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PAEDIATRICS > Growth / Development / Gait + WRAP UP > Flashcards

Growth / Development / Gait + WRAP UP Flashcards

1
Q

What is the earliest sign of puberty in girls?

A

Breast budding

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2
Q

What is the earliest sign of puberty in boys?

A

Testicular enlargement

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3
Q

When does puberty usually occur in girls?

A

8-13 (growth spurt at 12.5)

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4
Q

When does puberty usually occur in boys?

A

9-14 (growth spurt at 14.5)

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5
Q

What is ‘true’ puberty in girls and boys?

A 
GIRLS = THELARCHE (breast development)
BOYS = increased testicular enlargement
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6
Q

What hormones are important in pubertal development?

A

Androgens / DHEA (converted to testosterone or estrogen in peripheral tissues) = sexual hair development, apocrine secretion (BO), skin oiliness

  • LH, FSH
  • Estrogen, progesterone
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7
Q

What questions are important to ask when assessing delayed puberty?

A
  • FHx of puberty
  • Onset and progression of pubertal characteristics (hair, breast development, genital enlargement, acne)
  • Look for chronic disease
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8
Q

What is true precocious puberty?

A
  • Pubertal development <8 in girls <9.5 in boys
  • CENTRAL activation with raised gonadotrophins
  • Usually caused by brain tumour
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9
Q

What is premature adrenarche?

A

Signs of adrenarche in girls <8 boys <9

  • Sexual hair development, apocrine secretion (BO), skin oiliness
  • Idiopathic premature adrenal adrenergic secretion
  • PERIPHERAL activation
  • Usually caused by CAH
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10
Q

What is the definition of delayed puberty?

A

Absence of any pubertal development (secondary sexual characteristics) in girls and boys >14 years

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11
Q

What are the most common causes of delayed puberty?

A

With normal gonadotrophins?

  • Constitutional delay
  • Endocrine causes (hypopituitarism, hypothyroid, hypoprolactinaemia)
  • Chronic illness
  • Poor nutrition

With HIGH gonadotrophins? (this means end-organ dysfunction - high FSH and LH, low testosterone/estrogen)
- Gonadal dysgenesis (chromosomal (XXY, X), gonadal damage (radiation, mumps, torsion), autoimmune disease)

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12
Q

What investigations are required in delayed puberty?

A
  • FBC with CRP, ESR
  • LFTs
  • TFTs
  • FSH, LH, testosterone/estradiol
  • Prolactin
  • Coeliac screen
  • Bone age X-ray
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13
Q

What is the most common cause of precocious puberty?

A

Hypothalamic hamartoma

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14
Q

What investigations are required in precocious puberty?

A
  • Refer to paed endo
  • FSH, LH, testosterone / estradiol
  • Dynamic gonadotrophin secretion
  • Bone age
  • Pelvic ultrasound
  • Brain imaging
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15
Q

What is premature thelarche?

A

Isolated breast development

  • rule out exogenous causes e.g. creams
  • relatively common >2years
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16
Q

What is premature adrenarche? What are the common causes?

A
  • ANDROGENS from somewhere
  • May be normal
  • CAH
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17
Q

What are some determinants of child growth?

A

Genetic factors
Nutrition
Chronic illness

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18
Q

What is the definition of failure to thrive?

A

Failure to grow normally, drop off in weight centiles followed by drop off in height centiles

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19
Q

How is short stature defined? What are some causes of short stature?

A

Below 3rd centile for age and sex

  • Genetics/familial short stature
  • Constitutional delay
  • IUGR
  • Chronic illness
  • Iatrogenic (steroids, radiation)
  • Skeletal dysplasia
  • Chromosomal abnormality / syndrome
  • Endocrine (GH deficiency, hypothyroidism)
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20
Q

What is bone age? How is it determined?

A

Degree of bone (epiphysial) maturation

  • Xray of left hand/fingers/wrist and interpreted using an atlas
  • Child’s current height and bone age can be used to predict adult height
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21
Q

What does an ‘advanced’ bone age indicate? What does a ‘delayed’ bone age indicate?

A

ADVANCED: Prolonged elevation of sex steroids (CAH, precocious puberty)
DELAYED: Variation of normal hormonal development (constitutional delay), GH deficiency, hypothyroidism, malnutrition

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22
Q

What investigations are required in a child with short stature?

A 
Investigate if there is a chromosomal abnormality of height velocity is slow
- Plot height/weight/HC
FBC and ESR (chronic disease)
Urinalysis + MCS (infection, chronic kidney disease)
CMP
TFTs
Coeliac screen (tissue transglutaminase)
IGF-1 (screen for GH deficiency)
Bone age xray of hands/wrist/fingers
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23
Q

How do you calculate mid-parental height?

