Development Flashcards
1
Q
1) Baby can transfer a rattle hand-to-hand, sit with a rounded back using hands for support. What is his age: 1. 3 months 2. 4 months 3. 6 months 4. 9 months 5. 12 months
A
- 6 months
- most primitive reflexes gone, sits in tripod, shakes rattle, holds cube with 2 hands, vocalizes to give answers, bangs cubes together
2
Q
2) An infant can sit with a round back using his hands for support, can roll from prone to supine, stands with support, has a palmar grasp, laughs, and babbles.
a) 3 months
b) 6 months
c) 8 months
d) 9 months
e) 12 months
A
b) 6 months
3
Q
3) What is true of a normal 9 month old child?
1. just acquired palmar grasp
2. says mama/dada and one other word
3. has object permanence
4. has names for objects
A
- has object permanence
Major milestone achieved by 9 months
4
Q
4) A 10 month old child bites you. Which statement is true?
a) This is an early sign of possible autism spectrum disorder
b) There may be an abusive situation in the family
c) Baby is developmentally normal and he is excited
A
c) Baby is developmentally normal and he is excited
Everything goes into the mouth at 6 months; lots of kids bite during play
5
Q
5) Which is the most characteristic of a 9-12 month old?
a. object permanence
b. imitates scribbling
c. transfers objects from hand to hand
d. uses mama and dada specifically
A
ANSWER: d. uses mama and dada specifically
a. object permanence - have by 9 months
b. imitates scribbling - 18 months
c. transfers objects from hand to hand - starts at 6 months
6
Q
6) All of the following are true about development EXCEPT:
a) walk 3 steps at 15 months
b) copy horizontal line at 15 months
c) stack 3 blocks at 18 months
d) speak 10 words at 18 months
e) climb stairs holding rail at 18 months
A
ANSWER: b) copy horizontal line at 15 months - “makes line with a crayon” at 15 months, but
“imitates vertical stroke at 18 months and horizontal stroke at 24 months”
a) walk 3 steps at 15 months - yes, should walk alone by 15 months
c) stack 3 blocks at 18 months - yes, should do this at 15 months
d) speak 10 words at 18 months
e) climb stairs holding rail at 18 months - yes, climbs stairs with one hand held
7
Q
7) A picture of child showing the parachute reflex is shown. What is true?
a) This is a primitive reflex that disappears by 4 months
b) This is a voluntary reflex which disappears when child starts walking
c) This is an involuntary reflex that appears at 7-9 months and does not disappear
A
c) This is an involuntary reflex that appears at 7-9 months and does not disappear
Need parachute reflex to start walking so if you fall you don’t smash your face; it doesn’t go away (so you keep not face smashing)
8
Q
8) Which is the indication for urgent evaluation?
a. Baby does not turn to sound at 4 month
b. Baby no babble at 6 mo
c. 15 mo does not follow simple command without gesture
d. 24 m without 2 word phrases
A
ANSWER: a. Baby does not turn to sound at 4 month
b. Baby no babble at 6 mo - should babble at 6 months, but not red flag if not
c. 15 mo does not follow simple command without gesture - 12 months should follow 1 step
command with gesture, 14 months should follow 1 step command without gesture
d. 24 m without 2 word phrases - should have 2 word phrases at 2 years
9
Q
70) A child is seen with her mother. The child reportedly wakes to loud noises. She stops crying when comforted by her mother. She makes some cooing and gurgling noises and is feeding well. When prone she is able to lift her head off the surface. When she is held up against her mother’s shoulder she lifts her head off the shoulder. She is not yet putting weight on her forearms when in prone. She is not yet holding her head steady when in a sitting position. The developmental age of the child is:
a) 2 weeks
b) 4 weeks
c) 6 weeks
d) 8 weeks
e) 10 weeks
f) 12 week= Nelson’s 3 mon= life head with arm extended, waves at toys, head lag partially
compensated, moro gone, sustained eye contact and says “aah, ngah”
A
ANSWER: d) 8 weeks= Nelsons= raises head sustained on ventral suspension, head lag when pull to sitting, follow objects, smile with contact, listen to voice + coo
f) 12 week= 3 mon= lift head with arm extended, waves at toys, head lag partially compensated, moro gone, sustained eye contact and says “aah, ngah”
10
Q
69) A little boy is brought in by his father. He responds to having his name called, smiles and babbles when you speak with him. He squeals with delight when bounced on his father’s knee. He grabs at a toy and puts the toy to his mouth When in prone he is able to push up on his hands and hold his head steady. He then rolls onto his back. In a sitting position he leans forward and puts some weight on
his hands. He not yet sitting unsupported. He is not picking up small items with thumb and first finger. The developmental stage is:
a) 2 months
b) 4 months
c) 6 months
d) 8 months
e) 9 months
A
c) 6 months
11
Q
73) A child visits your office with her mother. She brings a doll and her purse with her. She asks her mother “where is my cookie?”. She tells you “I went to Allison’s birthday party. I wore my pink Sleeping Beauty dress, we had a fashion show and we made a wand craft. I am having a Dora birthday and all my friends are coming.” Her party is in 2 days. She easily imitates drawing a circle and cross, but has trouble with a square. She is happy to pretend to examine her doll with your stethoscope while you talk to her mother. How hold will this child be at her birthday party?
a) 3 years
b) 4 years
c) 5 years
d) 6 years
A
b) 4 years = at least 3 given circle, cross but not quite 4 y.o. milestones so next birthday party is
12
Q
72) The average 2 year old has the following developmental milestones?
a) Vocabulary of 100 words
b) Speaks in 2 word sentences
c) Follow 2 step commands
d) Clear articulation
e) 1 and 2
A
e) 1 and 2
a) Vocabulary of 100 words= YES should have by 18-24 month
b) Speaks in 2 word sentences = YES should have by 18-24 month
c) Follow 2 step commands= attained usually between 24-36 month
d) Clear articulation -> 90% in 4 y.o. and 100% in 5 y.o.
e) 1 and 2
13
Q
68) A girl comes to your office, she walks into the room independently and squats to pick up a ball and follows the direction “throw me the ball” when you ask. She says dada and mama for dad and mom and baba for bottle and says “all gone” or “uh oh” in the exam room. When asked “where is your nose, eyes and head” she points appropriately. She points to a ball and says “ba”. She says “mo” to request more cheerios. She makes good eye contact. She stack 3 small blocks. When she leaves
the exam room she waves bye-bye. What is her developmental age?
a) 10 months
b) 12 months
c) 15 months
d) 18 months
e) 20 months
A
d) 18 months
-Gross Motor: walk (12 mon), squats (< 2y.o.)
