Developmental Pediatrics MCQ Flashcards by Chidera Nwaroh

You are evaluating a toddler girl with microcephaly, language regression and hand-wringing. What is the inheritance of the most likely diagnosis?

A. X-linked
B. Autosomal dominant
C. Autosomal recessive
D. Something else

X-linked

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Which of the following would prompt referral to SLP?

A. 18-month infant from bilingual household with no single words
B. 2-year-old with 50 words
C. 3 year or started developing disfluency and repeating whole words
D. 4-year-old with trouble with certain phenomes

18-month infant from bilingual household with no single words

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8-year-old female with history of behavioral problems. She used to eat her food in a certain order, now she refuses to have her food touch each other on the plate. In school she refuses to be close to her peers and she refuses to walk on certain pattern on the sidewalk.
Which questionnaire Would you use to screen her?

A. SNAP
B. SCARED (anxiety)
C. Yale children OCD
D. Eating Attitude Test

Yale children OCD

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An 11-year-old male with severe autism presents with a number of concerns. He has had swelling and tenderness in the lower limbs, and inability to walk. He has been confused with gum hypertrophy. He has a very restricted diet with intake mainly pasta, water, and milk. What is the most likely vitamin deficiency?

A. Vitamin C
B. Vitamin B12
C. Carnitine
D. Vitamin E

Vitamin C

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15-month-old is brought to the office for concerns by mom for concerns with development. What would be the most concerning?

a) Not pointing to show interest
b) Only stacking 2 blocks
c) Not walking
d) No intelligible words yet

Not walking - 12 mo milestone is when takes first steps

No intelligible words - 15 mo old should have 5 word + mama/dada

Not pointing to show interest - 15 mo milestone

Only stacking 2 blocks - this is a 15mo milestone

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Which feature is most developmentally concerning in a term child?

A. No responsive smiling by 6 m
B. No independent sitting by 8m
C. No putting 2 words together by 2 years
D. No walking by 16 months

No responsive smiling by 6 months (expect this by 6 weeks)

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18mo referred for Autism assessment. What tool do you screen / assess with?

A- Childhood Autism Rating Scale (CARS)
B- Autism Diagnostic Observation Schedule (ADOS)
C- Social Reciprocity Scale
D- Weiss Scale

Autism Diagnostic Observation Schedule (ADOS)

Appropriate for 12 months +

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8 year old boy with ADHD well controlled on vyvanse for the past 6 months. Now presenting with intermittent flexion of his neck (description sounds like motor tic). Doesnt bother anyone. What do you do?

A. Reassure parents
B. Stop the medication
C. Order an EEG
D. Check a calcium

Reassure parents - no need to treat unless functionally impairing the child

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15 mo boy with 1 week history of not walking. Previously walked well since 11 months. Parents have noticed rapid, irregular eye movements over past three days. Also difficulty self-feeding due to jerking movements of the arms. He is irritable. Which investigation is most likely to give you the diagnosis?

A. Abdo ultrasound
B. LP
C. Head MRI
D. MIBG scan

MIBG

Opsoclonus-Myoclonus-Ataxia syndrome (dancing eye syndrome), associated with neuroblastoma

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2 year old boy recently immigrated to Canada. He has intellectual disability, poor growth/developmental delay, hepatosplenomegaly, hearing loss and a “thickened tongue”. What is the most likely cause?

A- Glycogen Storage Disease
B- Beckwith Wiedemann Syndrome
C- Hypothyroidism
D- Hurler Syndrome

Hurler Syndrome

= mucopolysaccharidoses type 1
- coarse face
- hepatosplenomegaly
- hearing impairement
- developmental regression
- tongue and tonsillar hypertrophy (can cause airway obtruction)

tx = liver transplant

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Repeat question about a boy brought in by his parents because he is clumsy and has poor handwriting. He has slightly low tone but an otherwise normal neurologic exam. What is the cause?

A. Cerebral palsy
B. Developmental coordination disorder
C. Physical conditioning
D. Some kind of neurodegenerative disorder

Developmental coordination disorder

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You are seeing a 7-year-old girl. Teacher is concerned about her social integration. She has no friends and is not invited to parties. She does well enough at school. She likes routines. Her desk is very organized and she is upset if people move it. She makes limited eye contact. What is the most likely diagnosis?

a) Autism spectrum disorder
b) Obsessive compulsive disorder
c) Social anxiety disorder
d) Developmental coordination disorder

Autism spectrum disorder

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You suspect a 3-year-old child of having autism. Described some features about their verbal and social development that were in keeping with autism spectrum disorder. What other feature on history would be most consistent with autism?

A. Walked at 15 months
B. Engages in parallel play with his siblings

Engages in parallel play with his siblings

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What is the best test for the evaluation of global developmental concerns in an 18 month old?

