Newman Clin Med

Question 1

Discuss the information garnered by a single point on the growth chart.

Answer 1

single point= how they plot on the curve THAT day

Question 2

what is necessary to evaluate rate of growth/growth pattern?

Answer 2

Multiple points

Question 3

NL BMI

Answer 3

“NL” = 18.5 - 24.9

Question 4

3. State the normal growth velocity for school age children.

Answer 4

NL rate of linear growth5YO => puberty is 5cm/year (2 inches/year).

Question 5

Growth parameter most commonly 1st affected in children with endocrine growth disorders.

Answer 5

Length or height

Question 6

5. Define what is meant by “delayed bone age.”

Answer 6

2 standard deviations or more below the chronologic age of the patient = delayed

Question 7

when should we begin to become concerned about growth patterns on a charge

Answer 7

when the points plotted on the growth chart for one (or all) growth parameters begin to deviate up or down from what had been the normal growth rate for that child

Question 8

Growth parameters on a growth chart include

Answer 8

1. height (or length if <24 months)
2. weight
3. BMI (if >36 months-of-age)
4. head circumference (if <24 months-of-of age)

Question 9

• if height parameter changes FIRST or more dramatically = think ________
• if weight parameter changes FIRST or more dramatically = think _______
• if head circumfrance changes 1st or more dramatically = think __________

Answer 9

• if height parameter changes FIRST or more dramatically = think endocrine
• if weight parameter changes FIRST or more dramatically = think calories/nutrition
• if head circumfrance changes 1st or more dramatically = think brain/skull/hydrocephalus

Question 10

conclusions?

Answer 10

child is big, but well-proportioned. no problems :)

Question 11

conclusions?

Answer 11

bbs weight has fallen off 1st and most dramatically: think caloric deprivation

• 1. not getting fed enough
• 2. not retaining enough calories (GERD, malabsoprtion)
• 3. Being fed NL, but metabolic demands are higher than NL (hyperthyroidism, congenital <3 dz)

Question 12

conclusions

Answer 12

Head circumfrances shows RAPID growth = hydrocephalus

Question 13

concluision?

Answer 13

length is falling off 1st and more dramatically: think endocrine (growth hormone deficiency)

Question 14

what is short stature?

Answer 14

• height > 2 SD below the mean height (50th percentile) for age and sex (below 3%))
• height is 2 SD below the mid-parental height

Question 15

what are the 3 most common benign causes of short stature?

Answer 15

• 1. familial (parents are small)
• 2. constitutional growth delay
• 3. Idiopathic (no endocrine, metabolic, other dx, no FHx)

Question 16

how we can ID familial causes of short stature on a chart?

Answer 16

Growls with NL velocity in all parameters; just plot lower on the growth cruve and their end height is consistent with mid-parental height.

Question 17

what is bone age?

Answer 17

• Bone age = gives us a rough estimate of a child’s skeletal maturation by assessing the ossification of the epiphyseal centers
• Bone age should be consistent with chronological age; if 2 SD below chronological age = delayed.

Question 18

What is constitional growth delay of short stature?

Answer 18

• Delayed puberty, however a puberty/growth spurt occur and the end height is NL.
• Usually FHx of “late bloomers”

Question 19

how we can ID constitional causes of short stature on a chart?

Answer 19

grow at a low NL rate and plot low on growth curve.

Question 20

Hallmark of constitional causes of short stature

Answer 20

delayed bone growth

Question 21

how we can ID idiopathic causes of short stature on a chart?

Answer 21

Height is MORE than 2 SD below the mean for height for age.

Question 22

Which causes of short stature are the [bone age] consistent with [chronological age]?

Answer 22

1. Familial
2. Idiopathic

Question 23

Discuss the importance of Insulin-like Growth Factor (IGF-1) and IGF Binding Protein 3 (IGFBP-3) in the work-up of short stature.

What are they?

Answer 23

• IGF-1 = hormone that is the major mediator of GH stimulated somatic growth
• IGFBP-3 = main IGF-1 transport protein in the blood

Question 24

What proves that IGF-1 contributes to statural growth?

Answer 24

GH = ↑ IGF–1 synthesis by osteoblasts and chondrocytes.

Question 25

Discuss the importance of Insulin-like Growth Factor (IGF-1) and IGF Binding Protein 3 (IGFBP-3) in the work-up of short stature.

Answer 25

• ↓ in IGF-1 and IGFBP-3 levels on work- up = ↓ GH

Question 26

When is the best time to check IGF-1 and IGFBP-3 levels?

Answer 26

Anytime :)

Levels are stable throughout the day because GH secretion is pulsatile

Question 27

If IGF-1 and IGFBP-3 levels are ↓, what should be done?

Answer 27

[Growth hormone stimulation testing]

Question 28

What are the 3 most reliable [GH stimulation tests]?

Answer 28

• 1. Administration of glucagon
• 2. Administration of arginine
• 3. Insulin induced hypoglycemia

Question 29

Define precocious puberty

Answer 29

Onset of secondary sexual characteristics

• Before 8 YO in girls
• Before 9 YO in boys

Question 30

Define precocious puberty and discuss the clinical settings in which the diagnosis should be

considered (in boys and girls).

Answer 30

Girls: progressive breast development and crossing major percentile lines upward on the linear growth chart

Boys: evidence of both testicular and penile enlargement and crossing major percentile lines upward on the linear growth chart

Question 31

Describe the basic work-up (growth measurements, lab, x-rays, etc.) for suspected precocious

puberty.

Answer 31

1. Hx and PE

2. Labs

3. Imaging

Question 32

H&P for precocious puberty

Answer 32

• 1. FHx of precocious puberty?
• 2. Exogenous steroids?
• 3. Throrough neurologic ROS and exam

Question 33

Labs for precocious puberty

Answer 33

1. LH/FSH
2. Estradiol and/or testosterone
3. 17-hydroxyprogesterone

Question 34

Imaging for precocious puberty

Answer 34

• 1. Bone age (will be advanced in precocious puberty)
• 2. MRI of head (CNS tumor?
• 3. US of gonads