📘 Essential for Pediatric Nursing, Adolescent Health, Community Health, GNM/BSc Nursing, NHM, GPSC, AIIMS, Staff Nurse Exams
Precocious puberty is the early onset of secondary sexual characteristics before age 8 in girls and before age 9 in boys, due to premature activation of the hypothalamic-pituitary-gonadal (HPG) axis or other hormonal disturbances.
✳️ The child appears physically older than peers but may have immature emotional or mental development.
| Type | Description | Cause |
|---|---|---|
| 🟩 Central (True) Precocious Puberty | Gonadotropin-dependent; early activation of HPG axis | Idiopathic (most common), CNS tumors, head trauma |
| 🟥 Peripheral (Pseudo) Precocious Puberty | Gonadotropin-independent; excess sex steroids without HPG activation | Ovarian/testicular tumors, congenital adrenal hyperplasia (CAH), hypothyroidism |
| 🟨 Incomplete Precocious Puberty | Only one sign (e.g., premature thelarche or adrenarche) | Often benign, no full puberty signs |
🔸 Female sex (5:1 ratio)
🔸 Obesity
🔸 Exposure to sex hormones (environmental or medication)
🔸 CNS injury or disease
🔸 Genetic syndromes (e.g., McCune-Albright)
| Feature | Girls | Boys |
|---|---|---|
| 🟣 Breast development (thelarche) | Early onset | Rare |
| 🟤 Pubic/axillary hair (adrenarche) | Common | Common |
| 🟠 Menstruation (menarche) | Before 8 yrs | – |
| 🟢 Genital enlargement | – | Early testicular/penile growth |
| ⚪ Acne, body odor | Present | Present |
| ⚫ Growth spurt | Tall for age initially → early epiphyseal closure → short adult height |
❌ Early epiphyseal fusion → short adult height
❌ Emotional or social issues (peer teasing, anxiety)
❌ Risk of early sexual behavior or abuse
❌ Underlying brain or adrenal tumors
❌ Poor school performance (due to emotional distress)
🟡 Precocious puberty = puberty <8 yrs (girls), <9 yrs (boys)
🟡 Central = GnRH-dependent; Peripheral = GnRH-independent
🟡 GnRH analog (Leuprolide) = treatment of choice in central cases
🟡 Bone age > chronological age
🟡 Early diagnosis prevents short stature & psychosocial issues
Q1. Precocious puberty is defined as:
🅰️ Puberty after age 12
✅ 🅱️ Puberty before age 8 (girls) or 9 (boys)
🅲️ Growth retardation
🅳️ Delayed menstruation
Correct Answer: 🅱️ Puberty before age 8 (girls) or 9 (boys)
Q2. Most common cause of central precocious puberty in girls:
🅰️ Brain tumor
✅ 🅱️ Idiopathic
🅲️ Hypothyroidism
🅳️ CAH
Correct Answer: 🅱️ Idiopathic
Q3. Drug of choice for central precocious puberty is:
🅰️ Insulin
✅ 🅱️ GnRH analog (Leuprolide)
🅲️ Corticosteroids
🅳️ Testosterone
Correct Answer: 🅱️ GnRH analog (Leuprolide)
Q4. A child with early breast development and advanced bone age likely has:
🅰️ Hypothyroidism
✅ 🅱️ Precocious puberty
🅲️ Rickets
🅳️ Anemia
Correct Answer: 🅱️ Precocious puberty
Q5. Which condition is a cause of peripheral precocious puberty?
🅰️ Head injury
🅱️ Pituitary tumor
✅ 🅲️ Congenital adrenal hyperplasia
🅳️ Growth hormone deficiency
Correct Answer: 🅲️ Congenital adrenal hyperplasia
Q6. Which test is best to assess bone maturation?
