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93 Cards in this Set

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What is the definition of latency?
Period of development b/w 6-12 yo.
Away from the safety and security of the home, what skills are greatly accelerated during latency?
Socialization skills.
What is the orderly progression of skeletal growth?
Distal to proximal in both extremities.
How many months after leg growth will there be an increase in width of chest and hips?
4 months
What are the last manifestations of the pubertal growth spurt?
Elongation of the trunk & increase in the AP diameter of the chest are the last manifestations of the pubertal growth spurt.
The distance between what 2 points is greater in males, secondary to androgens?
Biacromial distance.
The distance between what 2 points is greater in females, secondary to estrogens?
Greater bitrochanteric distance.
Why do males have longer arms and legs relative to total body lenth?
b/c of later onset of growth spurt.
Why is the carrying angle of the male arm less than that of the female?
Due to differential growth of cartilage of the lateral humeral epicondoyle during puberty.
Growth velocity is at its lowest point when?
Just before puberty.
For females, when does peak growth occur?
Before menarche, 12 years old
For males, when does peak growth occur?
Mid to late puberty-14 yo
What is an examination of skeletal maturity used to assess the pace of physical growth?
Bone age.
How is bone age determined?
By getting an x-ray of wrist and comparing the adolescent hand to normal wrist in adults.
Delayed bone age will be seen in adolescents with what illnesses?
Hypothyroidism, Hypopituitarism, Chronic illness, and constituational delay of puberty (most common cause)
How is height age determined?
By locating the corresponding age where height reaches 50% on growth chart. Find actual height of child, and draw line to the left to find where it crosses the 50% mark.
If a person falls dramatically off the curve in regards to weight, what does this mean?
There has to be some difficulty or other problem going on.
What is the upper segment ratio?
Measured from crown of head to pubic symphysis.
What is the lower segment ratio?
Measured from symphysis to bottom of feet.
What is the average upper:lower ratio at birth?
1.7
What is the average upper:lower ratio at age 10?
1.0
What is the average upper:lower ratio of an adult?
0.9-1.0
What is the average upper:lower ratio of an individual with hypothyroidism & chrondoplasia?
>1.0
How is adult height predicted for a female?
Paternal height + maternal height -5 /2
How is adult height predicted for a male?
Paternal height + maternal height +5/2
All control of growth & sexual maturation starts where?
CNS
Changes of sexual maturation are regulated by what hormone?
Gonadotropin releasing hormone.
What does gonadotropin releasing hormone have an affect on?
Gonadotropins-->LH, FSH
What does the ovary produce?
Estradiol & progesterone.
What do the testes produce?
Testosterone.
What happens to the hypothalamic-pituitary axis in the pre-pubertal period?
Quiescent-prominence of inhibiting neural pathways
What happens to the hypothalamic-pituitary axis at puberty?
Less inhibition of gonadotropin secretion, decreased sensitivity of the hypothalmic pituitary axis, and less inhibition of sex steroids.
What hormones are responsible for pubic hair development?
Secretion of androgens by adrenal glands.
When does pubic hair development occur?
3-6 months after breast budding or testicular enlargement.
In females, what is thelarche, the first sign of sexual maturation?
Breast budding.
In females, when does pubic hair appear?
Pubic hair appears 3-6 months later, after breast budding.
What is pubarche?
When pubic hair appears, 3-6 months later.
What happens to hair/skin during sexual maturation?
Increased oiliness of hair/skin, increased perspiration and body odor.
When does the peak growth for a female occur?
Age 12.
When does the first bleed for a female occur?
Within 2.5 yrs. of breast budding.
When is the average age of menarche?
12.5-13 yrs.
By menarche, how much of pubertal physical development and growth potention have females completed?
75% of pubertal physical development, and more than 90% growth potential.
For a female, when is normal sexual development complete?
Within 1.5-5.5 years (avg.3.5) following observation of first physical features.
What is the first sign of sexual maturation in a male?
Testicular enlargment.
For a male, during what time frame does growth of the penis occur?
12-18 months later, after first sign of sexual maturation (testicular enlargement)
For a male, when does pubic hair growth occur?
3-6 months after testicular enlargement.
What is pubertal gynecomastia?
Breast growth may occur in males in puberty.
When does peak growth occur for a male?
2-2.5 years after testicular enlargment and continues until complete fusion of epiphysis.
At what age does precocious puberty occur in males and females?
Females: 8 yo
Males: 9 yo
In whom is precocious puberty more common?
Females more than males.
What causes central precocious puberty?
Gonadotropin dependent-secondary to head trauma, tumors (hamartomas of hypothalamus)
What causes peripheral precocious puberty?
Elevation of circulating sex steroids that may come from ingested sex steroids, tumors, or enzymatic defects.
