# Growth, Puberty and Adolescence Flashcards

1
Q

What is standard deviation?

A

It is a measure of variability- the wider it is, the more variation

2
Q

What is the z-score?

A

The number of standard deviations away from the mean

3
Q

If there are 100 people measured, how many people will be within 1SD of the mean value?

A

68

4
Q

If there are 100 people measured, how many people will be within 2SD of the mean value?

A

95

5
Q

On a growth chart, how far apart are the centile lines spaced?

A

2/3rds of a standard deviation

6
Q

At what age in childhood will a child be leanest?

A

3/4/5

7
Q

How much do babies roughly grow per year? What is this driven by?

A

20cm a year, driven by nutrition

8
Q

What drives the teenage stage of growth?

A

Hormones

9
Q

How should babies be weighed?

A

With no clothes or nappies

10
Q

What should children ages older the 2 be wearing when getting weighed?

A

Vest and pants (no shoes, or toys in hand)

11
Q

What scales should be used to measure weight?

A

Class III electronic scales in the metric setting

12
Q

When should a babies length be measured? How many people are required to do this?

A

If they are < 2 years and you are concerned about their growth. Needs two people.

13
Q

What should a baby be wearing to get their length measured?

A

Nothing (not even nappy)

14
Q

Where should head circumference be measured?

A

15
Q

When should a child’s height be measured?

A

From 2 years of age

16
Q

How should the child be standing to get their height measured?

A

Heels, bottom, back and head touching the apparatus, with eyes and ears at 90 degrees

17
Q

Should you measure height on inspiration or expiration?

A

Expiration

18
Q

When is a child described as being ‘on the X centile’?

A

If they are exactly on the centile line or within 1/4 space of a centile line

19
Q

When is a child described as being between centiles?

A

If they are outwith 1/4 of a centile gap

20
Q

When does puberty occur?

A

When the secretion of gonadotrophins by the hypothalamus increases

21
Q

What other hormone is produced once GnRH is stimulated to be released from the hypothalamus at the start of puberty?

A

Pulsatile secretion of LH increases which results in secondary sexual development

22
Q

In boys, LH stimulates where to do what?

A

Leydig cells to produce testosterone

23
Q

In boys, FSH stimulates where to do what?

A

Sertoli cells to enhance spermatogenesis

24
Q

What hormone rises when sex hormone binding globulin levels fall in boys?

A

Androgens

25
Q

In girls, LH stimulates the production of which cells?

A

Follicular and theca cells

26
Q

In girls, LH stimulates the secretion of which hormone during the follicular stage of the menstrual cycle?

A

Androgens

27
Q

In girls, FSH induces the proliferation of which cells?

A

Granulosa cells

28
Q

In girls, FSH increases the activity of what? What is the function of this?

A

Aromatase; so that more androgens are converted to oestrogens

29
Q

Ovulation results from the interaction of which hormones on the developing follicle?

A

LH, FSH and oestrogen

30
Q

In both sexes, during puberty there are increased levels of sex hormones and insulin. What effect does this have on GH and IGF-1?

A

Secretion is enhanced

31
Q

What are the relative LH and FSH levels when a child is first born? What happens after this?

A

They are high at birth and then stop in the first year of life until puberty

32
Q

What is the average age of puberty for girls and boys?

A

Girls = 11, boys = 11.5

33
Q

What is the relative weight of girls with precocious puberty? Why?

A

They tend to be fatter because of increased leptin

34
Q

What does stage 1 of the tanner scale show?

A

Pre-pubertal body

35
Q

What does stage 5 of the tanner scale show?

A

36
Q

What is the best measurement of the onset of puberty in boys?

A

Testicular volume

37
Q

What indicates the beginning of puberty in boys?

A

Testicular volume > 4ml

38
Q

What is the best measurement of the beginning of puberty in girls?

A

Breast development

39
Q

What is thelarche?

A

Breast development

40
Q

A

Body hair and odour development

41
Q

What is menarche?

A

Start of periods

42
Q

What is the timescale of menarche in relation to thelarche?

A

Menarche is usually 2 years later

43
Q

What is true central precocious puberty?

A

Normal pubertal development occurring abnormally early

44
Q

What is precocious puberty for girls?

A

< 8

45
Q

What is precocious puberty for boys?

A

< 9

46
Q

Which sex does precocious puberty occur more frequently in?

A

Females

47
Q

What is pubertal delay?

A

The absence of secondary sexual development (girls - breasts, boys - testicular volume < 4)

48
Q

What age is pubertal delay in boys?

A

14

49
Q

What age is pubertal delay in girls?

A

13

50
Q

Pubertal delay occurs more commonly in which sex?

A

Males

51
Q

When do girls reach peak height velocity?

A

12 years

52
Q

When do boys reach peak height velocity/

A

14 years

53
Q

Why do boys end up taller than girls?

A

Their growth plates form around 3 years alter so they have a higher pre-pubertal height

54
Q

What hormones should be tested when assessing a growth problem?

A

Gonadotrophins, growth hormone and factors, testosterone/oestrogen, thyroid

55
Q

How do you assess bone age?

A

X-ray of the non-dominant wrist

56
Q

Why should you only perform a growth hormone stimulation test if there is very high clinical suspicion?

A

Makes the child hypoglycaemic

57
Q

What are some imaging tests which may be required in investigation of a growth problem?

A

USS uterus/MRI brain

58
Q

Describe genetic short stature?

A

A healthy child who has inherited short stature from parents with no underlying endocrine abnormality and normal bone age

59
Q

Describe constitutional short stature?

A

Late maturation causing short stature with unknown cause

60
Q

When does constitutional short stature tend to present? What with?

A

Around puberty, with delayed onset and delayed bone age

61
Q

What does the line down the middle represent?

A

The mean

62
Q

What does this growth chart show?

A

Normal growth

63
Q

What does this growth chart show?

What does this indicate?

Is this worrying?

A

Dropping centiles for weight

This indicates that the child hasn’t grown as much as they should have

Yes

64
Q

This is a graph of weight distribution over the last 30 years showing a shift to the right.

What does the shift to the right indicate?

What does the longer tail increase?

What is the trend with height?

A

The mean value for weight has increased

Higher incidence of severe obesity

Upward, increasing height