Disorders of Growth — MCQs
What is the growth status of a child who has a normal weight but is below average height for their age?
A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?
Best indicator of growth monitoring in children is
Which of the following is not a feature of Turner's syndrome?
Following are the features of cretinism, except
A boy presented with prolonged jaundice, constipation, and umbilical hernia. What is the probable diagnosis?
Which of the following is true regarding precocious puberty:
Which is false in Congenital Hypopituitarism?
In the case of a 7 -year-old school-going child, which would be the most appropriate indicator to measure the current nutritional status?
Ear lobe creases in a child are commonly associated with which disorder that also presents with macroglossia and macrosomia?
Disorders of Growth Indian Medical PG Practice Questions and MCQs
Question 1: What is the growth status of a child who has a normal weight but is below average height for their age?
- A. Wasted and stunted
- B. Wasted
- C. Stunted growth (Correct Answer)
- D. None of the options
Explanation: ***Stunted growth*** - **Stunting** is defined as having a **low height-for-age**, indicating **chronic undernutrition** or recurrent illness. - A child with normal weight but below-average height fits this diagnostic criterion for impaired linear growth. *Wasted* - **Wasting** describes having a **low weight-for-height**, indicating **acute malnutrition** or rapid weight loss. - This child has a normal weight, so they are not considered wasted. *Wasted and stunted* - This option refers to a child with both **low weight-for-height** (wasted) and **low height-for-age** (stunted). - Since the child has a normal weight, they are not wasted, even if they are stunted. *None of the options* - This option is incorrect because the child's presentation clearly matches the definition of **stunted growth**. - The specific term "stunted" accurately describes a child who is too short for their age.
Question 2: A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?
- A. Malnutrition
- B. Familial short stature
- C. Constitutional short stature (Correct Answer)
- D. Cretinism
Explanation: ***Constitutional short stature*** - This condition is characterized by a **delayed bone age** compared to chronological age, indicating a delay in skeletal maturation. - Children with constitutional short stature typically have **normal parental height** and will eventually reach a normal adult height, although puberty and growth spurts are often delayed. *Malnutrition* - While malnutrition causes **short stature** and **delayed bone age**, it would also likely present with other signs of nutritional deficiency such as **weight loss** or failure to thrive. - The case does not mention any dietary issues or poor socioeconomic conditions typically associated with malnutrition. *Familial short stature* - In familial short stature, the child's height is typically proportional to the parents' height, indicating a strong genetic component to their shorter stature. - It is characterized by a **normal bone age** for chronological age, unlike the delayed bone age seen in this child. *Cretinism* - Cretinism, or congenital hypothyroidism, results in **severe growth retardation** and **delayed bone age**. - However, it is also associated with distinct features like **coarse facial features**, macroglossia, umbilical hernia, and severe developmental delays, which are not mentioned in this case.
Question 3: Best indicator of growth monitoring in children is
- A. Weight
- B. Mid-arm circumference
- C. Rate of increase in height & weight (Correct Answer)
- D. Head circumference
Explanation: ***Rate of increase in height & weight*** - Monitoring the **rate of increase** in both height and weight over time provides a comprehensive picture of a child's growth trajectory and identifies deviations from normal growth patterns. - This indicator helps detect both **acute and chronic malnutrition**, as well as potential endocrine or genetic disorders affecting growth. *Weight* - While important, **absolute weight** at a single point in time can be misleading as it doesn't account for age or previous growth. - It's a key component of growth assessment but needs to be evaluated in terms of **weight-for-age** or **weight-for-length/height** and plotted over time to show growth velocity. *Mid-arm circumference* - **Mid-arm circumference (MAC)** is primarily an indicator for assessing **acute malnutrition**, especially in emergency settings, due to its correlation with muscle and fat mass. - It does not provide a complete overview of a child's overall growth and development as it doesn't reflect linear growth. *Head circumference* - **Head circumference** is a crucial indicator for monitoring **brain growth and neurological development**, particularly during the first two years of life. - While important for detecting conditions like microcephaly or hydrocephalus, it is not the best single indicator for overall physical growth status.
Question 4: Which of the following is not a feature of Turner's syndrome?
