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MBBS2 Anatomy > Scenario 22: Puberty > Flashcards

Scenario 22: Puberty Flashcards

1
Q

How do we construct a growth chart?

A

Define the reference population, decide whether longitudinal or cross-sectional. Use centiles.

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2
Q

Why do we need new growth charts?

A

‘Secular trend’, the obesity epidemic, based on worldwide data not just UK, based on breast-fed infant population, describe optimal rather than average growth

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3
Q

How do growth rates before puberty relate to the timing of puberty?

A

Faster developers or overweight children often hit puberty earlier, slower developers or underweight children later

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4
Q

What is the best measure of the tempo of growth?

A

The bone age viewed by an x-ray of the left hand and wrist. View the growth plate where GH and IGF1 and other transcription factors act. Uses skeletal maturity scoring system

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5
Q

What are the Tanner stages?

A

Stages of breast development, pubic and axillary hair, penis and scrotum development, testicular volume

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6
Q

What is the Prader Orchidometer?

A

The string of beads used to size the testes to assess their development

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7
Q

How can we predict the adult height of a child?

A

Plot parental target height. Plot height of parent of same sex as child on chart and opposite sex (+12.5cm for mother of boy, -12.5cm for father of girl) target height is the mid point between the 2 parents

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8
Q

When may ‘crossing centiles’ be normal?

A

In infants- to catch up or catch down growth

In puberty- early or delayed developers

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9
Q

What are some key points relating to short stature?

A

Birth weight, nutrition and feeding in infancy, other physical abnormalities, developmental history, evidence of recent growth failure

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10
Q

How does family history relate to short stature?

A

Ethnic origin, parental stature, parental nutrition, parental disproportion, pubertal development of parents

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11
Q

What may cause a low birth weight?

A

Prematurity, chromosomal/genetic abnormalities, inter-uterine infection, other toxins (e.g. foetal alcohol syndrome)

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12
Q

What are the features of Silver-Russel syndrome?

A

Prenatal growth failure, no post-natal catch up growth, skeletal abnormalities (limb asymmetry, incurved 5th finger), small triangular face, normal HC

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13
Q

What are some severe syndromes causing short stature?

A

Seckel, Delange, Rubinstein-Taybi, Smith-Lemli-Opitz

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14
Q

What are some moderate syndromes causing short stature?

A

Williams, Prader-Willi, Noonans

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15
Q

What would a marked delay in bone age signal?

A

Hormone deficiency, delayed puberty

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16
Q

What would a moderate delay in bone age signal?

A

Chronic disease, psychosocial issues,

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17
Q

What would a normal delay in bone age signal?

A

IUGR syndromes, bone dysplasias

18
Q

What would an advancment in bone age signal?

A

Obesity, sexual prcocity, sex hormone excess

19
Q

How does acquired hypothyroidism present?

A

Somewhat overweight, elevated TSH, small thyroid, short stature

20
Q

What are the symptoms of coeliacs disease in children?

A

Short, thin, tired, anaemic, positive antibodies, negative jejunal biopsy, response to diet

21
Q

What may cause a short spine in children?

A

Spinal anomlay, scoliosis, SED, irradiation, haemoglobinopathy

22
Q

What may cause short legs in children?

A

Hypothyroid, rickets, skeletal dysplasia, turner syndrome

23
Q

What may cause long legs in children?

A

Klinefelter’s syndrome, delayed puberty

24
Q

What are the signs of Turner syndrome?

A

Short stature, abnormal upper/lower segment ratio, high palate, small jaw, cubitus valgus, short metacarpals, webbing, oedema,

25
Q

What can Turner syndrome cause?

A

Gonadal failure and infertility, cardiovascular abnormalities, renal abnormalities, pigmented naevi, hashimotos thyroiditis, hypothyroidism, hypertension, deafness

26
Q

How can we treat delayed puberty?

A

Low dose testosterone in boys, or oestrogen in girls

27
Q

What may cause a tall stature?

A

Genetics, thyrotoxicosis, precocious puberty, congenital adrenal hyperplasia, Klinefelter’s, fragile X-syndrome, Marfan’s syndrome

28
Q

How can we treat growth hormone deficiency?

A

Subcutaneous injection of synthetic growth hormone once daily in evening until reach adult height

29
Q

What is the first external sign of puberty in boys and girls?

A

Breast budding in girls, testes enlargement in boys. Pubic hair not generally regarded as pubertal onset.

30
Q

What is the definition of precocious puberty?

A

Any secondary sex characteristic appearing before 8 years (girls) or 9 years (boys)

31
Q

Why does facial hair grow at a different rate to pubic or axillary hair in puberty?

A

Axillary or pubic hair only requires a low level of androgens to stimulate growth in both sexes. Facial hair required a high level of androgens and is male-related.

32
Q

What occurs in the 0-2 year stage of child development?

A

Attachment, maturation of sensory, perceptual and motor functions and understand objects through senses.

33
Q

What occurs in the 2-6 year stage of child development?

A

Locomotion, fantasy play, language development, sex role identification and group play

34
Q

What occurs in the 6-12 year stage of child development?

A

Friendship, skill learning, self-evaluation, team play, understand cause and effect and conversation

35
Q

What occurs in the 12-18 year stage of child development?

A

Physical maturation, emotional development, peer group and sexual relationships, understand abstract thinking

36
Q

What are the 5 stages of language development?

A

Preverbal communication, phonological development, semantic development, syntax and grammar development, pragmatics development

37
Q

According to Piaget what are the 4 main stages of cognitive development?

A
  1. Sensorimotor- Initial reflexes via sensory motor schema. Child interacts with environment and manipulates objects. Understanding of object permanence.
  2. Pre-operational- Internal representation of concrete objects and situations. Child uses symbolic schemes like language. Ego centric. Reasoning dominated by perception
  3. Concentrate operations- Reasoning involves more than one salient feature (conservation) Logical reasoning can only be applied to objects that are real or can be seen.
  4. Formal operation- Can think logically about potential events or abstract ideas. Can test hypotheses about hypothetical events
38
Q

How does attachment develop according to Bowlby?

A

Process of proximity seeking identified attachment figure in situations of distress or alarm for purpose of survival

39
Q

How does the progesterone only contraceptive prevent fertilisation?

A

Thickens cervical mucus, variable effect on ovulation

40
Q

How does the combined contraceptive pill prevent fertilisation?

A

Suppress FSH release, stabilises endometrium, potentiates action of progesterones, suppresses LH, thickens cervical mucus, produces unreceptive endometrium, affects secretion and peristalsis within fallopian tube

MBBS2 Anatomy (8 decks)

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