| Show Learning Points most relevant to Phase 1: |
Child with abnormal puberty
| Clinical Discipline(s)/Organ System(s) Endocrinology, Genitourinary System, Paediatrics | Progress Test Topic(s) Child health |
Description
A mother brings her 13 year old NZ European daughter to see their GP. She is concerned that her daughter has no breast development and has not had menarche.
Progress Test-Type Questions: Question 1Applied Science for Medicine
- Role of nutrition in normal growth and development
- Normal sequence of puberty: hypothalamic pituitary axis, pubarche vs menarche vs thelarche
- Role of nutrition in normal growth and development
- Normal sequence of puberty: hypothalamic pituitary axis, pubarche vs menarche vs thelarche
Clinical and Communication Skills
- Elicit a history; attention to family history of growth delay/short stature/pubertal timing
- Measure height, weight and head circumference, calculate height velocity, body mass index (BMI), midparental height, mean predicted final adult height
- Use growth charts and Tanner stages of puberty
- Recognition of normal patterns and variations of puberty, and clinical features of premature and delayed puberty
- Utility of bone age in short stature of pubertal delay
- Appropriate investigations and their indications in short stature, pubertal delay and precocious puberty
- Clinical features of syndromic causes of pubertal delay (especially Turner's syndrome)
- HEADSS assessment of the adolescent
- Elicit a history; attention to family history of growth delay/short stature/pubertal timing
- Measure height, weight and head circumference, calculate height velocity, body mass index (BMI), midparental height, mean predicted final adult height
- Use growth charts and Tanner stages of puberty
- Recognition of normal patterns and variations of puberty, and clinical features of premature and delayed puberty
- Utility of bone age in short stature of pubertal delay
- Appropriate investigations and their indications in short stature, pubertal delay and precocious puberty
- Clinical features of syndromic causes of pubertal delay (especially Turner's syndrome)
- HEADSS assessment of the adolescent
Personal and Professional Skills
- Communicate empathetically with child and caregivers
- Perform examination in a manner that acknowledges the child's natural embarrassment
- Talking to young people and adolescents without parents
- Consent issues for young people <16 years (Gillick competence)
- Communicate empathetically with child and caregivers
- Perform examination in a manner that acknowledges the child's natural embarrassment
- Talking to young people and adolescents without parents
- Consent issues for young people <16 years (Gillick competence)
Conditions to be considered relating to this scenario
Common
delayed puberty (constitutional), precocious puberty
delayed puberty (constitutional), precocious puberty
Less common but 'important not to miss'
Hypothalamic/pituitary tumour, chronic disease (especially coeliac, inflammatory bowel disease)
Hypothalamic/pituitary tumour, chronic disease (especially coeliac, inflammatory bowel disease)
Uncommon
chromosomal or genetic syndrome (Turner's syndrome), imperforate hymen, hypothyroidism
chromosomal or genetic syndrome (Turner's syndrome), imperforate hymen, hypothyroidism