-Fine Motor: throws (min. 12 months), 3 tower (min. 12 month since agex3= # cubes in tower)
-Speech: specific mama and dada (12 month minimum), points (15 month), follow simple command
(15 months). Not quite 2-3 word phrases = 2 y.o.
-Social: knows body parts (18 month),
14
Q
71) Which milestone do most children achieve first?
a) Overhand throw of a ball
b) Kicking a ball
c) Hopping
d) Riding a tricycle
e) Skipping
A
b) Kicking a ball (18 month)
a) Overhand throw of a ball (2 y.o.)
b) Kicking a ball (18 month)
c) Hopping (4 y.o. hops on one foot)
d) Riding a tricycle (5 y.o.)
e) Skipping ( 5 y.o.)
15
Q
93) Who to refer to SLP?
a. 6 year old with trouble with phonemes
b. no words by 18 months, in a bilingual household
c. 2 year old, people only understand 50%
A
b. no words by 18 months, in a bilingual household
refer to SLP if: not using 3 words at 15 months
16
Q
102) Delayed 4 y/o. Can go up and down stairs one foot at a time. Three word sentences. Vertical lines, no circle. 50 words. What is his developmental age.
a. 18
b. 24
c. 30
d. 36
A
c. 30
Vertical line at 18 months, circle at 3 years, 3 word sentence at 2-3 years, alternating feet on stairs at 3 years
17
Q
Name 1 milestone in each of the following criteria for a 36 month old: 1 line each
a) gross motor
b) fine motor
c) language
d) social
A
a) gross motor – tricycle, stairs alternating feet, stands on one foot briefly
b) fine motor – 9 block tower, circle, uses utensils, undresses
c) language – 3 word sentences, 250 words, 75% intelligible
d) social- group play, shares, knows name and age
18
Q
Write “normal” or “abnormal” for an 18-month old child that you are assessing in your office?
Has 2 words
Walked at 14 months and is unable to go up and down stairs
Doesnʼt point to things
Displayed a hand preference at 10 months of age
A
Has 2 words – abnormal (should have 7-20)
Walked at 14 months and is unable to go up and down stairs - normal
Doesnʼt point to things - abnormal
Displayed a hand preference at 10 months of age – abnormal
19
Q
Kid is 10 months old, ex 28 weeker. What is developmental age. Sitting independently for 10 min, could roll over, not yet cruising, no pincher grasp. Babbled. Not pulling to stand. Look for dropped objects briefly.
A
Sitting independently for 10 min (6-8m) , could roll over ( 6-8mo) , not yet cruising ( 9-11m) , no
pincher grasp (9-11m). Babbled (6-8mo). Not pulling to stand (9-11). Look for dropped objects
briefly. (9-11m)
- cGA 7 months, developmental age 6-8m
20
Q
Child who is 2 years old. Speaks 8 words. Points and gestures. Socially appropriate. What is the most likely diagnosis:
- Global developmental delay
- Developmental language disorder
- PDD
A
- Developmental language disorder
21
Q
A 3 year old child is seen in your office. He just started making 2 word sentences and has about a 50 word vocabulary. His receptive language is better than his expressive language. He can build a tower of 12 blocks and make a very nice house out of Legos. What do you counsel the mother that he is at risk for in the future:
a. Autistic spectrum disorder
b. Developmental disorder
c. Reading disorder
d. ADHD
A
c. Reading disorder (yes! strong association (50%) between language disorder and later reading disorder)
22
Q
A mother is concerned that her 3-year-old child was able to speak 3-4 words sentences at 22 months of age but now she seems to be stammering/having dysfluency of speech a lot. What next:
a) reassure
b) audiology testing
c) refer to speech pathologist
d) complete neurodevelopmental assessment
e) emotional disturbance can be the cause of stammering
A
a) reassure - developmental disfluency - common between 2-3 years, lasts weeks to months and resolves by age 4 without treatment; child is not frustrated or distressed versus stuttering they are
If they specifically were talking about stuttering, usually onsets between 4-5 years, multiple repetititions common (more severe than dysfluency), and needs referral to SLP (of note, can be caused/worsened by emotional disturbance)
23
Q
7 yo boy with past history of speech delay. His reading is now below a grade 1 level. Teacher thinks that he has ADD. What would be the most appropriate next step:
a) investigate for learning disability
b) psychotherapy
c) behavior therapy
d) Ritalin 5mg bid
e) Ritalin 20 mg bid
A
a) investigate for learning disability
Early language disorder is strongly associated with reading disorder
24
Q
In a child with expressive speech delay, the parents should be encouraged to all of the following except:
a) read to him at night
b) make him repeat incorrectly pronounced words over and over
c) make him stop his activity and look at you when you talk
d) don’t complete his sentences
A
b) make him repeat incorrectly pronounced words over and over
25
A 2 year old boy has only 3 single words, he has poor receptive language, does not point to indicate his wants, does not orient to his own name and does not engage in pretend play. He loves to play with his blocks. Which of the following is important in your investigation of his problem:
a. Psychological assessment
b. MRI head
c. Speech/language assessment
d. Audiology testing
d. Audiology testing
Sounds like autism, but always need to rule out hearing impairment
26
You are seeing a 3 year old girl for language delay. While her mother is talking she wanders around your exam room. She says ‘go out’ to her mother. She puts her mothers hand on a toy to get her to fix it. She does not respond when you call her name. Of the following history items, which would assist you to make your diagnosis?
