paediatric growth and endocrine

Question 1

growth assessment tools

Answer 1

height/length, weight
growth charts + plotting
MPH and target centiles
growth velocity
bone age 
pubertal assessment

Question 2

growth disorders: indications for referral

Answer 2

• extreme short/tall stature (off centiles)
• height below target height
• abnormal height velocity (crossing centiles)
• hx chronic disease
• obvious dysmorphic syndrome
• early/late pubery

Question 3

common causes of short stature

Answer 3

familial
constitutional
SGA/IUGR

Question 4

growth investigaions

Answer 4

FBC + ferritin 
U&E, LFTs, Ca, CRP
coeliac serology and IgA
IGF-1, TFT, prolactin, cortisol
karyotype/microarray

Question 5

staging of puberty: tanner method

Answer 5

breast development
genital development
pubic hair
axillary hair

Question 6

early and delayed puberty: boys

Answer 6

early <9yrs

delayed >14

Question 7

early and delayed puberty: girls

Answer 7

early <8yrs

delayed >13

Question 8

constitutional delay of growth and puberty

Answer 8

boys mainly
FH in dad or brothers
bone age delay
need to exclude organic disease

Question 9

pathological causes of short stature

Answer 9

undernutrition 
chronic illness - IBD, coeliac
iatrogenic - steroids
psychological, social
hormonal (GHD, hypothyroid, glucocorticoid excess) 
syndromes - Turner, P-W, Noonan, PHPT
skeletal dysplasias

Question 10

Turner syndrome: gene and who

Answer 10

45X0

girls

Question 11

turner syndrome features

Answer 11

poor growth, short stature
1ry amenorrhea (ovarian dysgenesis) 
delayed/absent pubertal development
webbed neck 
skeletal abnormalities
congenital heart defects: aortic coarctation, bicuspid aortic valve

Question 12

prader-willi syndrome genes

Answer 12

deletion of 15q11-q13 chromosome region

Question 13

noonan’s syndrome features

Answer 13

autosomal dominant
short stature
abnormal facial features
congenital heart defects: pulm valve stenosis 
chest deformities

Question 14

causes of delayed puberty

Answer 14

chronic disease - Crohn’s, asthma
constitutional
primary gonadal disorders
impaired HPG axis

Question 15

central precocious puberty

Answer 15

true pubertal development - breast development/testicular enlargement
growth spurt
advancing bone age

Question 16

assessment of childhood obesity

Answer 16

weight 
BMI 
height
waist circumference
skin folds
hx and exam
complications

Question 17

obese + short =

Answer 17

abnormal

Question 18

complications of childhood obesity

Answer 18

metabolic syndrome 
fatty liver disease
gallstones
thromboembolic disease
pancreatitis
obstructive sleep apnoea
GORD
psychological
left ventric hypertrophy
RS heart failure

Question 19

causes of childhood obesity

Answer 19

simple obesity
drugs 
syndromes
endocrine disorders
hypothalamic damage

Question 20

managing childhood obesity

Answer 20

diet
exercise
psychological input
drugs»

Question 21

small and obese child: endocrine cause

Answer 21

growth failure

Question 22

small and obese child: syndromes

Answer 22

learning difficulties

Question 23

small and obese child: hypothalamic cause

Answer 23

loss of appetite control

Question 24

small and obese child: genetic causes

Answer 24

starts <5yrs

Question 25

diabetic symptoms chldhood

Answer 25

thirsty
tired
thinner
using toiler more

return to bedwetting - reg flag for diabetes

Question 26

other diabetes features in kids <5yrs

Answer 26

heavier nappies than usual
blurred vision
candidiasis - oral, vulval
constipation 
recurring skin infection
irritability

Question 27

first test for childhood diaberes

Answer 27

finger prick capillary blood test

> 11 mmol/l - diabetes
<11mmol/l - other cause

Question 28

making early diagnosis of childhood diabetes

Answer 28

T symptoms (thirsty, thinner, tired, toilet more)
test - finger prick glct test
telephone - same day specialist review

Question 29

tanner I

Answer 29

prebupertal

Question 30

tanner II

Answer 30

minimal pubic hair

breast budding

Question 31

tanner III

Answer 31

voice changes, pubic hair over penis

PH, AH, breast enlargement

Question 32

tanner IV

Answer 32

adult pubic hair

areolar enlargement

Question 33

tanner V

Answer 33

as adult

Question 34

pader willi syndrome features

Answer 34

short stature
infantile hypotonia/poor feeding
childhood hyperphagia, obesity
developmental delay

Question 35

early sexual development: breast development

Answer 35

hypothalamic activation

e.g. central precocious puberty

Question 36

early sexual development: secondary sexual characteristics

Answer 36

sex steroid hormone secretion

e.g. precocious pseudopuberty