Clinical Growth Problems Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary determinant of growth during the infancy phase?

Genetics

Hormones

Physical activity

Nutrition (correct)

In the context of growth problems, which condition could be characterized by a child on the 3rd centile for height?

Idiopathic short stature (correct)

Precocious puberty

Overnutrition

Delayed puberty

Which hormone is primarily responsible for triggering the adolescent growth spurt?

Thyroxine

Cortisol

Insulin

Growth hormone (correct)

What is the significance of epiphyseal fusion in relation to a person's growth?

Limits final adult height Signup and view all the answers

What age range characterizes the childhood phase of growth?

From 2–3 years to the onset of puberty Signup and view all the answers

Which clinical case illustrates early onset of secondary sexual characteristics?

A 5-year-old girl developing breasts Signup and view all the answers

Which key hormone is involved in the regulation of growth across all phases of childhood?

Growth hormone Signup and view all the answers

What clinical examination would be most relevant for assessing delayed puberty in a teenager?

Bone age assessment Signup and view all the answers

What age is considered precocious puberty for females?

8 years Signup and view all the answers

What is the Tanner staging used to classify?

Pubertal development Signup and view all the answers

At what testicular volume is maximum height velocity typically attained in boys?

12 mL Signup and view all the answers

What is the key measure to determine true height velocity in children?

Measuring at least six months apart Signup and view all the answers

How do you estimate the final adult height of a girl using mid-parental height?

Subtract 12.5 cm from the father's height and average with mother's height Signup and view all the answers

What does a height velocity below the 25th centile for at least 18 months indicate?

Growth failure Signup and view all the answers

What does an orchidometer measure?

Testicular size Signup and view all the answers

What is the prevalence of Turner syndrome in girls?

1 in 5000 Signup and view all the answers

What is the primary genetic cause of Turner syndrome?

Absence of one of the sex chromosomes Signup and view all the answers

Which feature is NOT typically associated with Turner syndrome?

Hyperactive behavior Signup and view all the answers

What benefit does growth hormone treatment provide for girls with Turner syndrome?

Increases final height by about 5 cm Signup and view all the answers

Which of the following would be important to explore in the history of a child with short stature?

Presence of chronic illness Signup and view all the answers

What is the significance of measuring parents' heights in assessing a child's short stature?

It helps calculate the child's expected height based on familial characteristics Signup and view all the answers

Which investigation would provide valuable information regarding a child's growth pattern?

Height velocity calculations Signup and view all the answers

Which of the following statements about psychosocial short stature is true?

It may result from emotional neglect or abuse Signup and view all the answers

What characteristic is indicative of constitutional delay of growth?

Normal growth intervals followed by temporary delays Signup and view all the answers

What initial investigation should be conducted if height velocity is below the 25th centile over 6 months?

X-ray of the left wrist to ascertain bone age Signup and view all the answers

What is a possible reason for delayed bone age aside from growth hormone deficiency?

Hypothyroidism Signup and view all the answers

What condition may benefit from growth hormone therapy?

Russell Silver syndrome Signup and view all the answers

Which factor in the patient's personal history might indicate precocious puberty?

Rapid height velocity Signup and view all the answers

For a reliable assessment of growth issues, what should be plotted on a growth chart?

Growth history including previous measurements Signup and view all the answers

What is NOT a cause of psychosocial short stature?

Genetic disorders Signup and view all the answers

What should be assessed to investigate isolated thelarche?

Family history of breast development in childhood Signup and view all the answers

What hormone stimulation test may be used for growth hormone assessment?

Insulin stress test Signup and view all the answers

What condition requires growth hormone therapy?

Growth hormone deficiency Signup and view all the answers

How is growth hormone administered in children who require treatment?

Subcutaneously daily Signup and view all the answers

What is the most likely diagnosis for a child with obesity without underlying pathology?

Exogenous obesity Signup and view all the answers

Which of the following is a sign of insulin resistance in children?

Abdominal striae Signup and view all the answers

When should children receiving growth hormone be retested for growth hormone secretion?

At the end of the growth period Signup and view all the answers

What factor primarily determines a child's weight?

Caloric intake and energy expenditure Signup and view all the answers

Which condition is NOT an indication for growth hormone therapy?

Familial short stature Signup and view all the answers

What is a common reassurance given to families of short normal children?

They are healthy Signup and view all the answers

Study Notes

Growth Problems

Differential diagnosis for short stature includes familial short stature, constitutional growth delay, psychosocial factors, and isolated growth hormone deficiency.
A child on the third centile for height indicates he is shorter than 97% of peers, but may still fall within the normal range.
Additional information to gather for assessment: duration of height concern, birth history, chronic illnesses, ethnic background, parental heights, and any social environment factors.
Essential clinical examination includes plotting parental heights and estimating mid-parental height.

Clinical Cases Overview

Case 1.1: 6-Year-Old Boy's Short Stature

Investigations: Serial height measurements spaced at least six months apart, calculation of height velocity. If below the 25th centile, consider IGF1 levels and wrist X-ray for bone age.
Likely outcomes: Familial short stature generally requires no treatment, while psychosocial causes necessitate addressing underlying issues.

Case 1.2: 5-Year-Old Girl with Breast Development

Differential diagnosis includes isolated thelarche, thelarche variant, and precocious puberty.
Important history includes onset and progression of breast development, presence of pubic hair, rapid height changes, and family history of early breast development.
Clinical assessment should monitor height and weight changes to assess growth velocity.

Case 1.3: 14-Year-Old Girl with Delayed Menstruation

Key concern is absence of pubertal development by age 14 in females, indicating possible hormonal or developmental issues.

Key Concepts in Growth

Phases of Growth: Infancy is the fastest growth phase (nutrition-driven), childhood growth is hormone-regulated, and adolescent spurt is influenced by growth and sex hormones.
Epiphyseal Fusion: Initiated by estrogen, crucial for determining final adult height.
Precocious Puberty: Development of secondary sexual characteristics before age 8 in females or 9 in males.
Delayed Puberty: Lack of pubertal signs by 14 in females and 15 in males.
Tanner Staging: Categorizes sexual maturity based on observable traits (e.g., pubic hair, breast development).

Measurement and Evaluation

Height and Height Velocity: To assess growth accurately, measure height on two occasions, six months apart; height velocity can be doubled to reflect annual growth.
Centile Charts: Children should maintain height velocity above the 25th centile to avoid growth failure diagnosis.
Mid-Parental Height Calculation: Estimate final height based on parental heights with a margin of ±8 cm for prediction accuracy.

Turner Syndrome Details

Frequency of occurrence: approximately 1 in 5000 girls.
Associated features: short stature, webbed neck, wide carrying angle, ovarian dysgenesis, and normal intelligence with possible socialization issues.
Treatment with growth hormone can increase height by about 5 cm, alongside estrogen for puberty induction.

Treatment and Counseling

Growth hormone therapy is not indicated for children of short normal stature, except for specific growth disorders (e.g., Turner syndrome, Prader-Willi syndrome).
Emphasize regular growth monitoring if growth hormone is administered to evaluate efficacy and compliance.
Addressing childhood obesity should consider diet, exercise, and potential endocrine disorders while reassuring families of underlying health status.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on growth problems through clinical cases. This quiz includes questions on differential diagnosis, patient history, clinical examination, investigations, and treatment options related to growth issues. Perfect for medical students and practitioners looking to reinforce their understanding.