a) Recent family stressors
b) Family history of delayed language
c) Description of her social interactions with family and children at daycare
d) Resuscitation history after birth
c) Description of her social interactions with family and children at daycare
She be autistic
27
2½-year-old child is referred with language delay and inferior ectopia lentis. You should
a) molecular studies for Marfan syndrome
b) echocardiogram to rule out aortic root abnormalities
c) fibroblasts/skin biopsy for enzyme assays
d) quantitative serum amino acids
e) platelet count and coagulation studies for hypercoagulability
d) quantitative serum amino acids
homocystinuria: mitral valve prolapse, tall stature, long bone overgrowth, developmental delay
diagnosis: elevated methionine or homocystine in body fluids (including blood
and urine) are diagnostic, cystine is low or absent in plasma
- can do liver biopsy to look for the enzyme
28
All of the following are true of vision in newborn infants EXCEPT:
a) should be able to fix on a large object from birth
b) by 2 months of age the infant can follow through 180 degrees
c) retinal hemorrhages are rare in newborns and cause permanent deficits
d) a newborn’s sclera is thin which causes a blue hue
c) retinal hemorrhages are rare in newborns and cause permanent deficits
- superficial retinal hemorrhages may be observed in many newborn infants
- the majority resolve within 2 weeks
- complete resolution of all birth related hemorrhages expected between 4-6 weeks
29
Which is true regarding children in foster care:
1. In older kids, occasional visits with parents is warranted if child previously had developed a strong attachment to parents
2. Disruption of continuity of care may be potentially detrimental to all children
3. If they are in a loving foster home for their first year of life, they will do well long term
4. Child should be placed with grandparents for best long-term outcome
2. Disruption of continuity of care may be potentially detrimental to all children
unpredictable contact with parents, and placement changes negatively impact child's health
30
1-year-old child with psychosocial deprivation. Which is the most likely finding:
a) poor appetite
b) parental history of inadequate caloric intake
c) microcephaly
d) normal development
e) absence of cuddling response
a) poor appetite - per Alli
31
A mother of a 9 yo boy visits you in your office. She would like to know what the effects of her separation and impending divorce will have on her son. The statement that you are most likely to include in your discussion with her would be:
a) If the mother and son undergo psychological counselling the effects of the separation and
divorce will likely be short-lived.
b) Males adjust better than females in the immediate period after divorce.
c) Joint custody is better for the child regardless of whether there is continued conflict between the parents.
d) Parental depression and conflict issues will more likely determine the adjustment of the child than custody issues.
e) The most important issue to address at this time is custody.
d) Parental depression and conflict issues will more likely determine the adjustment of the child than custody issues.
3 most significant factors impacting child’s well being during a divorce:
- quality of parenting
- quality of parent-child interaction
- degree, frequency, intensity and duration of hostile conflict
32
Of the following behavioral phenotypes, which describes Williams Syndrome (7q11.23 deletion)?
a) Strengths in verbal short term memory, extreme weakness in visual-spacial skills, excessive
talking, hyperacusis, inattention, phobias and sleep problems
b) Depression, shyness, social anxiety, executive function deficits, cognitive decline and dysinhibition
c) Delays in motor and language skills, mild cognitive impairments or learning disabilities, and obsessive compulsive characteristics
d) Severe cognitive impairments, minimal verbal communication, movement or balance disorder,
easily excitable
a) Strengths in verbal short term memory, extreme weakness in visual-spacial skills, excessive
talking, hyperacusis, inattention, phobias and sleep problems
NOTE: c) Delays in motor and language skills, mild cognitive impairments or learning disabilities, and obsessive compulsive characteristics (Usually more ADHD, GAD)
33
You are seeing an 18 month old boy with Fragile X syndrome. Which of the following developmental issues would not be seen in boys with a full FMR mutation?
a) Delays in fine and gross motor skills
b) Relatively strong expressive communication
c) Cognitive impairments
d) Hyperactivity and distractibility
e) Social avoidance and anxiety
b) Relatively strong expressive communication (usually delayed speech by 2y.o.)
34
You are seeing a 3 year old boy with his foster parents. There is a confirmed history of prenatal alcohol consumption. Which of the following physical findings would support a diagnosis of FAS?
a) Weight at 50 th percentile
b) Height at 50 th percentile
c) Philtrum length at <3 rd percentile
d) Palpebral fissure length <3 rd percentile
e) Head circumference at 25 th percentile
d) Palpebral fissure length <3 rd percentile
35
Of the following syndromes with tall stature, which does not have MR as part of the presentation?
a) Fragile X
b) Sotos Syndrome
c) Karyotype XYY
d) Marfan’s Syndrome
e) Homocysteinuria
d) Marfan’s Syndrome
Karyotype XYY: (Jacob’s tall and possible LD and behavioural/aggression; and extra note:
XXY- tall stature called Klinefelter also at risk for LD)
36
What syndromes are on the differential diagnosis for a child with tall stature and developmental of behavioural abnormalities?
Klinefelter, fragile X, homocysteinuria, Loeys-Dietz, Sotos, Weaver syndrome
37
What's the syndrome? ● Tall stature, Gynecostmastia, delayed puberty, infertility, small firm testes, high pitched voice, LD
Klinefelter (XXY)
38
What's the syndrome? Tall stature, ● large head, long thin face with receding hairline
● feeding difficulty since birth with facial flushing and hypotonia.
● High palate and pointy chin
Sotos syndrome (5q35 deletion)
39
What's the syndrome? ● marfan-like habitus, developmental delay, inferior subluxation of lens , cataracts, crowding of teeth
Homocysteinuria
40
You are asked to consult on a newborn with congenital anomalies. The child has a coloboma of
the iris, TOF, choanal atresia, dysplastic low set ears. The pregnancy and family history are
unremarkable. The karyotype is normal and FISH for microdeletion of 22q11 is negative. What is the
most likely diagnosis?
a) Cornelia de Lange
b) Williams Syndrome
c) Noonan Syndrome
d) Vater association
e) CHARGE syndrome
e) CHARGE syndrome - AD genetic disorder, usually no fhx
● Coloboma (hole in structure of eye: iris, retina, choroid disc etc.)
● Heart Defects (including conotruncal like TOF), AV canal defect, aortic arch abnormalities
● Atresia Choanae (unilateral or bilateral)
● Retardation of growth/development (DD, short stature)
● Genital/urinary abnormalities (micropenis, cryptorchidism, hypoplastic labia, delayed puberty)
● Ear abnormalities and deafness (asymmetric, reduced height, cup shaped etc.)
Note major criteria are different than acronym - coloboma, choanal atresia, cranial nerve anomalies, ear anomalies
41
How is CHARGE syndrome diagnosed?
