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167 Cards in this Set

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  • Back
For children, what is the most important indicator of health?
Growth
What are the biggest predictors of illness in children?
Weight loss or gain
If a child has a serious bacterial infection, they will have tachycardia outside of proportion to ____?
Fever
How long should respiratory and HR be counted for?
1 minute
Each degree of Farenheit increase in a child raises the HR ___ to ___ beats/minute
8 to 10
At what age should BP be taken on a child?
>3
What is the upper limit of HR in children?>
160
What does rosiola cause?
Significant fever
If you have trouble getting a BP on a child, what trick should you use?
Raise the patients arm to make it louder
What are the 3 rules in measuring a child's height?
1. must be in the center of the scale
2. look at child's heels: they must be against the wall
3. head is eye level
If a child's measurement does not fit their growth curve, what should the nurse do first?
Remeasure!
The arm span of a child should be (< or >) the height span.
<
How old must a child be to start measuring BMI?
2
Accurate and reliable physical measurements are used to...
1. monitor the growth of a patient
2 detect growth abnormalities
3. monitor nutritional status
4. track the effectiveness of medical or nutritional interventions
What do weight for age charts indicate?
1. reflects body weight relative to age
2. influenced by recent changes in health or nutritional status
3. used in early infancy for monitoring weight and helping explain changes in weight-for-length and BMI-for-age in older children
True or False: Weight for age growth charts can be used to classify infants, children and adolescents as under or overweight?
FALSE!!
which growth chart is used to classify children as underweight, overweight or obese?
BMI-for-age
If a child presents with trunchal obesity and thin extremities, what should they be worked up for?
Cushings
Describe an abnormal channeling up?
When the child has crossed more than 2 growth curves
What percentage range of BMI does a child need to be in to be considered overweight?
>85th and <95th
What percentile on the weight for length/stature chart indicates obesity in children?
>95th
If a child is in the >95th percentile for BMI for age, what would they be diagnosed as?
obese
What ages is it common to have a drop in BMI with the lowest level of body fat?
Ages 4-6
If a child rebounds in their BMI before age 6, what can this be a sign of?
Future fighting with weight
What are the growth charts that can be used to determine if a patient is underweight and what percentile must they fall in?
BMI-for-Age and Weight-for-length
Short stature can be determined using which growth chart?
Stature/length-for-age and under the 5th percentile
Developmental problems can be assessed with which growth charts? What percentile would the patient fall in to be worked up for such problems?
Head Circumference for age chart

must fall in the <5th percentile and the >95th percentile
BMI is a (screener/diagnostic tool)?
Screener
Which is worse mico or macrocephaly?
Micro
What is the ballard/dubowitz scale?
Standards for intrauterine growth by gestational age
Define SGA.
Small for gestational age which is when the child is below the 10th percentile in weight, length or head circumference.
How would a child be considered large for gestation age?
THe chid's birth weight (or length or head circumference) lies above the 90th percentile for that gestational age
True or False: early puberty does not tend to cause obesity?
FALSE: it can cause obesity because growth slows down
In examining if a child's growth or lack there of is abnormal, what should the HCP obtain from the parents?
They must obtain the midparental height.
How do you determine the midparental height?
Girls: Father's height + mother's height - 5 inc/ 2

Boys: Father's height + mother's height + 5 inc/2

Target height: Midparental height= 2 SD (1 SD =2 inch)
What is the calculation for midparental height in cm?
Girls: (Father's height -13cm) + mother's height/2

Boys: (Father's height + 13cm) + mother's height/ 2
What is the predominant factor in growth from ages 0-2?
Nutrition
Growth Hormone plays the biggest factor in the growth of children of what age group?
2-12
Children ages 12 and up grow as a result of _____?
Sex steroids/growth hormone
What test should be done if a child has an abnormal temp of growth?
Bone age on the left wrist
True or false: a tall obese child may have hypothyroidism?
False! would not be tall
If the bone age is delayed by 2 or more years, what might the child have?
constitutional growth delay
What are terms of a constitutional growth delay?
1. family history
2. the child is healthy, grwoing below but parallel to the 3rd percentile line
3. between 6-24 months, the linear grwoth and weight track downward to the 3rd percentile
4. delay onset of puberty and a growth spurt and usually end up with heights in the lower half of the normal range
5. Slow growth rate between 12-30 months
Give 4 examples of confounding factors in late childhood growth?
-infrequent measurement opportunities
-normal prepubertal growth deceleration
-Effects of medications for common disorder (ADHD, asthma, depression)
-Normal variation in onset of puberty
-
Growth charts are designed for children to start puberty at ___ for girls and ___ for boys.
11 and 12.5
Describe type I growth drop?
Retardation of weight with near normal or slowly decelerating height and head circumference

Suggests undernutrition
Which pattern is described by near proportional retardation of weight and height with normal head circmference: constitutional growth delay, genetic short stature, endocrinopathies, structural dwarfs?
Type 2
Describe Type III patterns.
Concomitant retardation of weight, height and head circumference.

