Pediatrics HYHO - Newman

Question 1

what is considered normal BMI

Answer 1

18.5-24.9

Question 2

what is the normal growth rate velocity for school age children (age 5-puberty)?

Answer 2

5cm a year = 2 inches a year

Question 3

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

Answer 3

length or height

Question 4

what is delayed bone age?

Answer 4

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

Question 5

what should you think about if heigh (length) changes first or most dramatically?

Answer 5

endocrine issue (like a growth hormone deficiency)

Question 6

what should you think about if weight changes first or most dramatically?

Answer 6

calories/nutrition

Question 7

what should you think about if head circumference changes first or most dramatically?

Answer 7

brain/skull or hydrocephalus

Question 8

what is short stature defined as?

Answer 8

height >2 standard deviations below the mean height (50th percentile) for age and sex
- which means the height would be less than the 3rd percentile on the growth chart

Question 9

what are the 3 most common benign causes of short stature?

Answer 9

1. familial
2. constitutional
3. idiopathic

Question 10

parents are small

• grows the normal velocity in all parameters, they simply plot lower on the growth curve and end height is consistent with mid-parental heigh
• bone age is consistent with chronological age

Answer 10

familial short stature

Question 11

• grow at a low normal rate and plot low on the growth curve
• puberty is delayed
• usually a family hx of “late bloomers”
• puberty and growth spurt occur later, end height is normal
• hallmark is delayed bone age

Answer 11

constitutional short stature

Question 12

• height greater than 2 standard deviations below the mean heights for age
• no encocrine, metabolic, or other diagnosis present
• no family hx of short stature
• bone age is consistent with chronological age

Answer 12

idiopathic short stature

Question 13

what is the hormone that functions as the major mediator of growth hormone stimulated somatic growth?

Answer 13

IGF-1

Question 14

what is the main IGF-1 transport protein in the blood stream?

Answer 14

IGFBP-3

Question 15

what hormone increases IGF-1 synthesis by osteoblasts and chondrocytes?
- suggestive that it contributes to statural growth

Answer 15

growth hormone

Question 16

when would you see:

- decreased levels of IGF-1 and IGFBP-3 consistent with growth hormone deficiency

Answer 16

patient with short stature

Question 17

if the levels of IGF-1 and IGFBP-3 are decreased, what testing should be performed?

Answer 17

growth hormone stimulation testing

• administation of glucagon
• administration of arginine
• insulin induced hypoglycemia

Question 18

onset of secondary sexual characteristics

• before the age of 8 in girls
• before the age of 9 in boys

Answer 18

precocious puberty

Question 19

• girls: progressive breast development and crossing major percentile lines upward on the linear growth chart
• boys: evidence of both testicular and penile enlargement and crossing major percentile lines upward on linear growth chart

Answer 19

precocious puberty

Question 20

what lab tests should be run on pt with suspected precocious puberty?

Answer 20

• LH
• FSH
• estradiol and/or testosterone
• 17-hydroxyprogesterone

Question 21

what imaging should be done on pt with suspected precocious puberty?

Answer 21

• bone age (will be advanced in precocious puberty)
• MRI of head (potential of a CNS tumor)
• US of genitals