Clinical criteria (all 4 major or 3 major and 3 minor); genetic testing - molecular testing
42
A 3 mo baby with wt. 6.3kg, length normal, hc 47cm. What initial investigation would you do?
Head U/S
43
4 biologic determinants of child development
- genetics
- in utero exposure to teratogens (mercury, alcohol)
- low birth weight
- postnatal illness/ insults (meningitis, TBI, chronic illness)
44
Which of the following interventions would be provided by an Early Childhood Resource
Specialist?
a) Design home or school based activities to practice speech and language skills
b) Provide consultation to parents regarding behavioral concerns and parenting strategies for children with special needs
c) Develop augmentative communications tools
d) Focus on sensory environment to achieve functional daily tasks
e) Provide information on positioning and handling
b) Provide consultation to parents regarding behavioral concerns and parenting strategies for children with special needs
45
You are working in an international adoption clinic. A family brings you a file on a potential adoptee. Which of the following is most likely to correlate with a poor outcome:
a. Microcephaly proportional to height and weight delay
b. Developmental delay proportional to height delay
c. Microcephaly with normal height and weight parameters
a. Microcephaly proportional to height and weight delay - to me more suggestive of malnutrition, which could be reversible
b. Developmental delay proportional to height delay
c. Microcephaly with normal height and weight parameters - more suggestive to me of underlying syndrome/early exposure that will not be reversible - peds in
review 2004 - preparing families for international adoption (red flags: IUGR, microcephaly out of proportion to other growth parameters, FAS facies)
46
2.5 year old child who is not combining 2-words, has about a 50-word vocabulary and other people understand about 25%. Otherwise, climbs stairs, runs around, throws underhand. Interested in other people. What is this most consistent with?
a . isolated language delay
b. global developmental delay
c. autism
a . isolated language delay
47
An 18 month old child in your office with the concern of developmental delay. He is babbling but does not yet say mama and dada or any other words. He is able to sit unsupported for a brief period of time. He does not yet have a pincer grasp
a. What is her developmental age?
b. He has a 13 year old brother in “special education” classes and a maternal cousin with autism. What one test would you want to do and why (2 lines)?
```
A) 6 months
Babbling: 6-8 months
Mama/dada: 9 months
Other words: 12 months
Sit unsupported briefly: 6 months
Pincer grasp: 9 months
```
B) fragile X - male child with global delay, has a brother similarly affected and fragile X is X-linked and would come from mother - notable that there is another affected relative on mom's side; fragile X can present like autism
48
A 3 y/o girl with regression of milestones is noted to have microcephaly. What is the most likely diagnosis:
1. Childhood disintegrative disorder
2. Autism
3. Rett's
4. Fragile X
5. TORCH infection
3. Rett's
1. Childhood disintegrative disorder - removed from DSM 5, not associated with microcephaly; now part of autism spectrum disorder
4. Fragile X - accounts for 3% of males with intellectual disability, females have less severe disease, no regression
49
You are seeing a 2 year old girl in whom you have told the family that you are suspicious of autism. The mother has been doing some research and asks you questions about Rett syndrome. Name 4 features of Rett Syndrome.
- normal prenatal/perinatal course
- normal development until at least 6 months
- regression of previously acquired milestones (especially language and social)
- acquired microcephaly
- repetitive hand wringing movements
50
Most predictive of mild MR?
a. Maternal alcohol during pregnancy
b. Cocaine during pregnancy
c. Mom did not finish high school
d. Neonatal hypoxia
c. Mom did not finish high school
51
Mother used IV heroin before and during her pregnancy. Her 10 month old child is now losing acquired milestones and developing bilateral spasticity. The most likely cause is:
a. HIV
b. CMV
c. cerebral palsy
d. syphilis
a. HIV
CNS HIV: variable - mild developmental delay to progressive encephalopathy with loss
or plateau of milestones, cognitive deterioration, impaired brain growth leading to acquired
microcephaly and symmetric motor dysfunction
- spasticity, hyperreflexia and gait disturbance can occur
Re: syphilis: babies with congenital neurosyphilis may have seizures, but otherwise wouldn’t present this way
52
You are seeing a 9 month old in your office. She is babbling and understands the command “no”.
She cries when you take her away from her mother. She rolls but does not sit. She picks up a small
object with an immature pincer grasp. What do you say to her mother about her development?
a) Her development is normal
b) She has delays in her language skills
c) She has delays in her social skills
d) She has delays in her gross motor skills
e) She has delays in her fine motor skills
d) She has delays in her gross motor skills
53
A 4 year old comes to your office with the concern of developmental delay. He can say his full
name, age, and sex, as well as count to 3 and name 3 body parts. He can ride a trike and stand
briefly on one foot. He helps to undress himself and plays pretend games with other children. He can
copy a circle and a cross. What is his developmental age:
a. 24 months
b. 36 months
c. 48 months
d. 60 months
b. 36 months
54
Developmental concerns associated with neonatal risk factors, motor delays, genetic conditions are typically identified early, often by primary physicians. Milder, often very common, developmental concerns are often not identified until later in childhood or upon school entry. Which of the following conditions is more likely to be identified in a school aged child rather than a younger child?
a) Learning disability
b) Mild cognitive issues (mild MR, borderline cognitive abilities)
c) Aspergers syndrome
d) 1 and 3
e) All of the above
e) All of the above
55
You are seeing a 10 year old boy with a previous diagnosis of MR. He is not dysmorphic and his growth parameters are at the 50 th percentile. He functions like a 5-6 year old. He did have a genetic work up which as all normal. His mother wonders if the cord wrapped around his neck at birth was the cause of his cognitive impairments. He needed minimal resuscitation. What do you say to her?
a) An etiology is commonly found for children with MR
b) He needs more testing to answer her question
c) He should have an MRI to delineate the etiology of the MR
d) It is unlikely that the delivery was the cause of his cognitive impairments
e) His diagnosis needs to be reviewed
d) It is unlikely that the delivery was the cause of his cognitive impairments
o Mild: IQ 50-70= mental age as adult near 9-11 y.o.
▪ more environmental; identifiable cause in < 50%
▪ If biocause: genetic or chromosomal (Williams, Noonans), IUGR, prem,
prenatal exposure (FAS)
o Severe: IQ < 50= mental age as adult near 3-5 y.o.