A. Rourke Baby Record
B. SNAP-IV
C. Modified Checklist for Autism in Toddlers
D. Ages and Stages

Rourke Baby Record

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25 wk GA infant, BW 809g, extubated to CPAP on DOL1. NICU course notable for apnea of prematurity, some feeding issues. HUS were normal. Never required treatment for ROP. What is the most likely outcome on long-term follow-up?

A. monoplegia
B. hemiplegia
C. blindness
D. spastic diplegia

spastic diplegia

spastic bilateral cerebral palsy = strongly associated with PRETERM birth and typically caused by periventricular white matter injury

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A something year old girl is brought to your clinic by mom. Clumsy, unable to hop. Poor handwriting. Slighty low tone. Normal reflexes, normal neuro exam.

A. Cerebral palsy
B. Developmental coordination disorder
C. Deconditioning
D. Marfan syndrome

Developmental coordination disorder

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A 20-month-old presents to the office and her parent is concerned about autism. What feature is most concerning for autism?

A. Stacks 3 blocks
B. Uses 10 words
C. No pointing
D. Knows 3 body parts

No pointing (not sharing interests)

wrong answers:

Stacks 3 blocks - usually can stack 4 blocks by 18 months, gross motor delay is is not associated with autism

Uses 10 words - expect 10-25 words by 18 months

Knows 3 body parts - on par with 18 months milestone

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Mom brings child to your office for developmental assessment. She is able to draw a circle, name 3-5 body parts, undresses herself. She is able to speak 2 word sentences. What is her developmental age?

A.18 months
B. 24 months
C. 36 months
D. 48 months

36 months - 2 word phrase (24 month milestone), able to undress (undress at 36 months, removing clothing is 18 mo), names 3-5 body parts (3 body parts by 18 months), draws a circle (36 months).

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8 year old with 1 year hx of motor and vocal tics, doesn’t bother him, but teacher finds it distracting in class. What to do?

A. Reassure and follow up
B. Start clonidine
C. Start risperidone
D. Start ER methylphenidate

Reassure and follow up

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3 year old, communicates non-verbally, points to show interest, has 12-15 words, follows 2 step commands. What is this MOST in keeping with:

A. Autism
B. Receptive language delay
C. Expressive language delay

Expressive language delay

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Tourettes treatment

A. Benzo
B. Alpha agonist (guanfacine)

Alpha agonist (guanfacine)

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At what age do most children have a secure gender identity?

A. 4
B. 6
C. 8
D. 10

10?

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Toddler with episodes where she doesn’t get her way, cries/throws tantrum, then loses consciousness and sometimes turns blue. These episodes are increasing in frequency. What do you recommend?

a) Ignore the behaviour and put her in timeout after the episode
b) Refer for behavioural therapy
c) Put her in time-out before behaviour has a chance to escalate
d) Give in to what she wants

Refer for behavioural therapy

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The Mother of a 3.5 yo girl is concerned about her speech. She said her first words at 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speak and insert “uh” in the middle of a sentences. She has associated facial twitches and blinking. What do you recommend?

A. Reassure
B. Follow up in 6 months
C. Refer to SLP
D. audiology

Refer to SLP

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A 3-year-old male is brought to you because the mother has concerns about his language. He guides mom’s hand to things that he wants, has 18 single words, and can follow 2 step commands. His fine motor and gross motor development is normal. What is this most consistent with? A. Expressive language delay B. Receptive language delay C. Normal variant D. Autism Spectrum Disorder

Expressive language delay vocab <200 words at 3 years old is red flag. He is using his mom’s arm to get things because he can’t express it with words. No concerns with understanding 2 step commands (receptive language fine)

You suspect a 3 year old female of having autistism spectrum disorder. What diagnostic test would MOST likely reveal an abnormality? a. karyotype b. very long chain fatty acids c. fragile x testing d. chromosomal microarray

chromosomal microarray

9 year old whose parents are getting a divorce. what type of behavior she will exhibit? a) Developmental regression b) Pick sides (mother vs. father) and blame the other parent c) Try to make everyone happy d) Blame herself for the divorce

Chooses one parent and takes their side Developmental regression - young child <3 Blame herself for the divorce - 4-5 year old child Pick sides and blames other parent - school age Try to make everyone happy - teen

Two year old child is brought in by her parents for concerning behaviour. Cries and screams when she is not able to get what she wants and sometimes these episodes are associated with her turning blue and having jerking movements (breath holding spell). Parents want to know what to do about these episodes? A. Ignore the behaviour, then put the child in time out afterwards B. Interrupt the behaviour with a time out before it escalates C. Give the child what they want to avoid the behaviour D. Refer for behavioural therapy

Interrupt the behaviour with a time out before it escalates ?Refer for behavioural therapy (note from emily: emailed dr redgate about this one, will update card when i hear back)

