Failure to Thrive Short Stature

Chapter 104 Failure to Thrive Short Stature




Clinical Case Problem 1: An 8-Month-Old Infant Who Appears Malnourished


An 8-month-old infant is brought to the emergency department by his mother for an assessment of an upper respiratory tract infection. He has been coughing for the past 3   days and has had a runny nose. On examination, his temperature is 37.5° C. His weight is below the 3   rd percentile for his age, his length is at the 25th percentile, and his head circumference is at the 50th percentile. He appears malnourished and has thin extremities, a narrow face, prominent ribs, and wasted buttocks. He has a prominent diaper rash, unwashed skin, a rash that resembles the skin infection impetigo contagiosa on his face, uncut fingernails, and dirty clothing.



Select the best answer to the following questions




1. What is the most likely diagnosis in the infant described?


a. nonorganic failure to thrive (FTT)

b. organic FTT

c. child neglect

d. a and c

e. b and c

2. Nonorganic FTT represents what fraction of FTT?


a. 10%

b. 25%

c. 50%

d. 75%

e. 90%

3. What is the most likely cause of this child’s condition?


a. maternal deprivation

b. cystic fibrosis

c. constitutionally small for age

d. infantile autism

e. congenital bilateral sensorineural hearing loss

4. What is (are) the procedure(s) of choice for this infant at this time?


a. provision of a high-calorie formula; reassessment of the infant in 1 week

b. initiation of outpatient investigations in the child to exclude serious organic disease

c. treatment of the respiratory tract infection and instruction to the mother in correct feeding practices

d. all of the above

e. none of the above

5. Where is follow-up of this child best performed?


a. in the hospital outpatient department

b. in the hospital emergency department

c. in the family physician’s office

d. in the home by the public health nurse

e. in the social worker’s office

6. The initial follow-up plan suggests the frequency of visits for the child to be which of the following?


a. every month

b. every 3 months

c. every week

d. every 6 weeks

e. every 6 months

7. The environment that exists for this child should be thoroughly assessed for which of the following?


a. child abuse or potential for child abuse

b. spousal abuse or potential for spousal abuse

c. level of family income

d. inappropriate parental coping mechanisms: alcohol and drug use

e. all of the above


Clinical Case Problem 2: Falling Off the Growth Curve


A 9-month-old infant comes in for a routine examination and immunizations. The infant has fallen off the previous centile line. The patient’s mother has an eighth-grade education, lives on state support, and has not identified the father of the child. On questioning, the mother indicates that she has been living with her parents but has been told she must find a place of her own. She has signs of depression.


Examination shows an infant with no physical anomalies but whose weight is disproportionate to height and has fallen off the curve set in the first 9   months.



8. There is a strong relationship of this child’s diagnosis to which of the following?


a. parental education level

b. poverty

c. family stress

d. markers of eating disorders

e. none of the above

9. As assistance is provided for the mother for the depression and financial challenges, the infant will


a. benefit from a behavioral feeding program

b. take several years to catch up with height/weight ratio

c. catch up with his peers by the age of 1 year

d. a and c

e. a and b

10. Which of the following investigations should be performed for a child with FTT or a child for whom short stature is unlikely to be familial in nature?


a. complete blood count (CBC)

b. complete urinalysis

c. serum blood urea nitrogen (BUN) and creatinine

d. T4 and thyroid-stimulating hormone (TSH)

e. all of the above


Clinical Case Problem 3: A 13-Year-Old Girl Who Is Short with a Webbed Neck


A 13-year-old girl is brought to your office for assessment of her short stature. On examination, the child has height and weight below the 5th percentile, webbed neck, lack of breast bud development, high-arched palate, and low-set posterior hairline.



11. What is the most likely diagnosis in this child?


a. Noonan syndrome

Related posts:

  1. Alcohol
  2. Pancreatic Carcinoma
  3. Urticaria Angioneurotic Edema
  4. Illustrated Review

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Failure to Thrive Short Stature

Full access? Get Clinical Tree
Get Clinical Tree app for offline access