▪ identified cause in > 75%
▪ Chromosomal: T21, Wolf-Hirschhorn Syndrome
▪ Genetic and Other: Fragile X, Rett Syndrome, Angelman, Prader-Willi
▪ Abnormal brain: example lissencephaly
▪ Inborn errors of metabolism or other neurodegenerative
56
Which of the following is a sign of Aspergers:
1. Gross motor delay
2. Preserved language development
3. Adequate social skills
4. Fine motor delay
2. Preserved language development
57
You are asked to assess a child for autism. Which of the following statements would best support the diagnosis?
a) child takes toys from other children in the examining room
b) child consistently displays a startle response to a ringing telephone
c) child spends much of the examination spinning a wheel on a toy truck
d) child brings each of the toys into the exam room to show his mother
c) child spends much of the examination spinning a wheel on a toy truck
Autism diagnosis: persistent impairment in social communication and
interaction + restricted repetitive pattern of behavior/interest
58
What are the 2 core criteria of autism diagnosis and an example of each?
1. impairment in social communication and interaction
- deficits in developing/maintaining relationships; deficits in non verbal behaviours; deficits in socio-emotional reciprocity
2. restrictive, repetitive behaviours or interests
- stereotypies (echolalia, hand flapping, spinning)
- inflexibility/strict demand for routine
- restricted fixated interests
- hyper/hyporeactivity to sensory inputs
59
A mother has a 2 year old child recently diagnosed with autism. Mother is currently pregnant with her second child and wants to know the risk of this child also having autism. What do you tell her about the recurrence risk?
a. It is lowered if she does not give the MMR vaccine
b. There is no difference from the population risk
c. There is a slightly increased risk over the general population
c. There is a slightly increased risk over the general population
● RF: male
o FHX: high recurrence risk in siblings (2-19%)
o Closer spacing of pregnancies
o Advanced maternal or paternal age
o Extreme prem birth (< 26 wk GA)
o FHX (+) for LD, psychiatric dx or social disability
60
15 month who only says “ma”, stereotypical play, does not engage in social play. What is the best predictor of autism?
a. Hyperactivity
b. Hand flapping
c. Does not point to things to show interest
d. Preserved language development
c. Does not point to things to show interest
61
3 year old male talking at a 1.5 year level. No echolalia. Plays normally. Comprehension better than expression. Motor development normal. What is he at risk for
a. PDD
b. Developmental Disorder
b. Developmental Disorder (abnormal pattern of development) - seems at risk for language disorder
(PDD = autism)
62
A 4 yo child with symptoms of autism. What is the diagnosis (1). What 2 neurologic disorders are associated with this.
1) Autism
| 2) Tuberous Sclerosis and Neurofibromatosis (Angleman, Rett, Fragile X)
63
Description of a child with florid autism. Name 3 tests you should order. Which 2 consultants or services would you involve to help you with your diagnosis?
1 ) Hearing Test, Microarray, Fragile X
| 2) Developmental Pediatrician, Speech and Language Therapist
64
List 4 diagnostic features of autism.
- Impairment in social communication and social interaction
- Restrictive and repetitive behaviours/ interests
- Presence in early developmental period
- Significant impairment in social occupational or other area of functioning
65
A mother brings her 1-year-old child for concern regarding head banging. Physical exam is normal. The parents are worried about brain damage. What should you do:
a) reassure
b) EEG
c) CT head
d) use a helmet to prevent head injury
e) family psychological assessment
a) reassure
- typically begin in the 3 years of life, often before age 2 years
- in typically developing children the movements resolve over time
- specifically self-injurious behaviours like head banging occur in up to 25% of toddlers but in kids over 5 are almost always associated with developmental disorders
- Developmentally Normal child unlikley to hurt themselves from injury
66
Parents bring their 18 month old son to see you because of concern about head banging. What treatment, if any, do you offer (1)?
Reassure- cannot cause brain/skull injury (in normally developing children) and usually grow out of it
▪ Mild- ignore the behavior, encourage substitute behavior and do not convey worry to child
● May disappear with time and elimination of attention
67
Mom has son with aggressive behaviors. You want to start risperidol. What 3 SERIOUS side affects will you tell mom about drug
EPS, Prolonged QT, NMS
68
Child 3 y/o referred for behaviour problems. Mom concerned because child refuses to wear patch for amblyopia for the past 8 months. What do you do?
1. Refer to social work
2. Immediate referral to ophthalmology for other treatment modalities
3. Refer to ophthalmology once child has started to wear patch again
4. Refer to parenting class through public health to learn skills to make child wear patch
2. Immediate referral to ophthalmology for other treatment modalities
69
Marital troubles at home, child is acting out at school and daycare. Mom has come in for advice.
a. give the mom parenting classes
b. request a meeting with both parents to assess the home situation.
c. give him Ritalin
b. request a meeting with both parents to assess the home situation.
70
Divorcing parents. What’s best for the kid?
a. best if joint custody could be given asap
b. best if child gets to see both parents (i.e. joint custody) even if the parents are fighting all the time
c. best if parents can settle their differences and not fight in front of kids
c. best if parents can settle their differences and not fight in front of kids
71
10 year old boy who has recently been made aware that his teenage brother is dying of ALL. He spends all his time out with his friends and is not wanting to be with the family. Mother concerned - what do you tell her?
- Death of family member is most difficult loss for a child
- Reluctant to talk because adults around them are uncomfortable to talk
- Turn to peers and tell adults they don’t want or need to talk about it
- Presence of secure and stable adults to meet needs and permit discussion about the loss is
most important
o No single way to grieve- respect difference and reach out to support each other
o Maintain emotional/ physical presence (hug, talk, ask)
72
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A 13 y/o boy starts fires, school problems, hurts pets, threatened a child at school with a knife.
What is his likely diagnosis?