Boy with stable ADHD has been on a stable dose of stimulant for the last two years. Had started to become very aggressive when spoken to and gets easily frustrated when he doesn't get what he wants. You’ve already ruled out psychosocial stressors. What do you want to do as your next step: 1. Benzo prn 2. Increase psychostimulant 3. Add SSRI 4. Add atypical antipsychotic

Increase psychostimulant (note form emily: emailed dr redgate)

36 mo baby what is the best predictor of cognition? a. Gross motor b. Fine motor c. Social d. language

Language

a 3 year old boy is in your office. He is very energetic, aggressive and destructive. His height is on the 50th percentile and his weight on the 95th percentile. He is described as having a voracious appetite. He comes to see you and hugs you. He speaks in 1 word sentences. What is the diagnosis? a. Emotional deprivation b. Diencephalic syndrome c. Prader Willi syndrome d. ADHD

Prader Willi syndrome

Which of the following would be the most helpful in confirming the diagnosis of ADHD in a 12 year-old male a. Symptoms are only at school b. Difficulty making friends c. Forgets his homework at school d. Spends a lot of time playing video games

Forgets his homework at school

2 year old girl, picky eater. Has not gained any weight in the last few months. Has always been trending on the same percentile. What do you advise parents? a) Offer a variety of accepted foods and allow child to choose what to eat b) Offer multiple snacks throughout the day c) Let the child pick whatever they want

Offer a variety of accepted foods and allow child to choose what to eat

A 9 year old boy has been refusing to go to school for the last 3 months. He becomes upset when discussing attending school and says he wants to be homeschooled. a) Allow him to be homeschooled this year. Return to school next year. b) Return to school immediately following gradual protocol and desensitization. c) Start Citalopram. d) Start Fluoxetine.

Return to school immediately following gradual protocol and desensitization.

A 10 month old baby wakes up every 2 hours and needs to be rocked back to sleep by his mom. What is the most likely cause? A. Benign rolandic epilepsy B. Sleep onset association disorder C. Night terrors

Sleep onset association disorder

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

this should improve if she learns to fall asleep in her crib vs. being rocked to sleep

A 15 year old healthy girl in your practice tells you that she plans to become sexually active soon. When does she need her first pelvic exam and pap smear? a. Now b. Before she starts OCPs, then every 1-2 years c. 21 years of age c. In 3 years then every 1-2 years

21 years of age

What is the best way for a 7 year told to ride in the back of a car, in the middle seat with no head rest? (pictures shown,taken from CPS statement) a. Forward facing car seat b. Booster seat with no back c. Booster seat with a full back d. Seat belt

Booster seat with full back

What is the recommended vitamin D supplementation for a 6 month old baby living above the 55th latitude during winter months? a. 200 international units b. 400 international units c. 600 international units d. 800 international units

800 international units vitamin D dosage should be 400 IU/day for all infants during the first year, with an increase to 800 IU/day from all sources between October and April north of the 55th parallel (latitude of Edmonton) and between the 40th and 55th parallel in individuals with risk factors for vitamin D deficiency other than latitude alone

A mom brings in her son for concerns around his school performance, but feels he is cognitively normal. He has trouble with reading, and has trouble understanding when he reads to himself. His teacher has been spending more resource time with him, and when she reads aloud to him, he understands well. What is the most likely diagnosis? a. Myopia b. Dyslexia c. General learning disorder D. Speech apraxia

Dyslexia - Specific Learning disorder with impairment in reading

A 7 month old baby is switched from breastmilk to formula and solids. He develops diarrhea, eczema and an erythematous rash around his orifices (mouth and anus). What is the most likely nutrient he’s deficient in? A. Calcium B. Zinc C. Protein D. Vitamin D

Zinc Zinc Deficiency (acrodermatitis enteropathica) autosomal recessive condition: - presents after weaning from breast milk - diarrhea - perioral/perianal eczematous rash FYI Derm biopsy is gold standard: pankeratosis, pallor of the upper epidermis Treatment: zinc 1 mg/kg/day for life

Kid with Hx substance abuse. Needs medication for ADHD. Whis is BEST option? A. Vyvanse B. Methylphenidate IR C. Guanfacine D. Ritalin SR

Guanfacine if hx of substance use, treat with nonstimulant (or extended release stimulant) guanfacine (intuniv) can be used as monotherapy in ADHD

BMI where a Pediatrician should intervene for the risk of obesity: A. 75% B. 85% C. 97% D. 99.9%

>85th%ile = overweight

17 year old female present with a small firm lump in her breast. What is the MOST likely cause A. Fibrocystic changes B. Fibroadenoma

Fibroadenoma - most common breast mass in an adolescence, rubbery , mobile, well-circumscribed wrong answer: Fibrocystic Changes - cyclic breast pain that worsens before MENSTRUAL cycle (rare in peds)

