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Flashcards in Growth + Development + Nutrition + Adolescence Deck (52)
1

Short stature

Ht below 3rd percentile

2

Patters of short stature (proportional)

Pathologic (postnatal onset) - nl initial ht --> low ht

Constitutional growth delay

Familial short stature - family hx of short ht, parallels the growth curve for family

Prenatal onset short stature (IUGR) - parallels growth curve

3

Constitutional short stature

Slow growth but at a normal rate

Nl ht --> low ht --> normal adult ht reached

Growth spurt and puberty delayed

Bone age and ht age are both behind chronological age

4

How do you dx bone age

What is height age

Xray of L hand and wrist

Ht age = age corresponding to 50th percentile for child's height

5

Endocrine causes tall stature

Growth Hormone excess
Androgen excess
Hyperthyroidism

6

Genetic syndromes calling tall stature

Homocystinuria (marfanoid apperance)

Cerebral gigantism (Sotos syndrome)

Beckwith-Wiedemann

Kleinfelter syndromes

7

Chronological age (CA) > Bone age (BA)

Short stature

+ normal growth velocity --> constitutional delay

+ abnormal growth velocity --> chronic systemic dz, endocrine DO

8

CA = BA

Short stature

+ normal growth veloicty --> genetic short stature

+ abnl growth velocity --> genetic, chromosomal syndrome

9

CA < BA

+ nl growth velocity --> obesity

+ abnl growth velocity --> precocious puberty, congenital adrenal hyperplasia, hyperthryodism

10

Birth wt
- doubled by...
- tripled by...

2x --> 4-5 mo

3x --> 1 yr

11

Tx FTT

Hospitalization to document caloric intake and wt gain sometimes

Sweat Cl test

12

Dx obesity

BMI > 95% for age/sex

> 30 BMI in adolescents

13

Enuresis

Bladder control usually by age 5

Involuntary urination in child who is toilettrained

Tx
- imipramine
- desmopressin

14

Encopresis

Fecal incontinence after age 4 years

More common in boys

15

Autism develops before

30 mo age

16

Kwashiorkor

Protein deficiency
Inadequate caloric intake

Present after weaning from breast
Edema

Decreased serum albumin

Tx - slow feeding of filute milk
- supplement vitamins
- protein supp slowly

17

Vit A
- functions
- sources
- deficiency signs

Retinal pigments
Bone + teeth dev
Epithelial maturation

Source:
- green and yellow veggies
- fruits

Deficiency:
- ocular lesions
- dry skin
- anemia
- increased ICP
- MR
- growth retardation

18

Vit B1
- functions
- sources
- deficiency signs

Coenzyme in carb metabolism
Generate NADP

Source:
- milk, veggies, cereals, fruits, eggs

Beriberi (CNS)
Peripheral neuritis
CHF
ataxia
paralysis of laryngeal N
cyanosis
dyspnea

19

Riboflavin
- functions
- sources
- deficiency signs

FAD - electron transport
Energy production

Source:
- liver, kidney, milk, cheese, eggs, leafy greens, cow milk

Glossitis
Keratitis
Conjunctivitis
Photophobia
Seborrhea

Normocytic normochromic anemia

20

Niacin
- functions
- sources
- deficiency signs

NAD, NADP cofactors --> glycolysis

Source:
- liver, lean pork, salmon, poultry, read meat

Pellagra
- dermatitis
- diarrhea
- dementia
Depression
Encephalopathy, delusions, disorientation, dementia

21

Vit B6 (Pyridoxine)
- functions
- sources
- deficiency signs

Coenzyme for decarboxylation + transamination of AA
NS function needed

Source:
- milk, cereals

Convulsions
Peripheral neuritis
Dermatitis
Anemia

22

Vit C
- functions
- sources
- deficiency signs

Reducing agent
Collagen formation

Source:
- fruits, veggies

Scurvy
- bleeding
- loose teeth
- gum swelling
- easy fx
Costochondral rosary

23

Vitamin D
- deficiency signs

Rickets - osteomalacia

Tetany

24

Vitamin E
- functions
- sources
- deficiency signs

Nucleic acid metabolism

Green, leafy veggies, nuts, legumes

Creatinuria
Focal necrosis of striated muscle
Weakness

25

Vitamin K
- functions
- sources
- deficiency signs

Oxidative phosphorylation
clotting factors

Sources:
- bacteria
- liver
- spinach

Hemorrhage

26

Adolescence

Between childhood and adulthood

Starts 11-12 yo and ends 18-21 yo

puberty
concrete --> abstract thinking
independent identity

27

3 stages of adolescence

Early (10-14 yo)
- physical changes related to puberty
- rapid growth
- body images, self esteem
- concrete thinkers usually

Middle (15-16 yo)
- independent
- sense of identity
- mood swings
- abstract thinking develops

Late (17-20 yo)
- less self centered, more caring
- future goals, plans, career
- idealistic

28

Vaginal discharge types - pathologic

Bacterial vaginosis
Trichomonas
Candida
Chlamydia/Gonorrhea

29

Bacterial vaginosis
- type of discharge
- wet prep
- STD?

