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Pediatrics > Growth + Development + Nutrition + Adolescence > Flashcards

Growth + Development + Nutrition + Adolescence Flashcards

1
Q

Short stature

A

Ht below 3rd percentile

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2
Q

Patters of short stature (proportional)

A

Pathologic (postnatal onset) - nl initial ht –> low ht

Constitutional growth delay

Familial short stature - family hx of short ht, parallels the growth curve for family

Prenatal onset short stature (IUGR) - parallels growth curve

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3
Q

Constitutional short stature

A

Slow growth but at a normal rate

Nl ht –> low ht –> normal adult ht reached

Growth spurt and puberty delayed

Bone age and ht age are both behind chronological age

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4
Q

How do you dx bone age

What is height age

A

Xray of L hand and wrist

Ht age = age corresponding to 50th percentile for child’s height

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5
Q

Endocrine causes tall stature

A

Growth Hormone excess
Androgen excess
Hyperthyroidism

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6
Q

Genetic syndromes calling tall stature

A

Homocystinuria (marfanoid apperance)

Cerebral gigantism (Sotos syndrome)

Beckwith-Wiedemann

Kleinfelter syndromes

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7
Q

Chronological age (CA) > Bone age (BA)

Short stature

A

+ normal growth velocity –> constitutional delay

+ abnormal growth velocity –> chronic systemic dz, endocrine DO

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8
Q

CA = BA

Short stature

A

+ normal growth veloicty –> genetic short stature

+ abnl growth velocity –> genetic, chromosomal syndrome

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9
Q

CA < BA

A

+ nl growth velocity –> obesity

+ abnl growth velocity –> precocious puberty, congenital adrenal hyperplasia, hyperthryodism

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10
Q

Birth wt

  • doubled by…
  • tripled by…
A

2x –> 4-5 mo

3x –> 1 yr

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11
Q

Tx FTT

A

Hospitalization to document caloric intake and wt gain sometimes

Sweat Cl test

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12
Q

Dx obesity

A

BMI > 95% for age/sex

> 30 BMI in adolescents

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13
Q

Enuresis

A

Bladder control usually by age 5

Involuntary urination in child who is toilettrained

Tx

  • imipramine
  • desmopressin
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14
Q

Encopresis

A

Fecal incontinence after age 4 years

More common in boys

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15
Q

Autism develops before

A

30 mo age

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16
Q

Kwashiorkor

A

Protein deficiency
Inadequate caloric intake

Present after weaning from breast
Edema

Decreased serum albumin

Tx - slow feeding of filute milk

  • supplement vitamins
  • protein supp slowly
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17
Q

Vit A

  • functions
  • sources
  • deficiency signs
A

Retinal pigments
Bone + teeth dev
Epithelial maturation

Source:

  • green and yellow veggies
  • fruits

Deficiency:

  • ocular lesions
  • dry skin
  • anemia
  • increased ICP
  • MR
  • growth retardation
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18
Q

Vit B1

  • functions
  • sources
  • deficiency signs
A

Coenzyme in carb metabolism
Generate NADP

Source:
- milk, veggies, cereals, fruits, eggs

Beriberi (CNS)
Peripheral neuritis
CHF
ataxia
paralysis of laryngeal N
cyanosis
dyspnea
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19
Q

Riboflavin

  • functions
  • sources
  • deficiency signs
A

FAD - electron transport
Energy production

Source:
- liver, kidney, milk, cheese, eggs, leafy greens, cow milk

Glossitis
Keratitis
Conjunctivitis
Photophobia
Seborrhea

Normocytic normochromic anemia

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20
Q

Niacin

  • functions
  • sources
  • deficiency signs
A

NAD, NADP cofactors –> glycolysis

Source:
- liver, lean pork, salmon, poultry, read meat

Pellagra
- dermatitis
- diarrhea
- dementia
Depression
Encephalopathy, delusions, disorientation, dementia
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21
Q

Vit B6 (Pyridoxine)

  • functions
  • sources
  • deficiency signs
A

Coenzyme for decarboxylation + transamination of AA
NS function needed

Source:
- milk, cereals

Convulsions
Peripheral neuritis
Dermatitis
Anemia

22
Q

Vit C

  • functions
  • sources
  • deficiency signs
A

Reducing agent
Collagen formation

Source:
- fruits, veggies

Scurvy
- bleeding
- loose teeth
- gum swelling
- easy fx
Costochondral rosary
23
Q

Vitamin D

- deficiency signs

A

Rickets - osteomalacia

Tetany

24
Q

Vitamin E

  • functions
  • sources
  • deficiency signs
A

Nucleic acid metabolism

Green, leafy veggies, nuts, legumes

Creatinuria
Focal necrosis of striated muscle
Weakness

25
Q

Vitamin K

  • functions
  • sources
  • deficiency signs
A

Oxidative phosphorylation
clotting factors

Sources:

