Rosh Pediatrics Practice Exam

A 14-year-old boy is concerned about his height relative to his peers. What is the best next step in the management of his suspected condition?

1. Bone age X-ray

2. Observation for spontaneous growth

3. Recombinant human growth hormone

4. Screen for celiac disease

The correct answer is: Bone age X-ray

The next step in managing a 14-year-old boy who is concerned about his height in relation to his peers is to obtain a bone age X-ray. This is a critical diagnostic tool that helps assess the maturity of a child's skeletal system. By comparing the child's bone age to their chronological age, healthcare providers can determine if there is delayed bone maturation, which might indicate a potential growth disorder or underlying endocrine issues. If the bone age is significantly behind the chronological age, it may indicate that the child has the potential for further growth, which could be due to conditions like constitutional growth delay. On the other hand, if the bone age is advanced, it might suggest that the child is nearing the end of their growth potential, which is important for assessing the implications of his height concerns. Conducting a bone age assessment can also guide any necessary interventions or referrals for further evaluation, such as endocrinology consultation or additional testing, depending on the findings. This makes it the most appropriate next step in management for this situation.