Growth Disorders — MCQs
Bone age is advanced in which of the following conditions?
Which of the following actions of GH is mediated by IGF-1?
Which is false in Congenital Hypopituitarism?
At the cellular level the physiological effects of human growth hormone are mediated by?
At what age does the birth length double: UPSC 07; FMGE 10, 11
What does it mean if a baby is in the 15th percentile for head circumference?
At what age do most children reach a height of 100 cm?
Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?
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?
At what age do newborns typically double their birth weight?
Growth Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Bone age is advanced in which of the following conditions?
- A. Congenital adrenal hyperplasia (Correct Answer)
- B. Hypothyroidism
- C. Hypopituitarism
- D. Constitutional delay in growth
Explanation: ***Congenital adrenal hyperplasia*** - In **congenital adrenal hyperplasia (CAH)**, the adrenal glands produce excessive androgens, leading to precocious puberty and **accelerated skeletal maturation**, thus advancing bone age. - The excess androgens cause early fusion of the **epiphyseal growth plates**, leading to a disproportionately taller stature in childhood but potentially shorter adult height. *Hypothyroidism* - **Hypothyroidism** causes delayed growth and development, including **delayed bone age**, due to insufficient thyroid hormone which is crucial for normal skeletal maturation. - Children with hypothyroidism typically have shorter stature for their chronological age and delayed ossification of epiphyses. *Hypopituitarism* - **Hypopituitarism**, especially growth hormone deficiency, leads to **delayed bone age** and significantly stunted growth because growth hormone is essential for normal skeletal development. - Insufficient growth hormone results in slower epiphyseal growth and delayed growth plate closure. *Constitutional delay in growth* - **Constitutional delay in growth and puberty** is characterized by a "late bloomer" pattern, where both linear growth and pubertal development are delayed, resulting in a **delayed bone age**. - These children typically have normal growth velocity for their bone age and will eventually reach a normal adult height, just later than their peers.
Question 2: Which of the following actions of GH is mediated by IGF-1?
- A. Na+ retention
- B. decreases insulin
- C. Antilipolysis (Correct Answer)
- D. Lipolysis
Explanation: ***Antilipolysis*** * **Insulin-like growth factor 1 (IGF-1)**, stimulated by GH, plays a role in reducing **lipolysis** indirectly. * IGF-1 promotes **anabolic processes** and nutrient storage, which can lead to decreased fat breakdown. *Na+ retention* * **Na+ retention** is more directly influenced by hormones like **aldosterone** and **ADH**, not IGF-1. * While GH can exert some influence on fluid and electrolyte balance, this specific action is not primarily mediated by IGF-1. *decreases insulin* * IGF-1 and GH generally tend to **increase insulin sensitivity** in some tissues or antagonize insulin effects indirectly. * IGF-1's primary metabolic role is not to decrease insulin itself directly. *Lipolysis* * **Growth hormone (GH)** directly promotes **lipolysis**, breaking down fat for energy. * However, the question specifically asks for actions mediated by **IGF-1**, which has an opposite, antilipolytic effect.
Question 3: 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 4: At the cellular level the physiological effects of human growth hormone are mediated by?
- A. Insulin
- B. Prolactin
- C. Somatotropin
- D. Insulin-like growth factors (Correct Answer)
Explanation: ***Insulin-like growth factors*** - The primary mechanism by which **growth hormone (GH)** exerts its physiological effects is by stimulating the production of **insulin-like growth factors (IGFs)**, particularly **IGF-1**. - **IGF-1** then mediates most of the **growth-promoting actions** of GH on target tissues through the **somatomedin hypothesis**. *Insulin* - **Insulin** is a hormone primarily involved in regulating **glucose metabolism** by promoting glucose uptake and utilization by cells. - While GH can influence **insulin sensitivity**, insulin itself does not mediate the primary growth-promoting effects of GH. *Prolactin* - **Prolactin** is a hormone primarily associated with **lactation** and **mammary gland development**. - It has distinct functions from growth hormone and does not mediate its growth-promoting actions. *Somatotropin* - **Somatotropin** is simply another name for **human growth hormone (hGH)** itself. - The question asks how the effects *of* growth hormone are mediated at the cellular level, implying a **downstream mediator**, not the hormone itself.
Question 5: At what age does the birth length double: UPSC 07; FMGE 10, 11
- A. 1 year
- B. 4 years (Correct Answer)
- C. 3 years
- D. 2 years
Explanation: ***4 years*** - Birth length typically doubles by the age of **4 years**. - At birth, the average length is about 50 cm, so doubling means reaching approximately **100 cm** by 4 years of age. *1 year* - By 1 year of age, a child's birth length typically increases by about **50%**, reaching approximately 75 cm. - While significant growth occurs, it does not usually double the birth length. *3 years* - By 3 years of age, a child's height is usually around **90-95 cm**. - This is a substantial gain but generally still falls short of exactly doubling the birth length. *2 years* - At 2 years of age, a child's birth length is approximately **85-88 cm**. - This represents a significant increase, but it is not the age at which birth length typically doubles.