3 week old blood mixed with stool, has been having since 2 weeks old, normal exam, growing/thriving, formula fed A. Anal fissure B. Cow's milk allergy C. Meckel's

Cow's milk allergy

8 yr old boy is brought to you because of “difficulties learning”. he has difficulties finding words and with some pronounciation. he does not comprehend what he reads. however, he understands when his parents read to him.what is the most likely diagnosis? A. aspergers B. specific language impairment C. verbal apraxia D. dyslexia

dyslexia

In a 15 month old infant, which of the following is the most indicative of an autism spectrum disorder? A. Not babbling frequently B. Not pointing to indicate interest

Not pointing to indicate interest

What is the first line intervention for sleep onset association type sleep disorder? A. Melatonin B. Stable bedtime routine C. Clonidine

Stable bedtime routine

child is referred to you for assessment of a learning disability. What do you do?

Refer for psychoeducational testing

A teenage boy with addiction issues is diagnosed with ADHD. His mother is concerned about the potential for abuse with some ADHD medications. Which stimulant do you start him on? A. Concerta XR B. Ritalin C. Vyvanse

Concerta XR extended release stimulants or nonstimulants as tx for pts with hx of substance abuse Concerta XR has a non deformable shell - makes it difficult to break, cut or crush , which reduces risk of abuse

In a 5 month old boy, which would be the most concerning? a) Doesn’t turn to the sound of his own name b) Doesn’t sit upright without support c) Fisting of one of his hands d) Doesn’t smile all the time at his caregiver

Fisting of one of his hands - consider CP or motor condition wrong answers: respond to own name is 12 mo milestone tripod sitting at 6mo is milestone ("1/2 year old should be able to sit halfway up") No one smiles all the time! lol

3 year old Girl with developmental regression and small head. What condition do they likely have?

Rett Syndrome - Girl with normal development initially followed by loss of speech, decr eye contact, deceleration of head growth and stereotyped hand movements (hand wringing) send MECP2 gene testing!

Boy with enuresis, what is a good non pharm way to treat it a) Positive reinforcement b) Bed Alarm c) Ddavp d) Bladder training

Positive reinforcement enuresis is outside of children’s control --> positive incentives for dry nights causes damage to self esteem Careful with wording: Positive incentives for dry nights is bad! Positive reinforcement for drinking water during the morning/early afternoon, peeing before bed, etc. is good

18 month old wont’ go to sleep, used to be breast fed at 12 months. What does he have? a) Sleep onset association disorder b) Nightmare c) Night terror d) Delayed sleep phase

Sleep onset association disorder

Child with expressive language delay and otherwise makes 12 piece puzzle, sociable. most likely to be associated with a) Reading difficulty b) Autism

Reading difficulty

2 ½ year-old girl who stutters. What would make you most concerned? a. Repeats whole word b. Repeats part of word c. Facial grimacing d. Pauses between words

Facial grimacing

12 year old boy with school difficulties. Teacher thinks he has a learning disability. Your history and physical exam are negative. What would you do? a. CBC, lead levels, TSH b. Start Stimulant c. Send to psychology d. Assess short term memory and fine motor skills

CBC, lead levels, TSH

Boy w hx of TAPVR, now has ADHD. You think he would benefit from stimulant medication. What is your next step? a. Hx & physical then referral to cardiology b. Refer immediately to cardiology

Hx & physical then referral to cardiology

A 3.5 year old girl was referred to you for assessment. She speaks 50 words and 50% of her words are intelligible to others. She points to things she wants. She can run well, can kick a ball, she can walk up and down stairs. She cannot throw a ball overhand. She can use a spoon. What is the MOST likely explanation of her symptoms? a. Hearing deficit b. Developmental delay c. Language delay

?language delay ?Hearing deficit

At what weight and age can a child start to use a front facing car seat? a. 9 kg, 9 mo b. 10kg, 12mo c. 18kg, 20mo

10kg, 12mo

A 13y.o. boy with ADHD is taking 36mg of Concerta. His symptoms and school performance have improved and his mother is happy with his improvements. For the past 2 weeks, however, he has been sad, often crying unpredictably. He also is having difficulty falling asleep at night. What is the next best step in his management? a. Decrease the dose of Concerta to 27mg b. Change from Concerta to Adderall c. Add fluoxetine d. Add melatonin

Change from Concerta to Adderall

4 year old with various developmental descriptions (stacks 7 cubes, 1 step at a time, 3 word sentences). What is their developmental age? a. 24 months b. 30 months c. 33 months d. 36 months

24 months

Kid talking well at home but refuses to talk at school. Normal development. What is your diagnosis? a. selective mutism b. language delay c. learning disability

selective mutism

Developmental Pediatrics MCQ Flashcards

(63 cards)