- A. Bicuspid aortic valve
- B. External genitalia are normal
- C. Swelling of nape of neck
- D. Tall stature (Correct Answer)
- E. Cubitus valgus
Explanation: ***Tall stature*** - **Tall stature** is a feature of conditions like **Klinefelter syndrome** (XXY), not Turner syndrome. - Individuals with Turner syndrome (monosomy X) typically present with **short stature**, which is one of the most consistent clinical features. *Bicuspid aortic valve* - A **bicuspid aortic valve** is a common cardiovascular anomaly found in individuals with Turner syndrome. - This congenital heart defect can lead to complications such as **aortic stenosis** or **aortic regurgitation**. *External genitalia are normal* - The **external genitalia** of individuals with Turner syndrome are typically **normal** and female in appearance at birth. - However, they experience **gonadal dysgenesis** (streaky ovaries), leading to primary amenorrhea and infertility. *Swelling of nape of neck* - **Swelling of the nape of the neck** is characteristic of Turner syndrome, often presenting as **nuchal folds** or a **webbed neck**. - This is due to **lymphatic malformation** during fetal development. *Cubitus valgus* - **Cubitus valgus** (increased carrying angle of the elbow) is a common skeletal abnormality in Turner syndrome. - This results from abnormal bone development and is present in approximately 50% of individuals with Turner syndrome.
Question 5: Following are the features of cretinism, except
- A. Normal intelligence (Correct Answer)
- B. Characteristic facial features
- C. Pot-belly
- D. Stunted growth
Explanation: ***Normal intelligence*** - **Cretinism** (congenital hypothyroidism) is characterized by **severe mental retardation** if left untreated during critical developmental periods. - Normal intelligence is **not** a feature; rather, impaired cognitive development is a hallmark of the condition. *Characteristic facial features* - Patients with cretinism often present with **coarse facial features**, including a **puffy face**, broad nose, and thick lips. - These distinct features are a diagnostic clue for untreated congenital hypothyroidism. *Pot — belly* - A **protuberant abdomen** (pot-belly) is a common sign in infants and children with cretinism. - This is often accompanied by **umbilical hernia** due to generalized hypotonia. *Stunted growth* - **Dwarfism** or severely stunted growth is a prominent feature of cretinism due to the critical role of thyroid hormones in skeletal development and linear growth. - Delayed bone maturation and short stature are expected.
Question 6: A boy presented with prolonged jaundice, constipation, and umbilical hernia. What is the probable diagnosis?
- A. Growth hormone deficiency
- B. Kernicterus
- C. Congenital adrenal hyperplasia
- D. Congenital hypothyroidism (Correct Answer)
Explanation: ***Congenital hypothyroidism*** - **Prolonged jaundice** is a common and early sign in congenital hypothyroidism due to delayed bilirubin conjugation and excretion. - **Constipation** and an **umbilical hernia** are classic features, reflecting decreased gut motility and weak abdominal muscles associated with thyroid hormone deficiency. *Growth hormone deficiency* - Primarily presents with **short stature** and delayed bone age, not typically with prolonged jaundice or umbilical hernia in infancy. - While it can be associated with some developmental delays, the combination of signs in the question points away from this diagnosis. *Kernicterus* - This is a neurological consequence of **untreated severe hyperbilirubinemia**, leading to brain damage, not a primary cause of jaundice itself. - While prolonged jaundice is present, kernicterus would manifest with severe neurological symptoms like lethargy, poor feeding, and opisthotonus, not umbilical hernia. *Congenital adrenal hyperplasia* - Presents due to deficiencies in adrenal steroid synthesis, leading to **ambiguous genitalia** in females and **salt-wasting crises** in classic forms. - It does not typically cause prolonged jaundice or umbilical hernia as primary manifestations.
Question 7: Which of the following is true regarding precocious puberty:
- A. Sexual maturity is attained early (Correct Answer)
- B. Mental function is increased
- C. Reproductive function is absent
- D. Body proportions remain unchanged
Explanation: ***Sexual maturity is attained early*** - **Precocious puberty** is defined by the development of secondary sexual characteristics significantly earlier than the average age. - This early onset of puberty means that affected individuals reach **sexual maturity** at a younger chronological age. *Mental function is increased* - Precocious puberty does not inherently lead to an increase in **mental function** or cognitive abilities. - While hormonal changes can influence mood and behavior, they do not enhance intelligence. *Reproductive function is absent* - Precocious puberty implies the premature activation of the **hypothalamic-pituitary-gonadal axis**, leading to the appearance of secondary sexual characteristics and, in many cases, the potential for **reproductive function**. - Girls, for example, can experience early menarche and boys can produce sperm, meaning fertility is not absent but rather accelerated. *Body proportions remain unchanged* - Precocious puberty often results in changes in **body proportions**, particularly due to the early closure of epiphyseal plates. - Although there is an initial growth spurt, the premature fusion of growth plates can lead to a shorter-than-average adult height.
Question 8: Which is false in Congenital Hypopituitarism?
