congenital adrenal hyperplasia Brain tumor Investigations DHEA for serum androgen concentration Bone age where normal shows delay and advancement indicates precocious puberty, CAH, adrenal tumour. Synacthen Test for congenital adrenal hyperplasia (low cortisol before and after administering synacthen)
31
What is the normal weight increase in g/week for ages 0-3 months 3-6 months 6-9 months
0-3 months: 240g/week 3-6 months: 120 g/week 6-9 months: 75 g/week
32
Define Faltering growth (with specifics)
Weight below 2nd centile Fall across 1 or more weight centiles if birth weight was below 9th centile Fall across 2 or more weight centiles if birth weight between 9th and 91st centiles Fall across 3 or more weight centiles if birth weight above 91st centile
33
History of faltering growth. quick
Intake of milk/food Abnormal losses: diarrhoea, vomiting, polydipsia Chronic conditions: CHD, Hypothyroidism Developmental progress Social environment
34
You look at a centile chart and are concerned for faltering growth. What would you be looking for on examination.
sx of respiratory distress Malnutrition: Subcutaneous fat at thigh/axilla Hepatomegaly Heart murmur (CHD)
35
Give 5 differentials for faltering growth
Genetic: T21, Turners GI: IBD, Celiac, GORD Endocrine: Hypothyroidism, GH deficiency, Rickets CHD Cystic Fibrosis Cerebral palsy Non-organic: Socioeconomics (malnutrition, parental education, parental mental health
36
You suspect a patient with malnutrition. How would you assess their nutritional status? How do you know if this weight loss is acute or chronic?
Subcutaneous fat on thigh and axilla Loose skin folds would indicate recent weight loss
37
What are red flags with regards to faltering growth?
Main 3: 1- Not regaining weight by 3 weeks of age (2 if bottle fed) 2- Not gaining weight on 2 separate occasions 3- Tachypnea or Dyspnea during feeds Infant <6 wet nappies over 24 hours 4- Recurrent infection recurrent vomiting irregular feeding patterns
38
Only 5% of faltering growth is due to a medical reason. What is your treatment plan? What if it hasnt worked?
Deal with underlying cause if present + Public health nurse and community dietitian for optimal feeding practices, increase energy intake etc.. If not, then Enteral feeding Social work team Occupational therapy Clinical psychology
39
Central adiposity is a sign of
Hypothyroidism
40
Define Growth Failure
It is slow growth velocity as in trend is more important than the actual height
41
What are pathological causes of growth failure/short stature?
Malabsorption: IBD, Celiac GH deficiency (Turner) Hypothyroidism Excess steroids (affects growth plate) Chromosomal: T21, Turner, Noonan, Prader Willi Skeletal dysplasia (SHOX gene, Achondroplasia, Hypochondroplasia) Scoliosis psychosocial deprivation
42
Turner's or 45X: Give up to 10 features Give Treatment:
Lymphoedema (puffy hands and feet) Neck webbing CHD (Coarctation, bicuspid aortic valve, and dilation of ascending aorta) Nail dysplasia infertility IUGR and short stature Low set hair line Same as with T21: Low set ears, otitis media, hearing loss, autoimmune hypothyroidism, celiac disease Tx: Growth hormone therapy
43
How do you treat hypothyroidism?
Levothyroxine, Eltroxin
44
Give the features of Russel Silver Syndrome
IUGR - Normal OFC bur reduced weight and height Post-natal growth failure Severe feeding problems (latching) Cafe au lait spots Cinodactyly (also in Downs) Genital abnormalities Asymmetry in length and muscle bulk Triangular facies
45
what types of skeletal dysplasia may cause short stature?
SHOX gene, Achondroplasia, Hypochondroplasia
46
A patient with achondroplasia on X-ray attends your OPD. Her mother wants Growth hormone therapy as she read about it on the internet for her daughter's condition. What will you do?
Growth hormone worsens the condition. There is no specific treatment for achondroplasia.
47
A patient with a known chromosomal disorder attends your clinic. They are wearing glasses and you notice their eyes are wider apart than normal. What condition is this and what are other features of this?
Noonan's: Visual impairment and hypertelorism Posteriorly rotated ears CHD (pulmonary stenosis)
48
How does bone age work? Where is it used in terms of short stature?
An Xray is taken of the patients left hand and wrist as they contain multiple growth plates. It is then compared to an atlas with a standard for each age. If Xray taken shows a younger bone age than the age of the child, it is consistent with constitutional delay. This can result in short stature but of no concern as the child will likely catch up and is just a late bloomer. May also indicate GH deficiency
49
What can delayed bone age indicate? What can advanced bone age indicate?
Delayed: Chronic illness, GH deficiency, constitutional delay Advanced: Precocious puberty (red flag), congenital adrenal hyperplasia
50
What investigations would you conduct to exclude chronic conditions that may cause short stature pathologically
FBC (anemia) U and E (electrolyte imbalances may indicate chronic renal disease) !Karyotype! Bone age (constitutional delay and GH deficiency) IGF-1 serology (marker for GH) CRP/ESR (autoimmunity causes including IBD, lupus etc..) Celiac screen TFTs
51
When do we test for GH deficiency via IGF-1 serology? How is it decided to give GH therapy to these patients? Who do we give GH therapy to without needing to conduct a test for IGF-1?
1) Height <2nd centile Poor height velocity Parental concern 2) It is an expensive drug. Team decision needed 3) SGA (<10th centile) without catching up by 4 years old Hypopituitarism Turner or Prader Willi Chronic renal failure
52
Only 5% of faltering growth is due to a medical reason. What is the first thing on your mind when a boy with short stature enters the clinic? Girl?
Boy: constitutional delay => Bone age Girl: Turner's => Karyotype

Paediatrics SC1 (19 decks)

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