To make a diagnosis for precocious puberty, what must one look for in the history?
History of trauma to CNS or infections
To make a diagnosis of precocious puberty, what diagnostic exams must one get?
X-ray the skull, get a bone age.
Labs: 24 hr. urinary ketosteroids, LH, FSH, testosterone
What is the requirement for a female to have delayed puberty?
If no breast budding by age 13.
What is the requirement for a male to have delayed puberty?
If no testicular enlargement by age 14.
In whom is delayed puberty more common?
More common in males than females.
What do all of these illnesses play a role in?
Congenital heart disease, diabetes, sickle cell, collagen disease, anorexia, hepatitis
Delayed puberty
1.Short stature
2.Lethargy
3.Poor school performance
4.Cold intolerance
5.Coarse brittle hair
6.Delayed achilles reflex
7.T4, TSH are adversely affected
8.Treatment with thyroxine
All of these are characteristics of what illness?
Hypothyroidism.
Besides hypothyroidism, what other illness causes delayed puberty?
Hypopituitarism.
What syndrome is the most common cause of delayed development associated with increased serum gonadotropins?
Turner's syndrome.
45XO, primary amenorrhea, webbed neck, increase carrying angle, low hair line, high arched palate, short stature, etc....These are all characteristics of what syndrome?
Turner's syndrome.
1.47XXY
2.Testicular atrophy
3.Gynecomastia
4.U:L segment ratio decreased
5.Azospermia & infertility
6.Mental retardation common
These are all symptoms of what syndrome?
Kleinfelter's syndrome.
1.Gonadotropin deficiency secondary to defect in hypothalamus.
2.Often have anosmia (lack of smell)
3.Delayed puberty
These are all symptoms of what syndrome?
Kallman's syndrome.
To evaluate delayed puberty, an x-ray of what should be taken?
Lateral skull x-ray to evaluate pituitary fossa.
How should females with short stature and delayed development be evaluated for delayed puberty?
Buccal smear.
What is the most common diagnosis in adolescent with delayed growth and sex maturation and normal serum gonadotropins?
Constitutional Short Stature
1.Healthy male, short in stature since infancy or childhood
2.Father or brother with similar patterns with attainment of adult height by 20 years
3.Moderately delayed bone age 1/5-4 years
4.Bone Age=Height Age. Potential for growth to still occur.
5.Normal physical exam, etc
What is the diagnosis?
Constitutional Short Stature
What is enuresis?
Bed wetting.
In whom does enuresis usually occur?
Heavy sleepers.
How does enuresis occur?
As child moves from deep to light sleep, they lose bladder control of detrussor muscle and void
What lab tests are obtained for enuresis?
UA, and urine culture to rule out UTI
What treatments are given for enuresis?
1.Sleep dry alarm
2.DDAVP 0.2 mg, give 1-3 at night
How does DDAVP, a treatment for enuresis work?
Acts on collecting tubules which lets individual hold on to more water.
During latency what immunizations are important?
TDaP, for 13 yo-->Menoctra vaccine for meningitis, Gardisil vaccine for HPV
Maximal increase in muscle mass will not be possible to achieve until individual has attained what stage of Tanner maturation?
Tanner 4-5 maturation
When does strength increase potential occur in males?
One year after peak height velocity (14 yo)
When does strength increase potential occur in females?
Occurs during the year of peak height velocity (12 yo)
When sports players are grouped together by Tanner development rather than chronological age, what does this lead to?
Less injuries.
At what tanner stage, are athletes in a period of most rapid bone growth with greatest risk to epiphysis?
Tanner 3
What is the strenght of the growth plate compared to the strenght of the ligaments?
Strength of growth plate is 1/3 the strength of ligaments.
65% of growth in lower limb occurs around what area?
Knee
35% of lower limb growth occurs in what area?
Distal femur
30% of lower limb growth occurs in what area?
Proximal tibia
What part of the knee attaches to the growth plate and can result in fracture?
Collateral ligaments
In an adult, would the ACL cause an avulsion fracture of the tibial plateau?
No, in an adult the ACL would tear.
In an adult, an inversion ankle sprain would cause injury of what?
Anterior talofibular ligament
In children, an inversion ankle sprain would cause injury of what?
Distal fibular epiphysis
Where does Osgood Schlatter disease occur?
Occurs where patellar tendon comes into tibial tubercle.
In Osgood Schlatter disease, swelling over the tibial tubercle usually occurs around what time frame?
At time of rapid growth.
How is Osgood Schlatter disease treated?
Ice massage with ice from styrofoam cup.
What is Sever's disease?
This is similar to Osgood Schlatter's, but occurs where achilles inserts into calcaneus.
What is the most common cardiac lesion responsible for sudden death in young athletes?
Hypertrophic obstructive cardiomyopathy.