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Questions and Answers
What is the primary determinant of growth during the infancy phase?
In the context of growth problems, which condition could be characterized by a child on the 3rd centile for height?
Which hormone is primarily responsible for triggering the adolescent growth spurt?
What is the significance of epiphyseal fusion in relation to a person's growth?
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What age range characterizes the childhood phase of growth?
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Which clinical case illustrates early onset of secondary sexual characteristics?
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Which key hormone is involved in the regulation of growth across all phases of childhood?
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What clinical examination would be most relevant for assessing delayed puberty in a teenager?
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What age is considered precocious puberty for females?
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What is the Tanner staging used to classify?
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At what testicular volume is maximum height velocity typically attained in boys?
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What is the key measure to determine true height velocity in children?
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How do you estimate the final adult height of a girl using mid-parental height?
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What does a height velocity below the 25th centile for at least 18 months indicate?
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What does an orchidometer measure?
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What is the prevalence of Turner syndrome in girls?
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What is the primary genetic cause of Turner syndrome?
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Which feature is NOT typically associated with Turner syndrome?
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What benefit does growth hormone treatment provide for girls with Turner syndrome?
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Which of the following would be important to explore in the history of a child with short stature?
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What is the significance of measuring parents' heights in assessing a child's short stature?
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Which investigation would provide valuable information regarding a child's growth pattern?
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Which of the following statements about psychosocial short stature is true?
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What characteristic is indicative of constitutional delay of growth?
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What initial investigation should be conducted if height velocity is below the 25th centile over 6 months?
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What is a possible reason for delayed bone age aside from growth hormone deficiency?
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What condition may benefit from growth hormone therapy?
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Which factor in the patient's personal history might indicate precocious puberty?
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For a reliable assessment of growth issues, what should be plotted on a growth chart?
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What is NOT a cause of psychosocial short stature?
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What should be assessed to investigate isolated thelarche?
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What hormone stimulation test may be used for growth hormone assessment?
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What condition requires growth hormone therapy?
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How is growth hormone administered in children who require treatment?
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What is the most likely diagnosis for a child with obesity without underlying pathology?
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Which of the following is a sign of insulin resistance in children?
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When should children receiving growth hormone be retested for growth hormone secretion?
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What factor primarily determines a child's weight?
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Which condition is NOT an indication for growth hormone therapy?
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What is a common reassurance given to families of short normal children?
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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.
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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.
