Revision - Development

Question 1

What 2 cancers is breastfeeding protective against?

Answer 1

1) ovarian
2) breast

Question 2

On formula feed, how much milk per kg of body weight should babies receive?

Answer 2

150ml/kg

Question 3

What is the most common cause of excessive weight loss or not regaining weight in the neonatal period?

Answer 3

Dehydration due to underfeeding

Question 4

What is the most reliable sign of dehydration in babies?

Answer 4

Sunken fontanelles

Question 5

What 3 measures are taken on a growth chart?

Answer 5

1) height
2) weight
3) head circumference

Question 6

Children go through three phases of growth.

What are they?

Answer 6

Infancy: birth to 2y

Childhood: 2y to 11y

Puberty: 11y to 18y

Question 7

In infancy, what are the 2 major drivers of growth?

Answer 7

1) insulin
2) nutrition

Question 8

In childhood, what are the 2 main drivers of growth?

Answer 8

1) GH
2) thyroxine

Question 9

In puberty, what are the 2 main drivers of growth?

Answer 9

1) GH

2) sex steroids

Question 10

Centiles for overweight vs obese on growth charts?

Answer 10

BMI >85th centile: overweight

BMI >95th centile: obese

Question 11

How often is growth monitored in the first 2 years of life?

Answer 11

0-1y –> should have at least 5 recordings

1-2y –> should have at least 3 recordings

Question 12

How often is growth monitored in children aged >2 y/o?

Answer 12

Annual

Question 13

What growth chart should be used for pre-term infants born <32 weeks gestation?

Answer 13

Neonatal and infant close monitoring (NICM) chart

Question 14

What growth chart should be used for pre-term infants born 32-27 weeks gestation?

Answer 14

lot all measurements in the preterm section until 42 weeks gestation.

Then plot on the 0-1-year chart using gestational correction.

Question 15

What is gestational correction?

Answer 15

Plot measurements at the child’s actual age, then draw a line back the number of weeks the infant was preterm.

Mark the spot with an arrow: this is child’s gestationally corrected centile.

Question 16

Up until what age should gestational correction on growth charts be continued for in preterms?

Answer 16

Up to 1 y/o

Question 17

A sustained drop in how many centiles is unusual and should be investigated?

Answer 17

A sustained drop across 2 or more centiles

Question 18

What is Tanner stage 1 for girls?

Answer 18

Pre-pubertal

Question 19

How is BMI calculated?

Answer 19

Weight (kg) / height (m)2

Question 20

What 2 investigations are indicated if faltering growth is suspected?

Answer 20

1) urine dipstick for UTI

2) anti-TTG & anti-EMA for coeliac

Question 21

Define short stature

Answer 21

Short stature is defined as a height more than 2 standard deviations below the average for their age and sex. This is the same as being below the 2nd centile.

Question 22

What investigation should you order in kids with short stature?

Answer 22

XR –> delayed bone age is a key feature of constitutional delay in growth and puberty (CDGP) i.e. a normal variation

Question 23

What testicular volume indicate the onset of puberty?

Answer 23

> 4ml

Question 24

Define thelarche

Answer 24

First stage of breast development

Question 25

What can precocious puberty be classified into?

Answer 25

1) Gonadotrophin dependent (‘true’)

2) Gonadotrophin independent (‘false’, ‘pseudo’)

Question 26

What stage of Tanner Stages of Sexual Development does menarche usually coincide with?

Answer 26

3

Question 27

What is gonadotrophin dependent (‘central’, ‘true’) precocious puberty due to?

Answer 27

Premature activation of the hypothalamic-pituitary-gonadal axis.

FSH and LH are raised

Question 28

What is gonadotrophin independent (‘pseudo’, ‘false’) precocious puberty due to?

Answer 28

Excess sex hormones

FSH & LH are low

Question 29

How can testes development indicate cause of precocious puberty in males?

Answer 29

Bilateral enlargement –> gonadotrophin release from intracranial lesion

Unilateral enlargement –> gonadal tumour

Small testes –> adrenal cause (tumour or adrenal hyperplasia)

Question 30

What are some causes of true gonadotrophin dependent precocious puberty?

i.e. central

Answer 30

1) CNS lesions e.g. GnRH secreting hamartoma

2) CNS tumours

3) Central malformation or damage e.g. hydrocephalus, neurofibromatosis

4) Acquired: post-sepsis, surgery, radiotherapy, trauma, birth anoxia

Question 31

What are some causes of false (gonadotrophin independent) precocious puberty?

i.e. peripheral –> causing increased secretion of sex hormones

Answer 31

1) Gonadal: ovarian cyst, ovarian tumour, Leidig cell tumour of testes

2) Adrenal: tumours, congenital adrenal hyperplasia

3) Ectopic hCG production by germ cell tumour

4) Exogenous sex steroids

5) Hypothyroidism

6) McCune Albright syndrome: polyostotic fibrous dysplasia

Question 32

What is Kallman syndrome?

Answer 32

Genetic condition causing HYPOgonadotropic hypogonadism.

Features:
- failure to start puberty
- anosmia

Question 33

What hormonal blood tests can be done in delayed puberty?

Answer 33

1) early morning FSH & LH

2) TFTs

3) prolactin

4) GH testing

Question 34

What is often used as a screening test for GH deficiency?

Answer 34

Insulin-like growth factor I

Question 35

Name 3 genetic conditions that can cause delayed puberty

Answer 35

1) Turner’s (XO)

2) Klinefelter’s (XXY)

3) Kallman’s

Question 36

What investigation is indicated in Kallman’s ?

Answer 36

MRI to assess olfactory bulbs

Question 37

What does a Leidig cell tumour produce?

Answer 37

Testosterone

Question 38

What type of precocious pubety can a germ cell tumour cause? Why?

Answer 38

Germ cell tumours produce AFP and hCG.

Production of hCG can lead to gonadotrophin independent precocious puberty (as hCG directly stimulates the production of testosterone, oestrogen, & sperm).