A

Add parent’s heights, divide by 2, add 7cm for boys, subtract 7cm for girls

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24
Q

What is the difference between familial short stature and constitutional short stature?

A

Familial: FHx short stature, normal height velocity, normal age of puberty, normal bone age, final height short but appropriate
Constitutional: boys more common, FHx pubertal delay, normal height velocity, puberty delayed, bone age delayed, normal final height

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25
Q

What are the different kinds of gait?

A

Antalgic (joint issue, bone issue #, inflam, cancer)
Ataxic (cerebellar, vestibular)
Weakness (duchenne, becker)
Abnormal muscle tone
Trendelenburg (Perthe’s, DDH, slipped capital femoral epiphysis)
High-step (foot drop)
Toe-walking (cerebral palsy, idiopathic)

26
Q

What is Gower’s sign and what disease is it indicative of?

A

Using hands to ‘walk’ up their body from a squatted position due to proximal muscle weakness
- Duchenne’s muscular dystrophy

27
Q

What are you expecting if the kid is short and relatively overweight?

A

Endocrinopathy - GH, pituitary, thyroid, cushings
Dysmorphic - short limbs - achondroplasia
- Downs

28
Q

What are you expecting if the kid is short and very underweight?

A

Not dysmorphic
- Intrauterine deficiency (IUGR, FASD)
- Chronic illness - renal/heart/lungs/IBD
- Nutritional deficiency - malabsorption, environmental
Dysmorphic
- Noonan, Turner

29
Q

What are the clinical features of Turner’s syndrome?

A

Wide spaced nipples, low hairline, webbed neck, low birth weight, difficult to feed in infancy, middle ear disease, poor concentration, coarctation

30
Q

How do you tell the difference between GH deficiency and constitutional delay on growth chart?

A

Constitutional delay have normal growth rate
GH deficiency have slow growth rate that drops off, children often appear younger than their stated age and frequently appear chubby (weight age > height age), delayed bone age

31
Q

What investigations are required if you suspect GH deficiency?

A

IGF-1
GH stimulation testing
Bone age

32
Q

What are the most common causes of limp in very young children?

A

Transient synovitis, DDH

All ages: Infections (osteomyelitis, septic arthritis), osteosarcoma, discitis, trauma, non-accidental injury

33
Q

What are the most common causes of limp in children aged 4-10yrs?

A

Transient synovitis, Perthes, Ewing’s sarcoma

All ages: Infections (osteomyelitis, septic arthritis), osteosarcoma, discitis, trauma, non-accidental injury

34
Q

What are the most common causes of limp in adolescent children?

A

Slipped capital femoral epiphysis, JIA, osteosarcoma

All ages: Infections (osteomyelitis, septic arthritis), discitis, trauma, non-accidental injury

35
Q

What are the most common causes of limp in children of all ages?

A

Infections (osteomyelitis, septic arthritis), osteosarcoma, discitis, trauma, non-accidental injury

36
Q

Compare and contrast osteosarcoma and Ewing’s sarcoma

A

Osteosarcoma: “arises from mesenchymal cells, occur at sites of bone growth”, metaphysis prior to epiphyseal closure,

  • Usually distal femur, proximal tibia
  • Older children, most common, males>females
  • ‘Sunburst’ appearance on x-ray (spicules of new bone)
  • Associated with retinoblastoma, Paget’s disease of the bone and radiotherapy

Ewings: “blue cell tumour”, diaphysis

  • Usually mid-proximal femur, also pelvis
  • Younger children, less common
  • Destructive lesion on x-ray
37
Q

Describe Ortolani and Barlow’s manouvres

A

Barlow: identifies unstable hip that can be passively dislocated
- Abduct and flex hip to 90, push leg posterior to push femoral head out of socket
- Palpable
Ortolani: determines whether hip is actually dislocated
- Flex hip to 90, relocate hip by abducting hip and pushing anteriorly
- Positive if hear audible clunk of reduction
**Confirm with ultrasound

38
Q

What is the difference between a hip that is reducible vs. irreducible?

A

Reducible: O and B positive
Irreducible: already dislocated and cannot relocate
- Needs closed reduction

39
Q

What are the management options for DDH?

A

Dislocated but reducible = Pavlik Harness

Dislocated non-reducible = Sx Closed reduction

40
Q

How will DDH present in a child >12months?

A

Trendelenburg gait
Uneven knee height
Uneven creases

41
Q

What is Legg-Calves-Perthes disease? How does it present? How is it diagnosed?

A

Idiopathic vascular impairment of the femoral head –> avascular necrosis
Common symptoms: Persistant hip pain, knee, thigh or groin pain (radiation), limp or wasting, limited ROM, leg shortening
Dx: x-ray

42
Q

What is slipped capital femoral epiphysis? How does it present?

