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ENRP Exam 2 > HYHO- Neman #1 > Flashcards

HYHO- Neman #1 Flashcards

1
Q

a single point on the growth chart only gives you information about how they plot on the curve on?

A

on THAT day

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2
Q

_ _ are essential to evaluare the growth pattern to determine if the rate of growth is adequate

A

multiple points

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3
Q

normal BMI

A

18.5-24.9

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4
Q

what is the normal growth velocity for school aged kids? - age 5-puberty

A

5cm/year or 2 inches/year

linear growth

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5
Q

what is the growth parameter most commonly first affected in children with endocrine growth disorders?

A

length or heigh

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6
Q

what is delayed bone age

A

this is a bone age that is 2 standard deviations or more below the chronological age of the patient

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7
Q

be concered when points on a growth chart begin to _ up or down from what had been a normal growth rate for that child

A

deviate

look for deviations up or down

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8
Q

what are the growth parameters on a growth chart

A

height (length if less than 24 months)
weight
BMI (if greater than 36 months)
head circumference (if less than 24 months)

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9
Q

if height/length changes first or most drastically on the growth chart think

A

endocrine- growth hormone def

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10
Q

if weight changes first or most drastically on the growth chart think

A

calories/nutrition

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11
Q

if the head circumference changes first or most drastically on the growth chart think

A

brain/skull/hydrocephalus

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12
Q

what is short stature

A

height greater than 2 standard deviations below the mean height (50th percentile) for age and sex

less than the 3rd percentile on the growth chart

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13
Q

what are the 3 benign causes of short statue

A

familial - parents are small

constiutional

idiopathis

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14
Q

in familial causes of short stature the kid grows at a normal velocity in all parameters but jsut plot lower for height; end height is consistent with mid-parental ht.

is bone age consistent with chronological age?

A

yes

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15
Q

what is the cause of constiutional short stature

A

the kid grows at a low normal rate and plot low on the growth curve

puberty is delayed “late bloomers”

end hight is normal and groth spurts occur later

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16
Q

the hallmark of constiutional delay is ?

A

delyaed bone age

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17
Q

what is idopathic short stature

A

short stature that is not caused by endocrine, metabolic, or other diagnosis, and there is no family hisotry of short stature

bone age is consistent with chronilogical age

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18
Q

what is important to workup in a kid with short stature?

A

IGF-1 (insulin like growth factor) and IGFBP-3 (igf binding protein 3)

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19
Q

igf-1 is?

A

this is a hormone that functions as the major mediator of growth hormone stimulated somatic growth

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20
Q

IGFBP-3 is?

A

the main IGF-1 transport protein in the blood stream

21
Q

_ increases IGF-1 synthesis by _ and _ suggetive that is contributes to statural growth

A

growth hormone

osteoblasts and chondrocytes

22
Q

in a patient with short stature there are decreased levels of?

A

IGF-1 and IGFBP-3 that are consistent with growth hormone defecinecy

23
Q

growth hormone secretion is _ while IGF-1 and IGFBP-3 levels are _

A

pulsatile

stable (meaning they can be drawn at any time of day)

24
Q

if the levels of IGF-1 and IGFBP-3 are decreases growth hormone stimulation must be tested and what are the three most reliable tests

A

adminsitration of glucagon
administration of arginine
insulin induced hypoglycemia

25
Q

precocoius puberty is defined as?

A

onset of secondary sexual characterisits in girls before 8 and in boys before 9

26
Q

the diagnosis of precoccious puberty should be entertained when

girls:

boys:

overall:

A

girls: if they have progressive breast development and crossing major percentile lines upward on the linear growth chart

boysL testicular and penile enlargment crossing major percentile lines upward on the linear growth chart

overall: if the rate of growth is fast initially but overall end-heigh is less than it would normally be

27
Q

workup for percoccious puberty

A
  1. H and P
  2. labortory tests
  3. imaging
28
Q

what labs should you get in precoccious puberty

A

LH, FHS, Estradiol and testosterone, 17-hydroxyprogesterone

29
Q

what imaging do we get for precoccious puberty

A

bone age (advanced)
MRI of the head (CNS tumor?)
ultrasound of the gonads

30
Q

what are the karyotypes of tuner syndrome

A

45X0- 60% of cases
45X/46XX and other mosaicisms - 15% of cases

25% of casses have 2 X chromosomes but the short arm of one X chromosome is missing

31
Q

most ppl with turner syndrome die in utero -98%

features of turner syndrome

A

short stature, wide shaped chest, wide spaced hypoplastic nipples, excessive skin at the back of the neck (webbed neck), gonadal dysgenesis , horsehose kidney , congenital heart disease

streak ovaries, primary amenorrhea, lack of pubertal development

32
Q

what is premature adrenarch

A

development of coarse dark pubic hair before 8 in girls and before 9 in boys

33
Q

premautre adrenarch may be associated with?

A

body odor, acne, increased oliness of hair and skin

34
Q

what causes premature adrenarche

A

a benign condition that caused by early maturation of the zona reticularis of the adrenal gland that is associated with increased androgen secretion

35
Q

when should you workup premature adrenarche

A

bone age assessment should be done: if normal or slightly advanced then it is most likely bening premature adrenarche

follow them clincially

IF it is associated with other secondary characterisitcs or bone age is advanced greater than 2 SD from the normal age—> workup
- clitoral enlargement, breast enlargement, penile enlargement, testicular enlargement

IF associated with significant growth acceleration

36
Q

whether premature adrenarch is benign or associated with precoicous puberty the patient needs to be?

A

closely monitored clinically (yearly)

37
Q

what is premature thelarche

A

breast development before age 8

can start as early as 6 months

most almost always associated with a normal growth rate

38
Q

when is work up for premature thelarche warranted

A

when associated with other signs of secondary sex maturation, if there is accelerated growth, if bone age is advanced before 2 SD for age

39
Q

congenital hypothyroidism in kids affects _ more, it is the inaquadte production of?

A

females (2:1)

thyroid hormone production

40
Q

congential hypothyroidism in kids is caused by?

A

absnece, dygenesis, or abnormal functioning og the thyroid gland

41
Q

what is the most common preventable causes of intellectual disability in children world wide

A

congential hypothyroidism

(the later treatment is initiated the lower the final IQ)

42
Q

signs of congenital hypothyroidism in kids

A

can be asymptomatic

signs can develop over the first few months of life: hoards cry, coarse facies, lethargy, feeding problems, constipation, macroglossia, hypotonia, large fontanels, prolonged jaundice

there is a newborn metabolic screen to check for this

43
Q

what is the most common cause of acquired hypothyroidism?

A

autoimmune thyroiditis

44
Q

what are the clinical manifestations of acquired hypothyroidism

A

declining growth velocity/short stature
abnormal pubertal development (delay)
declining school preformance
sluggishness, fatigue, cold intolerance, constipation, dry skin, brittle hair, facial puffiness, muscle aches and pains

45
Q

linear growth depends on the balance between _ and _ of the _ at the growth plate

A

proliferation and deterioration of the chondrocytes at the growth plate

46
Q

what is the primary determinant of normal post natal growth and skeletal maturation

A

T3 (thyroid hormone)

47
Q

what is an important regulator of bone and mineral metabolism in older children and adults

A

T3 (thyroid hormone)

48
Q

what is a major prerequisite of normal matruation of bone?

A

T3 (thyroid hormone)

ENRP Exam 2 (13 decks)

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