🅰️ MRI brain
🅱️ USG abdomen
✅ 🅲️ X-ray left wrist
🅳️ CT pelvis
Correct Answer: 🅲️ X-ray left wrist
Q7. One psychosocial issue in precocious puberty is:
🅰️ Intellectual disability
🅱️ Delayed speech
✅ 🅲️ Peer pressure and emotional stress
🅳️ Epistaxis
Correct Answer: 🅲️ Peer pressure and emotional stress
📘 Essential for Pediatric Nursing, Adolescent Health, Endocrine Disorders, GNM/BSc Nursing, NHM, GPSC, AIIMS, Staff Nurse Exams
Gynecomastia is the benign enlargement of male breast tissue, usually due to an imbalance between estrogen and androgen activity. It is common during puberty and usually resolves spontaneously.
✳️ Not to be confused with pseudogynecomastia, which is fat deposition in the chest area without glandular proliferation.
| Type | Description | Examples |
|---|---|---|
| 🟩 Physiological | Occurs as part of normal development | Newborns, adolescents, elderly |
| 🟨 Pathological | Due to hormonal imbalance or disease | Tumors, liver disease, endocrine disorders |
| 🟥 Pharmacological | Drug-induced | Spironolactone, Digoxin, Ketoconazole |
| 🟦 Pseudogynecomastia | Fat accumulation (not true glandular) | Obesity-related chest fat in males |
💊 Spironolactone
💊 Cimetidine
💊 Digoxin
💊 Ketoconazole
💊 Antipsychotics (e.g., Risperidone)
💊 Anabolic steroids
| Feature | Observation |
|---|---|
| 🎯 Onset | Pubertal age (13–14 years) most common |
| 🧠 Symptoms | Tenderness, swelling under nipple, bilateral or unilateral |
| ⏳ Duration | Usually regresses within 6–24 months |
| 📏 Size | Soft to firm, 0.5–5 cm disc under areola |
| 🚨 Red Flag | Rapid growth, hard mass, nipple discharge → suspect malignancy (rare) |
Most physiological gynecomastia does not require tests unless atypical.
❌ Psychosocial embarrassment
❌ Poor self-image, bullying
❌ Depression or anxiety
❌ Rarely – underlying tumor or genetic disorder
🟡 Gynecomastia = benign breast tissue enlargement in males
🟡 Most common in puberty and often resolves spontaneously
🟡 Drug causes: Spironolactone, Digoxin, Cimetidine
🟡 Tamoxifen is used if persistent or painful
🟡 Pseudogynecomastia = fat, not glandular enlargement
Q1. Gynecomastia is defined as:
🅰️ Breast cancer in boys
✅ 🅱️ Benign enlargement of male breast tissue
🅲️ Chest fat accumulation only
🅳️ Nipple pigmentation
Correct Answer: 🅱️ Benign enlargement of male breast tissue
Q2. Most common age of physiological gynecomastia is:
🅰️ 0–1 year
🅱️ 3–5 years
✅ 🅲️ 13–14 years
🅳️ 18–21 years
Correct Answer: 🅲️ 13–14 years
Q3. A drug known to cause gynecomastia is:
🅰️ Ibuprofen
✅ 🅱️ Spironolactone
🅲️ Cefixime
🅳️ Loratadine
Correct Answer: 🅱️ Spironolactone
Q4. Which syndrome is commonly associated with gynecomastia?
🅰️ Down syndrome
✅ 🅱️ Klinefelter’s syndrome
🅲️ Turner’s syndrome
🅳️ Rett syndrome
Correct Answer: 🅱️ Klinefelter’s syndrome
Q5. Which medication is sometimes used to treat gynecomastia?