Question 6: What does it mean if a baby is in the 15th percentile for head circumference?
- A. The child's head circumference is at the 15th percentile.
- B. 15% of children will have a head circumference less than this baby. (Correct Answer)
- C. 15% of children will have a head circumference greater than this baby.
- D. None of the options.
Explanation: ***15% of children will have a head circumference less than this baby.*** - A **percentile** indicates the value below which a given percentage of observations in a group of observations falls. - Being in the **15th percentile** means that **15% of children have a smaller head circumference** than this baby, and **85% have a larger head circumference**. - This concept is fundamental in **growth monitoring** and assessing whether a child's growth is within normal limits. - Values below the 3rd percentile or above the 97th percentile typically warrant further evaluation. *The child's head circumference is at the 15th percentile.* - This statement merely restates the given information without explaining what it means. - It doesn't provide insight into the statistical significance or clinical implications. - While factually correct, it doesn't answer what the percentile *means*. *15% of children will have a head circumference greater than this baby.* - This statement **reverses** the meaning of a percentile. - If only 15% had a greater circumference, the baby would be at the **85th percentile** (100 - 15 = 85), not the 15th. - This is a common misconception when interpreting percentiles. *None of the options.* - This is incorrect because the first option accurately defines the meaning of being in the 15th percentile. - Understanding percentiles is essential for interpreting **growth charts** in pediatric practice.
Question 7: At what age do most children reach a height of 100 cm?
- A. 3 years
- B. 2 years
- C. 5 years
- D. 4 years (Correct Answer)
Explanation: **4 years** - Most children reach approximately **100 cm** in height around their fourth birthday. - This represents a doubling of their birth length, as the average birth length is around 50 cm. *2 years* - A child's height at 2 years is typically around **86-89 cm**. - While they have often doubled their birth weight by then, they haven't typically reached 100 cm in height. *3 years* - By 3 years of age, the average height for a child is usually between **94-96 cm**. - This is close, but still generally less than the 100 cm mark. *5 years* - Children aged 5 years are generally taller than **100 cm**, typically averaging around **108-110 cm**. - Reaching 100 cm would occur well before this age.
Question 8: Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?
- A. Increase in length of 25 centimetres in the first year (Correct Answer)
- B. Weight gain of 300 grams per month till 1 year
- C. Anterior fontanelle closure by 6 months of age
- D. Weight under the 75th percentile and height under the 25th percentile
Explanation: ***Increase in length of 25 centimetres in the first year*** - A **25 cm increase in length during the first year** is a normal and expected growth rate for infants, indicating adequate overall growth and development since overall length growth is a sensitive indicator of good health. - This corresponds to roughly a **50% increase in birth length** (which is typically around 50 cm), demonstrating appropriate linear growth. *Weight gain of 300 grams per month till 1 year* - While weight gain is crucial, an infant typically **gains more than 300 grams per month** in the early months (e.g., 500-1000g/month for the first 3-4 months) and then the rate slows. - This value represents an **average over the entire year** and may not reflect adequate growth during periods of rapid weight gain. *Anterior fontanelle closure by 6 months of age* - The **anterior fontanelle typically closes between 10 to 18 months of age**, with closure as early as 6 months being within the normal range but not the *best* indicator of overall growth. - While fontanelle closure is an important developmental milestone, it is **not a direct measure of growth in length or weight**, which are more indicative of nutritional status. *Weight under the 75th percentile and height under the 25th percentile* - Having weight under the 75th percentile and height under the 25th percentile means the **child is growing disproportionately**, which could suggest a growth problem or underlying health issue. - **Optimal growth** is typically indicated when weight and height measurements fall within a similar percentile range, generally between the 25th and 75th percentiles.
Question 9: 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 10: At what age do newborns typically double their birth weight?
- A. 3 months
- B. 9 months
- C. 12 months
- D. By 6 months (Correct Answer)
Explanation: ***By 6 months*** - Infants typically **double their birth weight by 5 to 6 months of age** as a significant milestone in rapid early growth. - This rapid weight gain reflects adequate nutrition and healthy development in the first half-year of life. *3 months* - At 3 months, infants usually gain about **1 to 2 pounds per month**, but they have not yet doubled their birth weight. - Their weight gain is steady, but they are still some weeks away from this specific milestone. *9 months* - By 9 months, infants have usually **tripled their birth weight**, surpassing the doubling milestone. - This age marks further significant development, including increased mobility. *12 months* - At 12 months, infants typically have **tripled their birth weight**, which is a more advanced growth milestone than doubling. - This is often considered the end of infancy, with continued but slower growth rates expected.
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