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47 Cards in this Set

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when measuring growth, what factor is most important
change over time (comparison of how big they were then and now)
utah growth study determined that endocrine caused how many growth problems
5% had an endocrine cause for their short stature.
short stature definition
standing height more than 2 SD below the mean for gender.
how do you compare growth patterns
Gender specific reference charts have been published for weight and height for most developed countries, most ethnic subpopulations, and the most common genetic disorders.
common causes of short stature
Primary Growth Disorders
Chronic Disease—including genetic and undernutrition
Familial Short Stature
Constitutional Delay of Growth and Development
before you get a zillion tests for short statures, what is most important
a good history, growth patterns, ROS (to rule out chronic disease), assess how the kid feels about their height
what do you examine in a kid to monitor their growth patterns
Height and weight
US/LS ratio
Inspect mucous membranes
Examine the midface
Test visual fields (if you pit has a tumor it can affect vision)
Palpate the thyroid
Cardiopulmonary exam
Look for other dysmorphisms
measurement of the head and limbs ratio
Anthropometric Measurments
know the bone age!! her favorite test
AP X-Ray of the left hand and wrist
Determines epiphyseal maturation by comparing to the published standard
Linked more closely with sexual maturity rating rather than chronological age
causes for delayed bone growth
constitutional growth delay, chronic illness, malnutrition, endocrinopathy (thyroid disease, GH def), psychosocial deprevation
The most common cause of short children is short parents.
Inheritability of height is 70-80%.
Growth velocity is normal.
Pubertal growth spurts are normal in timing and magnitude.
Bone age=Chronological age
familial short stature
bone age is delayed 2-4 years, bone age consistant with height and SMR rather than age, the late bloomers
constitutional growth delay
A 12 year old boy is on the 5th percentile for height and the 10th for weight. Both his parents are below average for height. what can you expect
pubertal growth spurt will occur on time, puberty will not be delayed
where is GH synthesized
anterior pit
function of GH
fatty acid release for adipose, insulin resistance, regulates blood glucose, bone thickness, soft tissue growth, protein synthesis
when does GH get secreted most often
during sleep: stage III, IV (non-rem)
why is GH released in a pulsatile fashion
the alternation between GHRH and somatostation
why do you grow during puberty
the increase in androgens increase the release of GH
what does GH release to cause growth
IGF-1 and 2 from the liver
Short stature, poor linear growth, delayed bone age
growth hormone deficiency
Low levels of IGF-1 and IGFBP-3 suggest
GH deficiency
why can you not check GH to determine growth hormone deficiency
its pusatile release makes it hard to distinguish a low part of the cycle and deficiency
what are acquired growth hormone deficiencies
radiation, malignancy, menigitis, histocytosis, trauma (ie: head trauma to hypothalamus)
side effect of GH tx
increase development of malignancy
who does not get GH tx
Kids with past malignancies & scoliosis kids
side effects of GH tx
Insulin resistance
Mild sodium and water retention
Transient lowering of thyroxine levels
Increased development of malignancies
Scoliosis
Gynecomastia
Slipped capital femoral epiphysis
if you have too much GH, what can happen
Prepuberty: gigantism
Postpuberty: acromegaly—bony and soft tissue overgrowth
Disorder affecting linear bone growth
osteochondroplasia (such as achondroplasia, hypochondroplasia, diastrophic dysplasia)
AD, short limbs, long trunk, midfacies, FGFR 3 mutation (what does this mutation cause)
the mutation affects the collagen deposition on bones - achondroplasia
the sulfate transporter is affected and affected cartilage deposition in bones
diatrophic dysplagia
chromosomal defects causing short stature
down syndrome, turner syndrome
turner syndrome characteristics (what characteristic are you looking for to make you diagnosis)?
Short Stature (key to dx)
Webbed neck
Increased carrying angle (elbow angle)
Peripheral edema
Ovarian failure
Mosaic form may not present until puberty
Short adolescent females with amenorrhea should all have a karyotype done
if you have a female with short stature, amenorrhea, age 15-16, what should you do
get a karyotype (you are thinking she has turner syndrome)
can you treat turner syndrome with GH tx?
YES
IUGR stand for
intrauterine growth retardation
causes of IUGR
primodial growth failure, placental abnormalities causing poor vascularization, maternal disease (mom has HTN, mom on drugs, mom malnurished)
Below normal linear growth rate, increased weight gain, and delayed bone age
hypothyroidism
Absence of distal femoral epiphysis
Epiphyseal dysgenesis
congenital hypothyroidism
PEDS endocrine growth disorders
hypothyroidism, cushing, GH axis disrupted
what does excess cortisol levels cause?
cushing syndrome
what is the disorder if a kid presents below normal linear growth, with delayed bone age, and round face, obesity, skin ulcers
cushing syndrome
how do you tx a cushing pt
remove the extra cortisol whether is exogenous or endogenous
related to abuse and neglect, disturbed eating and sleeping pattern, delayed bone age
transient pit hormone deficiency, psychosocial dwarfism
transient pituitary homrone deficiency
psychosocial dwarfism
A 14 y.o. is concerned because he’s shorter than his classmates. On exam he has the sexual maturity rating of a 12 year old. His dad says he had a similar problem, but grew out of it by the time he reached college. what do you expect to see on an x-ray?
delayed bone age this is constitutional growth delay
Which of the following is the key to diagnosis of Turner Syndrome?
short stature
what is the US/LS ratio for a new born ? 2 year old? 10 year old? adult?
1.7 vs 1.4 vs. 1.0 vs 0.9