🅰️ Paracetamol
🅱️ Vitamin C
✅ 🅲️ Tamoxifen
🅳️ Ciprofloxacin
Correct Answer: 🅲️ Tamoxifen
Q6. A key distinguishing feature of pseudogynecomastia is:
🅰️ Painful mass
🅱️ Nipple discharge
✅ 🅲️ Fat tissue without glandular proliferation
🅳️ Hard lump
Correct Answer: 🅲️ Fat tissue without glandular proliferation
Q7. One major nursing role in pubertal gynecomastia is:
🅰️ Immediate surgery
✅ 🅱️ Reassure and monitor progression
🅲️ Remove the gland
🅳️ Ignore complaints
Correct Answer: 🅱️ Reassure and monitor progression
📘 Essential for Pediatric Nursing, Mental Health Nursing, Community Health, Sociology in Nursing, GNM/BSc Nursing, NHM, GPSC, AIIMS, Staff Nurse Exams
Juvenile delinquency refers to criminal or antisocial behavior by children or adolescents (typically under 18 years of age), which is against legal or social norms and may involve violence, theft, substance abuse, or truancy.
✳️ A juvenile delinquent is a child (as per Juvenile Justice Act – <18 yrs) who commits an act punishable under law but is dealt with differently than an adult.
| Type | Description | Examples |
|---|---|---|
| 🟥 Individual Delinquency | Personal emotional or psychological issues | Aggression, lying, impulsiveness |
| 🟨 Social Delinquency | Due to peer pressure, poor role models | Gang violence, theft, substance use |
| 🟩 Situational Delinquency | Opportunistic, not habitual | Shoplifting, vandalism |
| 🟦 Habitual Delinquency | Repeated violations | Repeat offenders with record |
| Provision | Detail |
|---|---|
| Age limit | Child under 18 years is treated as juvenile |
| Authority | Juvenile Justice Board (JJB) handles cases |
| Objective | Reformation, not punishment |
| Measures | Counseling, education, vocational training, rehabilitation |
| Latest revision | Juvenile Justice (Care & Protection) Act, 2015 – allows trial as adult for heinous crimes (16–18 yrs) |
❌ Criminal records
❌ Substance addiction
❌ Unemployment or drop-out
❌ Mental illness (e.g., depression, conduct disorder)
❌ Risk of being exploited or recruited into crime networks
🟡 Juvenile = <18 years as per Indian law
🟡 Juvenile delinquency = illegal behavior in minors
🟡 Most common cause = family dysfunction and peer pressure
🟡 Handled under Juvenile Justice Act 2015
🟡 Goal = Rehabilitation, not punishment
Q1. Juvenile delinquency refers to:
🅰️ Academic failure
✅ 🅱️ Criminal behavior in children <18 years
🅲️ Malnutrition in children
🅳️ Mental retardation
Correct Answer: 🅱️ Criminal behavior in children <18 years
Q2. The law governing juvenile justice in India is:
🅰️ IPC 420
✅ 🅱️ Juvenile Justice (Care & Protection) Act, 2015
🅲️ POCSO Act
🅳️ NDPS Act
Correct Answer: 🅱️ Juvenile Justice (Care & Protection) Act, 2015
Q3. Most common psychological disorder linked to delinquency is:
🅰️ OCD
🅱️ Autism
✅ 🅲️ Conduct disorder
🅳️ Phobia
Correct Answer: 🅲️ Conduct disorder
Q4. A main aim of juvenile justice is:
🅰️ Imprisonment
🅱️ Legal punishment
✅ 🅲️ Reformation and rehabilitation
🅳️ Capital punishment
Correct Answer: 🅲️ Reformation and rehabilitation
Q5. Which is a social cause of juvenile delinquency?
🅰️ High intelligence
🅱️ Good parenting
✅ 🅲️ Peer pressure and gang culture
🅳️ Strict school discipline
Correct Answer: 🅲️ Peer pressure and gang culture
Q6. Role of nurse in managing juvenile delinquency includes:
🅰️ Punishing child
🅱️ Isolating them
✅ 🅲️ Counseling and behavior therapy support
🅳️ Ignoring behavior
Correct Answer: 🅲️ Counseling and behavior therapy support
Q7. A delinquent child is best managed by:
🅰️ Imprisonment
✅ 🅱️ Counseling and skill development
🅲️ Solitary confinement
🅳️ Police lathi charge
Correct Answer: 🅱️ Counseling and skill development