Constitutional delay and familial short stature — branching viva

Outpatient setting: a fourteen-year-old boy with no signs of puberty, a bone age of eleven years, a father who shaved late, and a height appropriate for his bone age. The examiner asks how you distinguish constitutional delay from familial short stature and from growth hormone deficiency — then branches to the short girl with a delayed bone age and the question of Turner syndrome, then to the offer of testosterone for the distressed boy.