Growth

Question 1

Define standard deviation

Answer 1

Measure of variability

Question 2

What is the Z score

Answer 2

Number of standard deviations from mean

Question 3

What percent of people are within 1 SD of the mean?

Answer 3

68%

Question 4

What percent of people are within 2SD of the mean?

Answer 4

95%

Question 5

How far apart are centile lines?

Answer 5

2/3 of a standard deviation

Question 6

In relation to their birth weight how fast do babies grow?

Answer 6

Double birth weight in six months

Treble birth weight in a year

Question 7

What is the middle growth phase controlled by?

Answer 7

Hormones

Question 8

What determines the third growth phase?

Answer 8

Age of puberty growth

Question 9

When is a child classed as showing normal growth?

Answer 9

• their measurements are within normal range

- their rate of growth is within the normal range

Question 10

How many infections will a normal child acquire in a year?

Answer 10

12-15

Question 11

Name three important factors when measuring weight

Answer 11

• no clothes/nappy on baby
• only vest & pants when <2 years old
• class III clinical electronic scales

Question 12

Name three important factors when measuring height

Answer 12

• use narrow plastic/disposable paper tape
• measure where head is widest
• take three measurements & average

Question 13

Briefly describe how puberty occurs

Answer 13

Hypothalamus releases GnRH and acts on pituitary to stimulate gonadotrophin which stimulate testes/ovaries.

Question 14

What are the two gonadotrophins?

Answer 14

FSH and LH

Question 15

Describe the progression of the gonadotrophic axis through childhood

Answer 15

In utero the gonadotrophin axis is quite active but this decreases after birth until puberty

Question 16

What is the average age to undergo puberty?

Answer 16

Girls - 11 years old

Boys - 6 months later

Question 17

How is puberty determined in boys?

Answer 17

Staging is determined by size of genitalial & amount of pubic hair - testicular volume >4ml

Question 18

How is puberty determined in girls?

Answer 18

Staging is determined by breast development due to oestrogen

Question 19

Define precocious puberty

Answer 19

Normal pubertal development occurring early <8 years old in girls, <9 years old in boys

Question 20

Define pubertal delay

Answer 20

Absence of secondary sexual development in girl aged 13 years old or boy aged 14 years old

Question 21

Name the three processes girls go through during puberty

Answer 21

Thelarche - breast budding
Adrenarche - body hair and odour
Menarche - periods (usually 2 years post thelarche)

Question 22

State seven investigations that are carried out on a child with abnormal growth

Answer 22

• bloods (gonadotrophin, IGF1, testosterone/oestrogen, thyroid)
• dynamic function test
• bone age (non-dominant hand)
• MRI brain
• USS uterus
• coeliac screen
• karyotype for short stature (turner’s syndrome)

Question 23

What is the gold standard test to measure growth hormone?

Answer 23

Insulin tolerance test but it is dangerous and only performed in tertiary centres

Question 24

Name five types of short stature

Answer 24

• genetic
• constitutional growth delay
• dysmorphic syndromes
• endocrine disorders
• chronic diseases
• psychosocial deprivation