1. ODD
2. Conduct Disorder
3. ADHD
```
2. Conduct Disorder
73
9 year old boy who has killed a cat in the last year and set fires to property. He has also been caught stealing and is aggressive at school. What is his diagnosis?
a. oppositional defiant disorder
b. conduct disorder
c. ADHD
d. Antisocial personality disorder
b. conduct disorder
74
You see a 7 year old child with the concern of thumb-sucking. Which of the following is important
to include in the discussion of the risks and benefits of intervention in this patient:
a) Thumb-sucking never causes self-esteem issues
b) Thumb-sucking can lead to dental malocclusion and facial growth abnormalities
c) Topical deterrents are very effective
b) Thumb-sucking can lead to dental malocclusion and facial growth abnormalities
- thumb sucking beyond 5 years can be associated with paronychia (red, tender bacterial or fungal infection at base of nail) and anterior open bite (gap between upper and lower front teeth)
75
A 4 yo sucks her thumb while watching TV. What to tell mom?
a. Put a bitter tasting substance on her thumbs
b. Reassure
c. Prescribe a mouth appliance
d. Reward system
d. Reward system
- mgmt: ignore thumb sucking; praise child for alternate behaviours
- reminders and reinforcement (sticker for each block of time with no thumb sucking)
76
A 30 month old child with temper tantrums starting after the onset of attempting toilet training. What to do:
1. Time outs
2. Persevere
3. Take a 1-3 month break from toilet training
4. Reward with stickers each time on the potty
3. Take a 1-3 month break from toilet training
77
2 yo with temper tantrums. Give advice to mom x2
- tantrums are common in this age group, triggered by anger/feeling overwhelmed and more likely if child is tired or hungry
- put in time out at early signs of tantrum to prevent escalation
- ***positive reinforcement for times when they are tantrum free
78
20 month old child. Each time the parents say "no" child cries, turns blue and then passes out with some generalized tonic clonic movements. He recovers within 1 minute and the parents administer CPR. What do you recommend?
1. Consistent discipline
2. do not upset the child
1. Consistent discipline
Breath holding spells - common in 6-18 months, can occur until age 5
● Tx: try to intercede before child highly distressed (time out, parent model anger control
you want child to show)
● Tx: ignore behavior when start
79
An 8 month old baby is not sleeping through the night. She is waking up one hour after being put down in her crib. Which of the following is true:
a) this should improve if she learns to fall asleep in her crib vs. being rocked to sleep
b) she should be allowed to cry to sleep to solve this problem
c) giving the baby a pacifier is a proven technique
d) she should be given a bottle of warm milk to help her fall asleep in her crib
a) this should improve if she learns to fall asleep in her crib vs. being rocked to sleep
80
At what age should a child be able to self-soothe when he awakens at night?
a. 5-7 months
b. 8-10 months
c. 11-13 months
d. 14-17 months
c. 11-13 months (most should be able to by ~12 months)
81
You are referred a 15 year old boy with a history of fatigue. On history you find that he is going to bed very late and having to get up very early for school each morning. There is nothing else concerning on history. What are five recommendations you make to him and mother regarding sleep hygiene?
- Quiet and comfortable sleep environment - dim lights, calm environment
- Consistent bed and waking time
- Avoid stimulation (Tv, computers, video games within 1-2 hours of bed time)
- avoid caffeine after mid-afternoon
- no smoking, alcohol, herbal remedies for sleep
- Read a book (not tablet) to mentally fatigue
- Increase physical activity in daytime (but not within two hours of bedtime)
- Limit bed use to sleep (not for tv, eating, homework)
82
A father comes to you because his 4 year old child has been awakening every night for the past 2 months; he and the child’s stepmother have gotten only 1 night of sleep per week over this time period. The child wakes every night at midnight and cries inconsolably for a short time before going back to sleep. She does not remember it in the morning. What do you advise:
a. Wake her every night at 11:45pm for 10 minutes for 7 days
b. No naps at day care
c. No liquids two hours prior to bedtime
a. Wake her every night at 11:45pm for 10 minutes for 7 days - actually need to do it for 4 weeks to see improvements
- only intervene to stop them from hurting themselves
(child has night terrors)
83
Description of night terrors. List two things to do for management.
o education and reassurance (self-limited)
-avoid sleep restriction and caffeine
(which both increase Slow Wave Sleep)
-scheduled awakenings 15-30 min prior to expected episode if occurring nightly - need to do this for 2-4 weeks
84
Signs of toilet readiness?
a. able to dress and undress himself.
b. desire to please based on positive relationship parents
c. can stay dry overnight
d. can communicate need for toilet using full sentences
b. desire to please based on positive relationship parents
85
An 8-year-old with primary nocturnal enuresis has tried the alarm for 8 weeks without success. He wants to go to summer camp. The best option is:
a) DDAVP
b) amitriptyline
c) imipramine at bedtime
d) imipramine 25 mg tid
a) DDAVP
Desmopressin (synthetic ADH) work short term and best
for camps and sleepovers. Avoid fluids 1hr before and 8h after
- note: imipramine is a TCA and can be used at bedtime (takes one week to reach effect); DDAVP better option
86
What would you suggest for a 7-year-old boy with nocturnal enuresis who sleeps through the night:
a) DDAVP
b) imipramine
c) conditioning alarm
d) parent awakening program
c) conditioning alarm
50% cure rate long term, but most effective treatment we have; needs motivation of child and whole family; can also just wait it out and not do anything
87
Mother comes to see you about starting to toilet train her child. What 5 questions can you ask her to assess for readiness.
o Gross Motor
▪ Able to walk to the potty chair (or adapted toilet seat)
▪ Stable while sitting on the potty (or adapted toilet seat)
o Control
▪ Able to remain dry for several hours
o Language
▪ Receptive language skills allow the child to follow simple (one and two step) commands
▪ Expressive language skills permit the child to communicate the need to use the potty (or adapted toilet seat) with words or reproducible gestures
o Social
▪ Desire to please based on positive relationship with caregivers
▪ Desire for independence , and control of bladder and bowel function
88
4 year old with primary enuresis. What is one important piece of advice that you should give to the parents?
This is still within a normal range to not yet be dry; avoid battles over toilet and provide encouragement and praise any successes; no punishment or humiliation
89
All of the following are features of sleepwalking EXCEPT:
a) occurs during stage 4 non-REM sleep
b) positive family history
c) can walk around furniture
d) do not walk into dangerous areas
e) resolve spontaneously in later childhood
d) do not walk into dangerous areas
90
2 year girl who has episodes of abnormal breathing and movements. Occurs when watching TV or bored. Mum can decrease length of episodes when talking to her. Episodes last 5-6 min. She seems responsive throughout the episodes. What do you recommend to do to mum (1)?