-SGA
-chromosomal aberrations
-CNS abnormalities
-Rarely familial
What is the normal US to LS in infants?
1.7 to 1.8 to 1
As a child approaches adolescence, their US to tLS ratio is ____ to ___
0.9 to 1.0: 1
In Marfan syndrome the Upper : lower segment ratio is ___?
Low
CNS and developmental problems have a tendency to make children go into puberty ____.
Earlier
What are 3 possible causes of deceleration of linear growth in a well-nourished child?
1. Growth hormone deficiency
2. Hypothyroidism
3. Glucocorticoid excess (cushing's)
What is the cause if a child has an initial decline in weight follow by decreased height velocity?
Malnutrition or systemic illness
Dysmorphic features are often caused by ___?
chromosomal abnormality
Skeletal dysplasia or metabolic bone disease are often a result of ____?
disproportionate features or skeletal abnormalities.
True or false: primary growth disturbances include intrauterine growth retardation.
Ture
What are the 5 general causes of short stature?
1. Normal patterns of growth
2. Primary growth distribution
3. systemic illness
4. genetic disorders
5. disproportionate short stature
what is one major symptom prader willi syndrome?
They eat all the time. Break into the fridge
What are the proper examination/test to conduct when w a child has decreased growth?
1. Physical exam
2. Free T4 and TSH
3. ESR
4. Electrolytes, BUN creatinine, UA, LFT
5. Bone age of left hand and wrist
Which hormones are responsible for skeletal maturation?
estrogen, thyroid hormone, androgen and growth hormone
Bone age is generally more than __ years in advance of chronological age in long-standing precocious ___ because of the action of ___ hormones.
2; puberty; sex
How do you take the bone age?
in the left hand and wrist a conventional xray is taken.
What is the most common cause of accelerated growth?
over-nutrition is the most common cause - weight affected more than height
What are the differential diagnoses to accelerated growth?
-Precocious puberty (adrenal or gonadal)
-Hyperthyroidism
-genetic (familial) or syndrome (Kleinfelter or Marfan's)
-GH excess
How is sexual maturity rated in males?
-size of the testes
-length of the penis and width
Female sexual maturity is rated on which 2 features?
1. breast development
2. pubic hair development
How is testicular size measured in boys?
-Prader orchidometer
What testicular size in boys is the first sign of puberty?
> or = to 4mL
What is the first sign of pubertal development in girls?
Breast buds
What is the official name for rating sexual maturity?
Tanner stages
85% of female have ____ as the first sign of puberty.
thelarche
What is Tanner 1 in girls?
No breast buds
If the breast bud diameter is </= areola width, the girl is in tanner __?
2
Describe tanner 3 in terms of female breast buds.
breast diameter > areolar width
Describe Tanner stage IV in girls.
Mounding of areola above plane of the breast
Adult breast are Tanner ___
5
Menarche occurs an average of ___ years ___ thelarche.
2; after
The peak height velocity of puberty in females is reached at ___ years immediately prior ___.
2; menarche
The long diameter of the penis must be ___cm to be considered the earliest sign of puberty.
2.5
What is tanner stage 2 in girls in terms of pubic hair?
slightly pigmented over mons or labia
If a girl has dark, course hair on the mons, what stage is she in?
Tanner 3
If a girl's pubic hair is adult in charactered and confined to the mons, which stage is this?
Tanner 4
Where is the pubic hair located in a girl with Tanner 5?
spread to the medial thigh
True or False: In males, the length of the penis growth before the width.
True
Describe Tanner stage 3 of the male genitalia.
Phallus growth in length

