Growth/Development Practice Questions

Question 1

A 45 year-old gentleman presents to his primary care physician complaining of wrist pain and is diagnosed with carpal tunnel syndrome. Upon further questioning, the patient admits that he has recently been outgrowing his gloves and shoes and has had to purchase a new hat as well due to increased head size. Upon exam, he is found to have new mild hypertension and on basic labs he is found to be hyperglycemic. Which of the following is the best blood test to diagnose his suspected disorder?

Accepted Answer

IGF-1 level

Answer

Hydroxyproline level

Answer

Cortisol level

Answer

Alkaline Phosphatase level

Answer

Growth Hormone level

Question 2

A 15-year-old girl comes to the physician with her father for evaluation of her tall stature. She is concerned because she is taller than all of her friends. Her birth weight and height were within normal limits. Her father is 174 cm (5 ft 7 in) tall; her mother is 162 cm (5 ft 3 in) tall. She is at the 98th percentile for height and 90th percentile for BMI. She has not had her menstrual period yet. Her mother has Graves disease. Vital signs are within normal limits. Examination shows a tall stature with broad hands and feet. There is frontal bossing and protrusion of the mandible. Finger perimetry is normal. The remainder of the examinations shows no abnormalities. Serum studies show a fasting serum glucose of 144 mg/dL. An x-ray of the left hand and wrist shows a bone age of 15 years. Which of the following is the most appropriate definitive treatment for this patient's condition?

Accepted Answer

Transsphenoidal adenomectomy

Answer

Caloric restriction

Answer

Letrozole therapy

Answer

Methimazole therapy

Answer

Leuprolide therapy

Question 3

A 15-year-old girl comes to the physician with her father for evaluation of short stature. She feels well overall but is concerned because all of her friends are taller than her. Her birth weight was normal. Menarche has not yet occurred. Her father says he also had short stature and late puberty. The girl is at the 5th percentile for height and 35th percentile for weight. Breast development is Tanner stage 2. Pubic and axillary hair is absent. An x-ray of the left hand and wrist shows a bone age of 12 years. Further evaluation of this patient is most likely to show which of the following sets of laboratory findings?

Accepted Answer

Low-normal FSH, Low-normal LH, Low Estradiol, Normal Prolactin

Answer

High FSH, High LH, Normal Estradiol, Normal Prolactin

Answer

Normal FSH, Normal LH, Normal Estradiol, Normal Prolactin

Answer

Normal FSH, Normal LH, Low Estradiol, Normal Prolactin

Answer

Low FSH, Low LH, Low Estradiol, Normal Prolactin

Question 4

A 4-year-old boy is brought to the pediatrician by his mother for a routine medical examination. His medical history is relevant for delayed gross motor milestones. The mother is concerned about a growth delay because both of his brothers were twice his size at this age. Physical examination reveals a well-groomed and healthy boy with a prominent forehead and short stature, in addition to shortened upper and lower extremities with a normal vertebral column. The patient’s vitals reveal: temperature 36.5°C (97.6°F); pulse 60/min; and respiratory rate 17/min and a normal intelligence quotient (IQ). A mutation in which of the following genes is the most likely cause underlying the patient’s condition?

Accepted Answer

Fibroblast growth factor receptor 3

Answer

Runt-related transcription factor 2

Answer

Alpha-1 type I collagen

Answer

Insulin-like growth factor 1 receptor

Answer

Fibrillin-1

Question 5

A 10-year-old girl is admitted to the medical floor for a respiratory infection. The patient lives in a foster home and has been admitted many times. Since birth, the patient has had repeated episodes of pain/pressure over her frontal sinuses and a chronic cough that produces mucus. She was recently treated with amoxicillin for an infection. The patient is in the 25th percentile for height and weight which has been constant since birth. Her guardians state that the patient has normal bowel movements and has been gaining weight appropriately. The patient has a history of tricuspid stenosis. She also recently had magnetic resonance imaging (MRI) of her chest which demonstrated dilation of her airways. Her temperature is 99.5°F (37.5°C), blood pressure is 90/58 mmHg, pulse is 120/min, respirations are 18/min, and oxygen saturation is 94% on room air. Physical exam is notable for bruises along the patient's shins which the guardians state are from playing soccer. The rest of the exam is deferred because the patient starts crying. Which of the following findings is associated with this patient's most likely underlying diagnosis?