- A. Hypoglycemia
- B. Growth hormone level < 7 ng/ml
- C. Baby small at birth (Correct Answer)
- D. Delayed puberty
Explanation: ***Baby small at birth*** - This statement is **false** because congenital hypopituitarism typically does not cause **intrauterine growth restriction** or a baby to be small at birth. - Growth hormone (GH) and other pituitary hormones are primarily involved in **postnatal growth**, so infants with this condition are usually of **normal size at birth**. *Hypoglycemia* - **Neonatal hypoglycemia** is a common and often severe manifestation of congenital hypopituitarism, especially due to **GH deficiency** and sometimes ACTH deficiency. - GH and cortisol play crucial roles in **glucose homeostasis**, and their deficiency leads to impaired gluconeogenesis. *Growth hormone level < 7 ng/ml* - A **peak growth hormone level of less than 7 ng/ml** in response to two provocative tests is a common diagnostic criterion for **growth hormone deficiency** in children. - This threshold indicates an inadequate secretion of GH essential for normal growth and metabolism. *Delayed puberty* - **Deficiency of gonadotropins** (LH and FSH) due to hypopituitarism prevents the normal onset and progression of puberty. - This results in features such as **absent or delayed secondary sexual characteristic**s and **incomplete pubertal development**.
Question 9: In the case of a 7 -year-old school-going child, which would be the most appropriate indicator to measure the current nutritional status?
- A. Birth weight
- B. Head circumference
- C. Mid upper arm circumference (Correct Answer)
- D. Weight for height
Explanation: ***Mid upper arm circumference*** - **Mid-upper arm circumference (MUAC)** is the most appropriate indicator among the given options for assessing **current nutritional status** in a 7-year-old school-going child. - While traditionally emphasized for children 6-59 months, **MUAC is increasingly recognized as a valid indicator for school-aged children (5-15 years)** for detecting acute malnutrition and wasting. - MUAC is **age-independent, practical, and can be measured easily** in school settings, making it particularly useful for screening current nutritional status in this age group. - **Note:** Ideally, **BMI-for-age** is the gold standard recommended by WHO and IAP for children aged 5-19 years, but it is not among the options provided. *Weight for height* - **Weight-for-height (WFH)** is primarily recommended for **children under 5 years of age** or those with height <120 cm according to WHO guidelines. - For school-aged children (>5 years), **BMI-for-age is the preferred indicator**, not WFH. - WFH becomes less accurate and less practical in older children, making it inappropriate as the primary indicator for a 7-year-old. *Birth weight* - **Birth weight** reflects **intrauterine growth and nutritional status at delivery**, not the current nutritional status of a 7-year-old child. - It is useful for assessing risk factors and early life influences but has no bearing on current nutritional assessment in school-aged children. *Head circumference* - **Head circumference** is primarily used to assess **brain growth** and detect conditions like **microcephaly or macrocephaly**, particularly in infancy and early childhood (up to 2-3 years). - In a 7-year-old, head growth has largely plateaued, and this measurement is **not useful for assessing current general nutritional status**.
Question 10: Ear lobe creases in a child are commonly associated with which disorder that also presents with macroglossia and macrosomia?
- A. Down syndrome
- B. Beckwith-Wiedemann syndrome (Correct Answer)
- C. Turner syndrome
- D. Noonan syndrome
Explanation: ***Beckwith-Wiedemann syndrome*** - **Beckwith-Wiedemann syndrome** is characterized by conditions such as **macrosomia** (large body size), **macroglossia** (enlarged tongue), **visceromegaly**, and **ear lobe creases** or pits. - It is an overgrowth disorder often associated with an increased risk of certain childhood cancers like **Wilms tumor** and hepatoblastoma. *Down syndrome* - **Down syndrome** (Trisomy 21) presents with distinct facial features like a **flat nasal bridge**, **epicanthal folds**, and a single palmar crease, but **ear lobe creases** are not a primary characteristic. - While **macroglossia** can be seen, **macrosomia** is generally not a feature; instead, individuals with Down syndrome often have growth delays. *Turner syndrome* - **Turner syndrome** (XO karyotype) is characterized by features such as **short stature**, a **webbed neck**, shield chest, and **low-set ears**, but not typically ear lobe creases or macroglossia. - Affected individuals are phenotypically female and experience **gonadal dysgenesis**. *Noonan syndrome* - **Noonan syndrome** shares some features with Turner syndrome, including **short stature**, **webbed neck**, and **pectus excavatum**, but also presents with distinct cardiac defects. - While it can involve various facial dysmorphia, **ear lobe creases**, **macroglossia**, and **macrosomia** are not typically defining characteristics.
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