Testes > 3cm, Volume 6mL-8mL
Which tanner stage in males corresponds to Testes >4cm and Volume 10-15mL.
Tanner 4: Phallus growth in width
Describe Tanner stage 5 of male genitalia.
Adult testes >5cm
Volume >15mL
What is Tanner stage 1 for male sexual maturation?
Testes, scrotum and penis about same size and proportion as early childhood
If the skin of the male scrotum reddens and changes in texture, but little or no enlargement of the penis has occur (10.5-12.5), which tanner stage is the male in?
Tanner 2
Stage and describe when Males have enlargement of the penis.
Tanner 3: first mailing in length; further growth of scrotum and testes
When is the peak height velocity achieved in males?
age 14, stage 4
The peak height velocity in ___ occurs in stage 3.
Girls
The increase in statue in males is due to ___ produced by the ___, so the growth spurt in stature is preceded by an increase in the size of the ____.
androgens; testes; testes
Androgens cause the penis to ___ and ___
Lengthen and widen
True or False: Men quickly enter stage 3 tanner?
FALSE: they take their time
What stage of Tanner is descriptive of male pubic hair that is adult like but not spread to the thigh?
Stage 4
Girls must have enough ___ to make sex hormones.
Cholesterol
From What stage do girls tend to maintain their weight?
Tanner 3
Between the ages of 12-13, girls at the 5th percentile gain less than ___ lbs, while those at the 95th percentile gain more than __ lbs.
8; 13
Explain why girls have an increase in weight that peaks just prior to menarche.
in early puberty their accumulation of total body fat, but during their peak height velocity they accelerate their accumulation of fat and lean body tissue
Boys tend to decrease body fat after age ___.
14
If a child's BMI is increasing at a rate of 0.5 units/year during most of their second decade, what percentile are they likely in?
5th
With rapid bone growth, ___ ___ levels increase.
alkaline phosphatase
T or F: Alkaline phosphotase levels can be 50-100% above the normal range during rapid bone growth.
Ture
Pre-pubertal growth (> or <) post-pubertal growth?
greater
A child who as a delay in puberty has a tendency to be (taller/shorter)
Taller
What does serum alkaline phophatase levels indicate?
Reflects growth/ turnover of bone
What is the definition of delayed puberty?
The absence or incomplete development of 2nd sexual characteristics by an age at which 95% of children of that sex and culture have initiatied sexual maturation
What is the upper 95th % age range for development of secondary sex characteristics for boys and girls in the US?
Boys: 14
girls: 12
Define adrenarche.
increased adrenal androgen secretion
When and what occurs during adrenarche?
-Occurs between ages 6-8
-transient growth spurt
-some children develop0 axillary and pubic
-no sexual development occurs
What are the 2 hormones that control gonadarche in boys and what do they specifically do?
-LH stimulates testosterone production
-FSH stimulates sperm maturation
What do FSH and LH do in girls?
-FSH stimulates estrogen and follicle formation
-LH stimulates the corpus luteum after ovulation
At what age in both boys and girls would adrenarche be considered precocious?
Boys: before age 9
Girls: Before age 7 (white)
before 6.5 (black)
What is the mean menarcheal age for white and black females?
Black: 12.2
White: 12.9
What disorder occurs when the endocrine organ (gonads) are not functioning and causes the pituitary to over produce the hormones?
Hypergonadotropic hypogonadism: high LH and FSH
What is hypogonadotropic hypogonadism?
Low or normal LH and FSH is secondary to constitutional delay or a central gonadotropin deficiency
List the requirements to have precocious puberty in girls?
-any sign of puberty in a girl less than 8
-with increase to tanner 3 in 6-12 month period in 6-8 year old
-menarche before age 10
-pubic hair
-white: before age 7
-black: before age 6
why would a girl who has menarche at age 10 be diagnosed with precocious puberty?
Puberty in girls begins 2 years before menarche: age 8 = age cut off for girls
What is one common cause of precocious puberty?
Adrenal hyperplasia
is precocious puberty in boys usually pathologic?
Yes, 50 % of the time. It is more common in girls
True or false; it is a red flag if menarche occurs without breast bud development in girls.
TRUE
What is contrasexual development?
Feminization of boys and virilization of girls
What are the red flags for pathologic pubertal development?
1. penis enlarges without scrotal
2. extensive pubic hair growth
3. rapid growth in breast development through tanner 3 before age 8
4. elargement of penis without testies
5. documented growth acceleration in a 6-12 month period in a girl less than 8 or boy less than 9
6. any clitoral enlargement, voice deepening, or increase in muscle mass
What is incomplete precocious puberty?
premature thelarche, adrenarche
What is the most common variation in girls in relation to precocious puberty?
premature thelarche, occurs in 1-4 years of age
T or F: premature thelarche is benign if it is not associated with the onset of other pubertal events.
TRUE
How would precocious adrenarche show in children?
Growth of axillary hair with odor stimulated by androgen. Also look for testicular enlargement in boys
What is psuedo-precocious puberty?
-some of the changes of puberty are present
-but appearance is isolated or out of normal sequence
What is isosexual puberty?
-when the changes of puberty are consistent with the child's gender
-when they are discordant with gender they are heterosexual
What is gonadotropin independent ovarian disease?
Decreased secretion of gonadotropin releaseing hormonal and prepubertal or lower level of LH and FSH
What are the most common ovarian causes of gonadotropin independent ovarian disease?
-follicular cysts of the ovary
-McCune Albright syndrom
-Granulosa-theca cell tumors of the ovary
Describe gonadotropin independent testicular disease and the common causes.
Increase in serum testosterone concentration with normal or low LH and FSH