Reassure - infantile masturbation
91
A child who is described as having a learning disability, has big ears. Mom has an LD as well. What to tell mom to expect:
1. Problems with tics
2. Problems with athetosis
3. Problems with hyperactivity
4. Problems with tremor
5. Problems with nystagmus
3. Problems with hyperactivity
Fragile X associated with hyperactivity (80% have ADHD)
92
An 8 year old boy at risk for failure in school is sent to your office for evaluation for specific learning disorders. History and physical exam are within normal limits. Which of the following do you do next:
a. Trial of stimulant medication
b. Psychological assessment
c. CBC, TSH and Pb level
b. Psychological assessment
Specific LD - most common is reading disorder (dyslexia) - 80% of kids with LD
- NO Ix beyond history, physical and psychometric testing needed
93
A 10 year old boy with a history of myelomeningocele and VP shunt placement for hydrocephalus comes to your office with a history of a recent decline in school performance of several months duration. There are no specific neurological, urological or MSK complaints and he does not complain of any pain. A CT scan is done and does not show any change from previous. Which of the following is your next step in management:
a. EEG
b. Psychological assessment
c. Assessment by neurosurgery
d. Trial of stimulant medication
a. EEG
- can develop shunt-related epilepsy
- recent rapid decline over a few months more suggestive of something like absence seizures than an underlying cognitive/LD that has never been a problem before
94
3 yo with isolated language delay. What do you tell mom he is at risk for?
a. Reading disability
b. ADHD
c. Articulation disorder.
a. Reading disability (dyslexia)
95
2. 5 year old child. Which is most consistent with an expressive language disorder?
a. 100 word vocabulary
b. no pronouns
c. no 2-word combos
d. stuttering
c. no 2-word combos
96
17. Child with dysfluency. List four indications to refer to speech therapy.
Dysfluency = stuttering
- 3 or more dysfluencies per 100 syllables
- avoidances or escapes (pauses, head nod, blinking)
- discomfort or anxiety while speaking
- suspicion of associated neurologic or psychotic disorder
97
What is the best predictor of difficulty reading in JK?
- Language disorder
| o Strongly related to later reading disorder
98
Teacher concerned about 4 yr old child who can't use scissors, can’t copy a square... she wonders about developmental coordination disorder. List 2 diagnostic criteria for developmental coordination disorder.
A) Acquisition/ execution of coordinated motor skills below expected (clumsiness, slowness, inaccuracy of skill)
a. Examples: catching, using scissors/cutlery, handwriting, riding a bike, sports
B) Significantly/ persistently impairs activities of daily living (self-care and self-maintenance) and school productivity, activities, play
C) Onset in early developmental period
D) Not better explained by ID, visual impairment or neurological condition
99
A 6-year-old boy has been having involuntary tics for approximately 1 month. He is in grade 1 and doing well. His mother feels that their onset correlates with the death of his grandfather. You suggest:
a) wait
b) refer to psychiatrist
c) treatment with haloperidol
d) treatment with methylphenidate
e) tell his mother that he will have Tourette’s syndrome
a) wait
- treat tics only if interfering with function and are a problem for the CHILD
- need at least 1 year of symptoms for tourette
100
You are about to put a child on stimulant medication for his ADHD. The mother asks you about the potential for increasing his potential for future drug addiction. What do you counsel her about her son’s future risk:
a. Stimulants have no effect on risk of drug addiction
b. Stimulants decrease future risk of drug addiction
c. There is an increased risk of drug addiction, but less so with the dextroamphetamines
b. Stimulants decrease future risk of drug addiction
101
Mother brings in her child who has a diagnosis of ADHD, you are treating him with long-acting Ritalin. What is a late onset side effect of stimulants:
a. Decreased appetite
b. Difficulty sleep
c. Tics
d. Depression
d. Depression
102
What is true about methylphenidate:
a) stimulates appetite
b) no effect on growth velocity - does reduce growth velocity but does not seem to have an impact on final adult height
c) may exacerbate tics
d) can cause dependency
e) effective in 60% of children with ADD
ANSWER: c) may exacerbate tics
b) no effect on growth velocity - does reduce growth velocity but does not seem to have an impact on final adult height
103
A 6 yo boy in grade 1 is not paying attention, disruptive, in danger of failing. He does not read or write as well as his classmates. Appropriate action:
a) fail him
b) full psychoeducational assessment
c) Ritalin
d) classic slow learner
b) full psychoeducational assessment
104
Which is true of ADHD?
1. teacher and parent reporting of symptoms on a checklist frequently agree
2. check for lead poisoning in each kid with ADHD
3. 25% of kids with ADHD have comorbid anxiety disorder
4. kids with ADHD often have thyroid hormone abnormalities
3. 25% of kids with ADHD have comorbid anxiety disorder
105
Which of the following medications used to treat ADHD is not a stimulant?
a) Concerta
b) Dexadrin Spansules
c) Biphentin
d) Strattera
e) Ritalin SR
d) Strattera (NON STIMULANT= Second line Non stimulant Agent= generic name Atomoxetine - SNRI) - good if comorbid anxiety disorder
a) Concerta (Methylphenidate group= Ritalin, Biphentin, Concerta)
b) Dexadrin Spansules (Dextroamphetamine Group= Dexedrine, Adderall, Vyvanse)
c) Biphentin (see above)
e) Ritalin SR (Yes Methylphenidate group)
106
An 8 year old boy with his father is seen for school concerns. There have been concerns raised by his teacher that he is not getting his schoolwork done. He needs reminders to do his work constantly. He is often chatting in class and often out of his seat. His medical history is unremarkable. His hearing is normal. His parents report similar concerns doing homework. What would be your initial course of action?
a) Trial of stimulant medication
b) Behavioural management referral
c) Family counseling
d) Psychiatric referral
e) Evaluation of academic skills
a) Trial of stimulant medication
If kid under 6, trial behavioural strategies first
107
Teen with ADHD, 14 lb weight loss. Currently ADHD is better controlled on his long-acting ADHD med. What is the best thing to do?
a. start Straterra
b. Consult a psychiatrist
c. Change from 7 days a week dosing to 5-days a week.
c. Change from 7 days a week dosing to 5-days a week.
108
Name 3 DSM-V diagnostic criteria for ADHD - inattentive subtype.