Profuse
Malodorous (fishy)

+ clue cells
+ WBC
+ lactobacilli
+ fish odor w/ KOH

NOT STD

30

Trichomonas
- type of discharge
- wet prep
- STD?

Gray-green
Frothy
Foul smelling

+ Trichomonads
+ WBC

YES STD

31

Candida
- type of discharge
- wet prep
- STD?

Normal, cottagecheese like

+ Branching hyphae and spores

NOT STD

32

Chlamydia/Gonorrhea
- type of discharge
- wet prep
- STD?

Purulent d/c

+ WBC

YES STD

33

A decrease in wt before height is indicative of systemic illness

Systemic illness

34

Length starts decreasing

Wt remains stable

Endocrine disorder

Bone age is delayed

35

Russel silver syndrome

Triangular facies

Antimongoloid slant

Hemihypertrophy

FTT

Renal abnormalities

36

Bardet-biedl syndrome

Obesity

Retinitis pigmentosa

Polydactyly

Mental retardardation

Renal failure

37

Albrights osteodystrophy

Lack of responsiveness to parathyroid hormone

Low serum Ca
High serum PO4
High serum PTH

Short stature
Obesity
MR
SubQ calcifications
Short 4th and 5th metacarpal/metatarsals

38

Bone pains suggesting metastatic disease

Unilateral pain

Systemic symptoms
- fever
- wt loss

39

Bone pains suggesting osteoid osteomas

Limb pain worse at night

Responds to NSAIDs

Most common in 2nd decade of life

Pain is unilateral

40

Bone pains suggesting growing pains

Night pain mostly

Usually in lower extremities

Usually bilateral

No limitation of physical activity

Normal PE

Pain relieved by heat, massage, or OTC NSAIDs

Tx
- education + reassure
- massage, muscle-stretching exercises, analgesics

41

When start to introduce pureed foods

6 mo

42

When start to introduce cow's milk

1 year

- will increase risk of iron def anemia if introduce earlier!

43

Premature adrenarche

Characterized by isolated appearance of axillary hair before age of 5 years

Change results from premature androgen secretion of the adrenal glands

Condition benign
NO clinical significance

44

Premature pubarche

Pubic growth before age of 8

More alarming

Assoc w/ CNS disorder in 50% cases

45

What causes premature breast development, uterine changes

Ovaries secrete estrogen and progesterone

Premature thelarche has no clinical significance

46

Precocious puberty classifcations

Gonadotropin-DEPENDENT (central precocious puberty)

Gonadotropin-independent (pseudo-precocious puberty)

Incomplete precocious puberty

47

Gonadotropin-DEPENDENT precocious puberty

Premature mautration of hypothalamic-pituitary-gonadal axis

Causes:
- Idiopathic (most)
- CNS tumors, lesions, irradiation
- severe, untreated hypothyroidism

1st study to do
- MRI of brain!

48

Gonadotropin-independent precocious puberty

Excessive sex hormones from endogenous or exogenous sources

Causes:
- CAH
- adrenal tumors
- exogenous T or E

Girls:
- ovarian cysts or tumors
- mccune albright

Boys:
- leydig cell tumor
- HCG-secreting germ cell tumor

1st test:
- girls = US of A/P
- boys = testicular US

49

Incomplete precocious puberty

Etiology unknown, variant of nl puberty

Causes:
- isolated premature thelarche
- isolated premature adrenarche

1st test:
- NONE needed

50

Gynecomastia

unilateral or bilateral firm subareolar nodules

Can be tender to touch

Thought to be 2/2 temporary reduction in testosterone : estradiol radio

51

Pubertal gynecomastia management

None - usually resolves within a few mo - 2 years

If suspect Kleinfelters (b/c testes small ie < 3 mL) --> karyotype

52

Nl testicular volume in prepubertal boys

< 3 mL