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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
Vitamin K - functions - sources - deficiency signs
Oxidative phosphorylation clotting factors Sources: - bacteria - liver - spinach Hemorrhage
26
Adolescence
Between childhood and adulthood Starts 11-12 yo and ends 18-21 yo puberty concrete --> abstract thinking independent identity
27
3 stages of adolescence
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
Vaginal discharge types - pathologic
Bacterial vaginosis Trichomonas Candida Chlamydia/Gonorrhea
29
Bacterial vaginosis - type of discharge - wet prep - STD?
``` Profuse Malodorous (fishy) ``` + clue cells + WBC + lactobacilli + fish odor w/ KOH NOT STD
30
Trichomonas - type of discharge - wet prep - STD?
Gray-green Frothy Foul smelling + Trichomonads + WBC YES STD
31
Candida - type of discharge - wet prep - STD?
Normal, cottagecheese like + Branching hyphae and spores NOT STD
32
Chlamydia/Gonorrhea - type of discharge - wet prep - STD?
Purulent d/c + WBC YES STD
33
A decrease in wt before height is indicative of systemic illness
Systemic illness
34
Length starts decreasing Wt remains stable
Endocrine disorder Bone age is delayed
35
Russel silver syndrome
Triangular facies Antimongoloid slant Hemihypertrophy FTT Renal abnormalities
36
Bardet-biedl syndrome
Obesity Retinitis pigmentosa Polydactyly Mental retardardation Renal failure
37
Albrights osteodystrophy
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
Bone pains suggesting metastatic disease
Unilateral pain Systemic symptoms - fever - wt loss
39
Bone pains suggesting osteoid osteomas
Limb pain worse at night Responds to NSAIDs Most common in 2nd decade of life Pain is unilateral
40
Bone pains suggesting growing pains
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
When start to introduce pureed foods
6 mo
42
When start to introduce cow's milk
1 year - will increase risk of iron def anemia if introduce earlier!
43
Premature adrenarche
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
Premature pubarche
Pubic growth before age of 8 More alarming Assoc w/ CNS disorder in 50% cases
45
What causes premature breast development, uterine changes
Ovaries secrete estrogen and progesterone Premature thelarche has no clinical significance
46
Precocious puberty classifcations
Gonadotropin-DEPENDENT (central precocious puberty) Gonadotropin-independent (pseudo-precocious puberty) Incomplete precocious puberty
47
Gonadotropin-DEPENDENT precocious puberty
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
Gonadotropin-independent precocious puberty
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
Incomplete precocious puberty
Etiology unknown, variant of nl puberty Causes: - isolated premature thelarche - isolated premature adrenarche 1st test: - NONE needed
50
Gynecomastia
unilateral or bilateral firm subareolar nodules Can be tender to touch Thought to be 2/2 temporary reduction in testosterone : estradiol radio
51
Pubertal gynecomastia management
None - usually resolves within a few mo - 2 years If suspect Kleinfelters (b/c testes small ie < 3 mL) --> karyotype
52
Nl testicular volume in prepubertal boys
< 3 mL

Pediatrics (17 decks)

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