  • bacteria
  • liver
  • spinach

Hemorrhage

26
Q

Adolescence

A

Between childhood and adulthood

Starts 11-12 yo and ends 18-21 yo

puberty
concrete –> abstract thinking
independent identity

27
Q

3 stages of adolescence

A

Early (10-14 yo)

  • physical changes related to puberty
  • rapid growth
  • body images, self esteem
  • concrete thinkers usually

Middle (15-16 yo)

  • independent
  • sense of identity
  • mood swings
  • abstract thinking develops

Late (17-20 yo)

  • less self centered, more caring
  • future goals, plans, career
  • idealistic
28
Q

Vaginal discharge types - pathologic

A

Bacterial vaginosis
Trichomonas
Candida
Chlamydia/Gonorrhea

29
Q

Bacterial vaginosis

  • type of discharge
  • wet prep
  • STD?
A 
Profuse
Malodorous (fishy)

+ clue cells
+ WBC
+ lactobacilli
+ fish odor w/ KOH

NOT STD

30
Q

Trichomonas

  • type of discharge
  • wet prep
  • STD?
A

Gray-green
Frothy
Foul smelling

+ Trichomonads
+ WBC

YES STD

31
Q

Candida

  • type of discharge
  • wet prep
  • STD?
A

Normal, cottagecheese like

+ Branching hyphae and spores

NOT STD

32
Q

Chlamydia/Gonorrhea

  • type of discharge
  • wet prep
  • STD?
A

Purulent d/c

+ WBC

YES STD

33
Q

A decrease in wt before height is indicative of systemic illness

A

Systemic illness

34
Q

Length starts decreasing

Wt remains stable

A

Endocrine disorder

Bone age is delayed

35
Q

Russel silver syndrome

A

Triangular facies

Antimongoloid slant

Hemihypertrophy

FTT

Renal abnormalities

36
Q

Bardet-biedl syndrome

A

Obesity

Retinitis pigmentosa

Polydactyly

Mental retardardation

Renal failure

37
Q

Albrights osteodystrophy

A

Lack of responsiveness to parathyroid hormone

Low serum Ca
High serum PO4
High serum PTH

Short stature
Obesity
MR
SubQ calcifications
Short 4th and 5th metacarpal/metatarsals
38
Q

Bone pains suggesting metastatic disease

A

Unilateral pain

Systemic symptoms

  • fever
  • wt loss
39
Q

Bone pains suggesting osteoid osteomas

A

Limb pain worse at night

Responds to NSAIDs

Most common in 2nd decade of life

Pain is unilateral

40
Q

Bone pains suggesting growing pains

A

Night pain mostly

Usually in lower extremities

Usually bilateral

No limitation of physical activity

Normal PE

Pain relieved by heat, massage, or OTC NSAIDs

Tx

  • education + reassure
  • massage, muscle-stretching exercises, analgesics
41
Q

When start to introduce pureed foods

A

6 mo

42
Q

When start to introduce cow’s milk

A

1 year

  • will increase risk of iron def anemia if introduce earlier!
43
Q

Premature adrenarche

A

Characterized by isolated appearance of axillary hair before age of 5 years

Change results from premature androgen secretion of the adrenal glands

Condition benign
NO clinical significance

44
Q

Premature pubarche

A

Pubic growth before age of 8

More alarming

Assoc w/ CNS disorder in 50% cases

45
Q

What causes premature breast development, uterine changes

A

Ovaries secrete estrogen and progesterone

Premature thelarche has no clinical significance

46
Q

Precocious puberty classifcations

A

Gonadotropin-DEPENDENT (central precocious puberty)

Gonadotropin-independent (pseudo-precocious puberty)

Incomplete precocious puberty

47
Q

Gonadotropin-DEPENDENT precocious puberty

A

Premature mautration of hypothalamic-pituitary-gonadal axis

Causes:

  • Idiopathic (most)
  • CNS tumors, lesions, irradiation
  • severe, untreated hypothyroidism

1st study to do
- MRI of brain!

48
Q

Gonadotropin-independent precocious puberty

A

Excessive sex hormones from endogenous or exogenous sources

Causes:

  • CAH
  • adrenal tumors
  • exogenous T or E

Girls:

  • ovarian cysts or tumors
  • mccune albright

Boys:

  • leydig cell tumor
  • HCG-secreting germ cell tumor

1st test:

  • girls = US of A/P
  • boys = testicular US
49
Q

Incomplete precocious puberty

A

Etiology unknown, variant of nl puberty

Causes:

  • isolated premature thelarche
  • isolated premature adrenarche

1st test:
- NONE needed

50
Q

Gynecomastia

A

unilateral or bilateral firm subareolar nodules

Can be tender to touch

Thought to be 2/2 temporary reduction in testosterone : estradiol radio

51
Q

Pubertal gynecomastia management

A

None - usually resolves within a few mo - 2 years

If suspect Kleinfelters (b/c testes small ie < 3 mL) –> karyotype

52
Q

Nl testicular volume in prepubertal boys

A

< 3 mL

Pediatrics (17 decks)

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