A

A separation of the femoral head from the neck/shaft due to a weakness in the proximal femoral growth plate
Clinical features: Groin or knee pain (referred pain), unable to weight bear, trendelenburgʼs gait with external
rotation of affected foot

43
Q

What are the risk factors for DDH?

A 
First born
Female (80%)
Family history
Feet first (breech)
- need to confirm with U/S for first FOUR months
44
Q

What are some causes of developmental delay?

A 
Prenatal 
○ Chromosomal e.g. fragile X, trisomy 
○ Metabolic e.g. PKU
○ Drugs / alcohol
Perinatal
○ Asphyxia - hypoxic ischaemic encephalopathy 
Postnatal 
○ Head injury
○ Encephalitis
○ Poison e.g. Pb overdose
45
Q

What investigations are required for developmental delay?

A 
HEARING AND VISION!!!
Full developmental assessment (Bailey's, Griffiths, 
IQ testing
Bloods – genetic/TFT/Pb/nutrition
ENT / sleep study
Ophthalmology
Neurology?/Imaging? 
 ? Regression
46
Q

What conditions are associated with developmental delay?

A 
Epilepsy
GORD
Vision/Hearing
Poor sleep
Dentition
Thyroid Disease
Aspiration
Osteoporosis /deformities
47
Q

What are the 3 primary features of autism spectrum disorder?

A
  1. Language regression
  2. Social aspects - no protodeclarative pointing, no social/emotional reciprocity, non-verbal communication
    establishing, maintaining relationships
  3. Obsessive behaviours/unusual interests (tics, lining up, echolalia, insistence on sameness, narrow intense interests, sensory issues)

+/- hand flapping (self-stimulating behaviours)

48
Q

What are some early signs of autism?

A

Not responding to their name
Language regression
Poor social skills
Lack of proto-declarative pointing

49
Q

What are the treatment options for autism?

A 
Needs early intervention
Social supports
Speech pathology
OT
Counselling/behaviour modification
50
Q

What are the three primary features of ADHD?

A
  1. Attention deficit
  2. Hyperactivity
  3. Impulsivity
51
Q

How is ADHD assessed / diagnosed?

A
  • Needs to occur at both school and home
  • School reports / counsellor assessment
  • Needs IQ assessment
  • Learning assessment
52
Q

What are the treatment options for ADHD?

A

Routines! ++
Classroom support
Behavioural management (OT/psych)
Medication

53
Q

What are some causes of enuresis?

A

Remember can be primary and secondary

  • Idiopathic
  • Poor arousal (heavy sleeper)
  • Nocturnal polyuria (decreased ADH)
  • Overactive bladder
  • Diabetes, diabetes insipidus
  • UTI
  • Constipation
  • Epilepsy
  • Social stressors, abuse
  • Poor fluid intake
54
Q

What examination and investigations would you do for enuresis?

A 
Examination: lumbosacral spine, LL, constipation
Urinalysis &amp; MCS
BSL
Renal tract ultrasound
ADH levels
55
Q

What are the treatment options for enuresis?

A

NO TRT - may grow out
Non-pharmacological
- Pad and bell (enuresis alarm)
- Bladder training and water restriction during evening, empty bladder before bed
Pharmacological
- ADH (desmopressin) **not curative, make sure to take very little fluid before and after, good for overnight trips

56
Q

What are some causes of chronic constipation?

A 
Hypothyroidism, hypocalcaemia 
Low fibre diet, dehydration
Coeliac disease
Hirschsprung's disease
FUNCTIONAL: Painful pooping --> fearful pooping --> with-holding --> more build up -->
57
Q

What questions are important to ask during the history of chronic constipation?

A 
Passage of meconium
Recent onset?
Diet 
Stress - school, recent illness
Urinary incontinence
58
Q

What examination and investigations would you do for chronic constipation?

A

Abdo exam with anorectal tone, inspect perianal area / lumbosacral region
Pelvic ultrasound - rectal diameter
TFT, CMP, Coeliac screen
Spinal imaging
Bacrium enema/rectal biopsy for Hirschsprung’s

59
Q

What are the treatment options for chronic constipation?

A

Stool softeners!! Movicol (osmolax ++), lactulose
Bowel stimulants
Toilet training (encourage enterocolic reflex, good posture)
Disempaction

60
Q

How do you break down the causes of failure to thrive?

A

Decreased intake
Poor absorption
Increased requirements (chronic disease)
Psychosocial factors

61
Q

What are some red flags for speech development?

A

Red flags for speech development include:
• loss of developmental skills at any age
• no vocalising by 3 months
• no babbling by 10 months, and
• not responding to name by 12 months.

62
Q

What is Kallman’s syndrome?

A

Hypogonadotrophic hypogonadism
Genetic disorder
Hypothalamus does not release GnRH
S&S: delayed puberty, anosmia (impaired growth of olfactory bulb)

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