Accepted Answer

Increased chloride in the patient's sweat

Answer

Social withdrawal and avoidance of eye contact

Answer

Hypocalcemia

Answer

Repeat sinus infections secondary to seasonal allergies

Answer

Diastolic murmur best heard along the right lower sternal border

Question 6

A 6-year-old girl is brought to the pediatrician by her father for an annual physical examination. The father reports that the patient is a happy and healthy child, but he sometimes worries about her weight. He says that she is a “picky” eater and only wants chicken nuggets and French fries. He also notes some mild acne on her cheeks and forehead but thinks it’s because she “doesn’t like baths.” The father says she has met all her pediatric milestones. She has recently started kindergarten, can tell time, and is beginning to read. Her teacher says she gets along with her classmates well. The patient was born at 38 weeks gestation. She has no chronic medical conditions and takes only a multivitamin. Height and weight are above the 95th percentile. Physical examination reveals scattered comedones on the patient’s forehead and bilateral cheeks. There is palpable breast tissue bilaterally with raised and enlarged areolae. Scant axillary hair and coarse pubic hair are also noted. A radiograph of the left hand shows a bone age of 9 years. Serum follicular stimulating hormone (FSH) level is 9.6 mU/mL (normal range 0.7-5.3 mU/mL) and luteinizing hormone (LH) level is 6.4 mU/mL (normal range < 0.26 mU/mL). Which of the following is the most appropriate diagnostic test?

Accepted Answer

Brain magnetic resonance imaging (MRI)

Answer

Pelvic ultrasound

Answer

Estrogen levels

Answer

17-hydroxyprogesterone levels

Answer

Dehydroepiandrosterone sulfate levels

Question 7

A 7-year-old girl is brought to the physician because of vaginal bleeding for 2 days. There is no personal or family history of serious illness. She is at the 95th percentile for height and at the 90th percentile for weight. Examination shows enlarged breasts, and the areola and papilla have formed a secondary mound. There is coarse pubic hair that does not extend to the inner thigh. The remainder of the examination show no abnormalities. An x-ray of the left hand and wrist shows a bone age of 11 years. Her serum luteinizing hormone concentration is 0.1 mIU/mL (N < 0.2 mIU/mL). Which of the following is the most appropriate next step in management?

Accepted Answer

GnRH stimulation test

Answer

Serum dehydroepiandrosterone level

Answer

Reassurance and follow-up

Answer

Ultrasound of the pelvis

Answer

MRI of the brain

Question 8

A 7-year-old boy is brought to the physician because his parents are concerned about his early sexual development. He has no history of serious illness and takes no medications. His brother was diagnosed with testicular cancer 5 years ago and underwent a radical orchiectomy. The patient is at the 85th percentile for height and 70th percentile for weight. Examination shows greasy facial skin. There is coarse axillary hair. Pubic hair development is at Tanner stage 3 and testicular development is at Tanner stage 2. The remainder of the examination shows no abnormalities. An x-ray of the wrist shows a bone age of 10 years. Basal serum luteinizing hormone and follicle-stimulating hormone are elevated. An MRI of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?

Accepted Answer

Leuprolide therapy

Answer

Testicular ultrasound

Answer

Cortisol supplementation

Answer

Radiation therapy

Answer

Observation

Question 9

A 2300-g (5.07-lb) male newborn is delivered at term to a 39-year-old woman. Examination shows a sloping forehead, a flat nasal bridge, increased interocular distance, low-set ears, a protruding tongue, a single palmar crease and an increased gap between the first and second toe. There are small white and brown spots in the periphery of both irises. The abdomen is distended. An x-ray of the abdomen shows two large air-filled spaces in the upper quadrant. This patient's condition is most likely associated with which of the following cardiac anomalies?

Accepted Answer

Atrioventricular septal defect

Answer

Tetralogy of Fallot

Answer

Atrial septal defect

Answer

Patent ductus arteriosus

Answer

Ventricular septal defect

Question 10

A 6-year-old boy is brought in by his mother for a well-visit. She reports that he is going to start kindergarten soon. She is worried that he doesn't like to play outside with the other kids on the block. When asked, the patient says "I like video games more than running. My big brother plays with me." His mother states that his teachers reported that he did well in pre-school and participated in group games. The patient is normally a good listener but has become more stubborn about wanting to "do things by himself," like getting dressed in the morning. The patient has no chronic medical conditions. He is allergic to peanuts. He takes no medications but has an epinephrine auto-injector for his allergy. His brother has asthma and his paternal grandfather died at age 56 of a myocardial infarction. The patient's blood pressure is 110/70 mmHg and pulse is 105/min. He is in the 50th percentile for height and weight. On physical examination, a grade II systolic murmur is heard. When the patient stands up, the murmur decreases. Capillary refill is less than 2 seconds. Which of the following is the most likely next step in management?

Accepted Answer

Reassurance

Answer

Electrocardiogram

Answer

Echocardiogram

Answer

Chest radiograph

Answer

Complete blood count

Growth/Development

Study Resources

Lessons

Questions

Flashcards

Lessons

Normal growth patterns

Growth charts and interpretation

Failure to thrive evaluation

Short stature workup

Tall stature evaluation

Obesity in children

Nutritional assessment tools

Puberty stages (Tanner stages)

Precocious puberty

Delayed puberty

Growth hormone disorders

Impact of chronic disease on growth

Catch-up growth

Practice Questions

Flashcards

About Growth/Development for USMLE

Lessons in Growth/Development

Master Growth/Development