Development Delay

Question 1

Development delays are typically assessed in the community by community paediatrics. Which of the following is NOT one of the 4 areas assessed in normal development?

1 - Gross motor skills
2 - Fine motor skills
3 - Speech and language skills
4 - Fine social skills with children
5 - Social skills

Answer 1

4 - Fine social skills with children

Hearing and vision are also assessed, but typically are part of these 4 areas

Question 2

In a newborn, which of the following is most likely to be assessed?

1 - Gross motor skills
2 - Fine motor skills
3 - Speech and language skills
4 - Social skills

Answer 2

1 - Gross motor skills

Looking at tone good tone and position, typically newborns are in a flexed position

Question 3

Can newborns see all colours or just black and white?

Answer 3

• black and white

May be cross eyed, but typically corrects after 6 weeks

Question 4

When do children typically receive a hearing test?

1 - while in hospital after birth
2 - 6 week check
3 - 1 year check
4 - 3 year check

Answer 4

1 - while in hospital after birth

Question 5

Newborns are born with primitive reflexes for survival. Which of the following is NOT one of these?

1 - Gag reflex
2 - Rooting
3 - Sucking
4 - Moro
5 - Palmar

Answer 5

1 - Gag reflex
Typically disappear at 6-8 weeks

• rooting = move head and open mouth for feeding if you stroke the face
• moro = startle reflex, arms stretch out to look for help

Question 6

Which 2 of the following are red flags for development in newborns?

1 - poor tone
2 - asymmetrical or absent reflexes
3 - no crying
4 - flexed position

Answer 6

1 - poor tone
2 - asymmetrical or absent reflexes

Question 7

At 6-8 weeks, which of the following would we NOT expect to see in a child’s development?

1 - Gross motor = lift head briefly to 45 degrees when on tummy
2 - Fine motor inc vision = fix on and follow objects/people
3 - Speech and language inc hearing = saying mama and dada
no significant change from birth
4 - Social = responsive to smiles

Answer 7

3 - Speech and language inc hearing = saying mama and dada

Typically there would be no significant change from birth
Social

Question 8

Which of the following are red flags for development in 6-8 week old babies?

1 - Not smiling
2 - Not fixing and following
3 - Excessive head lag
4 - Not responding to sound
5 - all of the above

Answer 8

5 - all of the above

Question 9

At 6-8 months, which of the following would we NOT expect to see in a child’s development?

1 - Gross motor = sit unsupported
2 - Fine motor inc. vision = palmar grasp, objects into mouth and colour vision
3 - Speech and language inc hearing = saying mama and dada
no significant change from birth
4 - Social = finger feeding

Answer 9

3 - Speech and language inc hearing = saying mama and dada
no significant change from birth

Typically just babble at this age

Question 10

Which of the following is NOT a red flags for development in 6-8 months old babies?

1 - Persistent primitive reflexes
2 - Not reaching for objects
3 - Hand preference
4 - Poor tone
5 - Not standing unaided

Answer 10

5 - Not standing unaided

Question 11

At year of age, which of the following would we NOT expect to see in a child’s development?

1 - Gross motor = walk unaided
2 - Fine motor inc vision = pincer grip, pointing
3 - Speech and language inc hearing = Few words
4 - Social = waving, peek-a-boo

Answer 11

1 - Gross motor = walk unaided

Typically babies can pull to stand—cruise—walking with aid of surrounding areas

Question 12

Which 2 of the following are red flags for development in a 1 year old baby?

1 - Not sitting unsupported
2 - Not walking
3 - Not babbling
4 - Not able to eat solids

Answer 12

1 - Not sitting unsupported
3 - Not babbling

Question 13

At 2 years of age, which of the following would we NOT expect to see in a child’s development?

1 - Gross motor = Running, kicking a ball, stairs two feet per step
2 - Fine motor inc vision = back and forth scribbles, copying a line
3 - Speech and language inc hearing = joining two-three words together
4 - Social = play with other children

Answer 13

4 - Social = play with other children

Typically, at 2 years babies have symbolic/imaginary play and play alongside other children, BUT not with them

Question 14

Which 2 of the following are red flags for development in a 1 year old baby?