-Leydig cell tumor
-difference in testicular size
-chronic gonadotropin secreting germ cell tumors
-McCune Albright syndrome
What is the best way to test for precocious adrenarche?
Smell the armpits!
What could hypertension in children with rapid CPP suggest?
congenital adrenal hyperplasia due to deficiency of 11 beta hydroxylase
What are 6 indicators that there is adrogenic influence on precocious puberty?
1. acne
2. facial or axillary hair
3. increased muscle bulk
4. extent of pubic hair
5. penile elongation
6. scrotal rugation increased with thinning
What do the presence of cafe au lait spots show for puberty?
Possible neurofibromitosis or McCune Albright syndrome
What should the HCP assess for in terms of thyroid function if a child has precocious puberty?
Thyroid enlargement or presence of myxedema
What findings help determine if precocious puberty is has estrogenic influence?
-size of breast tissue
-must distinguish breast from soft smooth consistency of increased fat
-reddish, les moist vaginal mucosa in prepubertal girl
-pale moist appearance of pubertal vaginal mucosa, elongated clitoris
-labia minor more visible as puberty progress
In clinical evaluation, what are the evidence of gonadotropic stimulation?
-measure phallic and testicular dimension: testicle must be =
-without testicular enlargment, penis enlargment, adrenal pathology
-testicular volume is greater than phallic size in normal puberty, CPP and Primary hypothyroidism
What are some examples of evidence of a mass involved with precocious puberty?
-asymmetric testicular enlargemtn
-hepatomegaly
-abdominal mass
What laboratory tests should be done during a work up for precocious puberty?
-CBC
-erythrocyte sed rate
-liver function test
-TSH and free T4
-bone age of left wrist
What serum tests should be taken to help distinguish between primary and secondary hypogonadism
random serum LH and FSH
-estradiol in girls and testosterone in males
A girl has delayed puberty if she has no menarche ___ years after breast development or no ___ by age 16.
5; menses
Over 50% of delayed puberty is due to ___ ___.
constitutional delay: late bloomer
What is the treatment for delayed puberty?
testosterone for males and estrogen for females
What is the most common cause of short stature?
familial or due to constitutional growth delay
When should a HCP worry about short stature in a child?
-abnormally slow growth rate
-downward crossing of percentil channels on the growth chart after the age of 18 months
-height below the 3rd percentile
-height significantly below genetic potential by 2 SD
What are the symptoms of Turner's syndrome?
-multiple nevi
-low posterior hairline
-webbed neck
-broad chest with wide spaced nipples
-short fourth metacarpals
-increased carrying angle of arms or CUBITUS VALGAS
What is cubitus valgas? when is it seen?
increased carrying angle of arms often seen in turner's syndrome
List the systemic illness that are associated with short stature.
1. hypocaloric (malnutrition, GI, poorly controlled DM)
2. Metabolic (Renal, hepatic, cardiac, hematologic, respiratory, chronic infection)
3. Endocine (hypothyroidism, cushing's, GH deficiency
What are some common causes of structural overgrowth in infancy?
-maternal diabetes
-cerebral gigantism
-beckwith-wiedemann syndrome
What is the most common cause for LGA infants?
Maternal diabetes
What is Soto's syndrome? Describe the symptoms
cerebral gigantism

-high forehead
-frontal bossing
-hypertelorism
-prominent jaw
-high arched palate
-mental retardation
-poor coordination
What are the symptoms of Beckwith-Wiedemann syndrome?
-Macrosomia
-visceromegaly
-macroglossia
-omphalocele
-prominent occiput
-hypoglycemia with hyperinsulinism
Name 6 non-endocrine disorders that can cause structural overgrowth in childhood.
1. familial
2. exogenous obesity
3. precocious puberty
4. marfan syndrome
5. homocystinuria
6. neurofibromatosis type 1
What endocrine disorder can cause structural overgrowth?
Growth hormone excess
which hormones are in the upper range of normal for familial tall stature?
GH secretion, serum IGF-1 and IFG binding protein-3
True or false: exogenous obesity can cause short stature. explain.
TRUE: bone age may be advanced and puberty starts early causing premature epiphyseal fusion
What is acromegaly>?
Disorder of GH excess in adulthood
What is gigantism?
Excessive linear growth that occurs with growth hormone excess when epiphyseal growth plates are open during childhood
What endocrine disorder can cause structural overgrowth?
Growth hormone excess
which hormones are in the upper range of normal for familial tall stature?
GH secretion, serum IGF-1 and IFG binding protein-3
True or false: exogenous obesity can cause short stature. explain.
TRUE: bone age may be advanced and puberty starts early causing premature epiphyseal fusion
What is acromegaly>?
Disorder of GH excess in adulthood
What is gigantism?
Excessive linear growth that occurs with growth hormone excess when epiphyseal growth plates are open during childhood