- lacks attention to detail/careless mistakes
- cannot sustain attention
- does not listen when spoken to directly (mind wandering)
- does not follow through (starts but does not complete chores, homework)
- poor organization/time mgmt
- avoids tasks requiring sustained mental effort
- loses important things
- easily distracted
- forgetful about daily activities
109
Name 3 DSM-V diagnostic criteria for ADHD hyperactive/impulsive subtype.
- fidgets/taps hands/squirms
- leaves seat inappropriately
- runs or climbs inappropriately
- unable to play quietly
- is “on the go”
- talks excessively
- blurts out answers, completes peoples’ sentences
- cannot wait turn (e.g. in line)
- interrupts or intrudes on others
110
How many criteria are needed for a diagnosis of ADHD mixed sub-type.
meet diagnostic criteria for both inattentive AND hyperactive subtype (6/9 for both - i.e. have minimum 12 symptoms)
111
Describe a child having difficulty in school. Teacher complains child not listening in class. Not getting homework done. List 3 things on your differential diagnosis.
- Hearing loss, learning disability, ADHD
112
Kid with known separation anxiety. Management of school phobia?
a. Return to school immediately
b. Return gradually with parents leaving gradually
c. Give SSRI
d. Give benzo
a. Return to school immediately
113
A 10 yo boy has headache, abdominal pain and lethargy anytime of the day . He has missed 30 days of school in 4 months. He has:
a) migraines
b) school phobia
c) Brain tumour
b) school phobia
114
3 mos girl BW SGA at 2200g at GA38, now wt 10th, ht 25th, HC 50 th
1. 2 yr for catch up growth in IUGR
2. f/u in 6 mos no nutritional intervention
3. need w/u for organic FTT
4. increase dietary protein
5. if not at 50th %ile by 6 months then needs work up for organic FTT
1. 2 yr for catch up growth in IUGR
115
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A 3 year old child comes to your office with concerns of failure to thrive. He is impulsive and destructive in your office and hugs you repeatedly on his first visit. He only says 8 words and does not form 2 word sentences. His mother states that he has a voracious appetite. What is his
diagnosis:
a. psychosocial deprivation
b. attention deficit disorder
c. diencephalic syndrome
```
a. psychosocial deprivation
116
Child with severe trigonocephaly. What is your management?
1. sablage of metopic suture
2. helmet
3. place child face down
4. craniostomy with removal of metopic suture
4. craniostomy with removal of metopic suture
| - if very mild, no treatment needed
117
A child has sustained a head injury and has been intubated in ICU with a fluctuating GCS of 6-9
for several days. There is no evidence of intracranial bleeding or cerebral edema. Upon discharge,
the mother can expect her child to develop:
a) fine motor problems
b) seizures
c) insomnia
d) behavior problems
e) psychiatric problems
d) behavior problems
- cognition is most affected following TBI
- also develop behavioural issues, and problems with learning, memory
118
Sign of sexual abuse?
a. Midline anal tag
b. Scar outside of midline anus
c. Atrophic shiny vaginal mucosa
d. Big rectum > 2 cm with lots of stool
b. Scar outside of midline anus (suggestive of abuse per AAP paper on signs of sexual abuse)
NOTE: c. Atrophic shiny vaginal mucosa - normal description of vaginal mucosa prior to exposure
to estrogen
119
A 9 year old is seen in your office with symptoms of depression and suicidal ideation. Which of
the following is a risk factor for this presentation:
a. Bullying
b. Recent parental divorce
c. Impulsive behaviour
d. Poverty
a. Bullying (likely most correct given CPS and Nelson’s)
recent divorce is also a risk factor, but if divorce leads to resolution of frequent conflict can actually be a relief for kids
120
An 8 year old child is slow to write because he checks each letter 3 times as he writes it. He has no trouble in his interpersonal relationships. What is the diagnosis:
d. Normal behaviour
e. OCD
f. ADHD
e. OCD
121
An 11 year old girl with a maternal history of bipolar disorder has recently become irritable and
restless. She is only sleeping 5 hours per night. What is her most likely diagnosis:
g. New onset of ADHD
h. Bipolar disorder
i. Marijuana abuse
h. Bipolar disorder
BPD is very heritable
122
The following is true of post traumatic stress disorder
a. Intrusive memories
b. Vegetative symptoms
c. No emotional disturbances prior event
a. Intrusive memories
123
A 2 year old child cries when mother is leaving for work everyday. She is also attached to a “special” teddy bear. What should be done?
a) remove child’s teddy bear since this is abnormal attachment to an object
b) reassure parents that this is normal separation anxiety appropriate for child’s developmental level
b) reassure parents that this is normal separation anxiety appropriate for child’s developmental level
18-24 months
- increased clinginess around 18 months
- parents feel they “can’t go anywhere” without a kid hanging off them
- separation anxiety often manifests at bedtime
- many children use a special blanket or stuffed toy as a transitional object
124
Question on car seat indications. When can the child use regular seat belt?
a) When child weighs 41 lbs
b) If child is > 6 yrs old
c) when child, while in booster seat, has level of ears over headrest of the seat
d) when child has a sitting height at or greater than 63 cm
c) when child, while in booster seat, has level of ears over headrest of the seat
125
You are treating a child, and you have a suspicion of Munchausen by Proxy disorder ( now falls under category of factitious disorder imposed on another in DSM V) . Define MBPD (1 line). Name 3 features that are characteristic of MBPD.
1. Form of maltreatment in which parent simulates or causes disease in their child
o Reported symptoms only by one parent
o Testing fails to identify medical diagnosis
o Appropriate treatment ineffective
126
A child shows features of Obsessive-Compulsive disorder. Define obsession and give 1 example (2 lines). Define compulsion and give 1 example (2 lines).
1. Obsessions: recurrent and persistent thoughts, urges or images that are intrusive and unwanted and cause distress
- e.g. bodily wastes and secretions, fear of something calamitous, fear of contamination
2. Compulsions: repetitive behaviours or mental acts performed in response to an obsession according to rigid rules. Acts are aimed at reducing anxiety but are not logically connected to the obsession they are neutralizing
- e.g. hand washing, checking of locks, washing and cleaning
127
What criteria is a necessity for the diagnosis of OCD to be made (1 line)?
Presence of obsessions, compulsions or both that are time consuming, distressing and unwanted