1 - Not eating unaided
2 - Not running
3 - Not babbling
4 - Not joining words together

Answer 14

2 - Not running
4 - Not joining words together

Question 15

The medical name for not being able to control your urine output is enuresis. At what age should a child typically be able to control their urine output?

1 - 2 years of age
2 - 3 years of age
3 - 4 years of age
4 - 5 years of age

Answer 15

B) 3 years of age

Question 16

In children, how common is it to have a problem with wetting or soiling?

1 - very, very common (1 in 4)
2 - very common (1 in 12)
3 - quite common (1 in 100)
4 - not that common (1 in 1000)

Answer 16

2 - very common (1 in 12)

Question 17

What is primary enuresis?

1 - first time a child loses control of urine
2 - new onset wetting after a period of 6 months of being dry
3 - not yet achieved bladder continence
4 - dry in the day but wetting at night

Answer 17

3 - not yet achieved bladder continence

Question 18

What is secondary enuresis?

1 - first time a child loses control of urine
2 - new onset wetting after a period of 6 months of being dry
3 - not yet achieved bladder continence
4 - dry in the day but wetting at night

Answer 18

2 - new onset wetting after a period of 6 months of being dry

Question 19

What is nocturnal enuresis?

1 - first time a child loses control of urine
2 - new onset wetting after a period of 6 months of being dry
3 - not yet achieved bladder continence
4 - dry in the day but wetting at night

Answer 19

4 - dry in the day but wetting at night

Can be primary or secondary

Question 20

At what age do children typically achieve nighttime dryness?

1 - 1 year
2 - 3 years
3 - 5 years
4 - 7 years

Answer 20

2 - 3 years

Typically, 6 months after daytime dryness is achieved

Question 21

Which of the following are signs of a small, overactive bladder?

1 -need to empty bladder before full
2 - sudden urgency to pee
3 - small, frequent wees
4 - leak before getting to toilet
5 - ‘wee dance’
6 - all of the above

Answer 21

6 - all of the above

Question 22

Which 2 of the following are linked with low levels of ADH and enuresis during the night?

1 - crying for mum and dad
2 - difficult to rouse and get out of bed
3 - large void builds up in middle of night
4 - pain in bladder

Answer 22

2 - difficult to rouse and get out of bed
3 - large void builds up in middle of night

ADH helps retain water, so if levels are low then body wants to get rid of the water

Question 23

Which of the following are associated with dysfunctional voiding?

1 - Unable to relax urethral sphincter when voiding
2 - Few, large volume wetting episodes
3 - Infrequent voiding
4 - Interrupted stream
5 - all of the above

Answer 23

5 - all of the above

Question 24

Which of the following is NOT associated with enuresis?

1 - UTI
2 - T1DM (polyuria+polydipsia)
3 - diarrhoea
4 - Postural urethral valves (PUV)
5 - Developmental delay
6 - Physical disability
7 - Sexual abuse
8 - Spinal cord tethering

Answer 24

3 - diarrhoea

Constipation can cause enuresis

Question 25

What general advice can be given in children with enuresis?

1 - Good drinking
2 - Regular voiding
3 - Double voiding
4 - Blowing bubbles when trying to urinate helps relax the external sphincter
5 - All of the above

Answer 25

5 - All of the above

Question 26

What general advice can be given in children with enuresis that typically occurs at night?

1 - Stop drinking <1hour before bed
2 - Wee before bed
3 - Avoid screens
4 - Do not chastise accidents or praise non-accidents
5 - Alarms – need to be motivated
6 - All of the above

Answer 26

6 - All of the above

Avoid screens = linked to melatonin levels, which affects ADH levels

Question 27

Which of the following can be used in children with enuresis during the day?

1 - oxybutinin
2 - desmopressive
3 - pyridostigmine
4 - bumetanide

Answer 27

1 - oxybutinin
- anti-muscarinics

Relaxes the bladder and allows more filling

Question 28

Which of the following can be used in children with enuresis during the day?

1 - oxybutinin
2 - desmopressive
3 - pyridostigmine
4 - bumetanide

Answer 28

2 - desmopressive

NO drinking after taking this

Synthetic ADH, tries to stop urination