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Flashcards in Paeds EMQs Deck (192)
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1

Steven has just had his first birthday party. During his party he commando-crawled with great speed, although he cannot walk. He managed to pick off all the Smarties (round chocolate sweets) from his birthday cake. He can say two words with meaning. After his birthday party, he impressed his guests by waving goodbye.

Which area of Steven’s development is delayed?

Gross motor
Fine motor and vision
Speech and hearing
Social, emotional and behavioural development
None of the above

None of the above

He has therefore achieved normal milestones for a 12-month-old.

2

Gerald is a 16-month-old boy who has not yet said his first word, and does not babble much. His mother believes he does not hear well because he doesn’t startle when a door slams or show any response to his name. His development is otherwise normal.

Which test would be best to assess Gerald’s hearing?

Evoked otoacoustic emission
Auditory brainstem response audiometry
Distraction hearing test
Visual reinforcement audiometry
Speech discrimination testing

Visual reinforcement audiometry

This is the most reliable test for a child Gerald’s age. The test requires an assistant to play with the child and keep their attention. Behind a soundproof window, another assistant will play sounds through a loudspeaker at particular frequencies. When the child turns around to the noise, a glass-fronted box with a toy inside that was previously dark lights up as visual reinforcement to reward the child for turning round.

3

Evie is 10 days old and was born in London. Her health visitor reviews her and her parents at home. She is feeding well and has a normal examination except that she has a squint. The health visitor mentions to parents she will keep this under review.

At what age does Evie need to be referred to an ophthalmologist if the squint is still present?

2 weeks
6 weeks
12 weeks
8 months
12 months

12 weeks

A newborn may appear to squint when looking at nearby objects because their eyes over-converge. By 6 weeks, the eyes should move together when following an object, and by 12 weeks there should be no squint present.

4

Sophie is a well 8-week-old baby who was born at term. She has come for a routine developmental check.

Which of the following would you not expect her to be able to do?

Raise her head when lying prone
Smile
Fix and follow a face or interesting object
Reach out and grasp an object
Quieten to a loud noise

Reach out and grasp an object

An 8-week-old infant will be able to do the remaining 4 activities, but still only has a primitive grasp reflex, so will not be able to voluntarily grasp an object. She will only be able to grasp what is placed in her hand.

5

Joanna is an active toddler. She is just being potty-trained, and has had several days where she has remained dry. She enjoys pulling her clothes off to use the potty, but cannot dress herself again. She enjoys playing by pretending to make her mother a cup of tea, but does not play well with her older siblings, as she has not yet learnt how to take turns. She is very bossy, and demands things by saying ‘give me’ or ‘me drink’. She can build a tower of six blocks, and enjoys running and climbing on furniture.

What developmental age is Joanna?

12 months
18 months
24 months
2 1/2 years
3 years

24 months

Joanna is dry by day, can undress and has symbolic play. She is not yet playing interactively; she will learn this at about 3 years of age. She is constructing two-word sentences. She constructs a tower of six blocks and can run.

6

Cordelia is a 4-month-old baby who is assessed by her general practitioner because of constant crying and poor feeding. She is fed by bottle on infant formula. Her mother tearfully complains that she is finding it very difficult to cope. She also has a 20-month-old boy who has recently been referred to the speech and language therapist because of language delay. She used to work as a solicitor, and her partner is a company director who often travels abroad. Charlotte’s developmental, growth and physical examination is normal.

What is the likely cause of Cordelia’s problems?

An inherited genetic condition
Gastro-oesophageal reflux
Maternal postnatal depression and stress
Pyloric stenosis
Down syndrome

Maternal postnatal depression and stress

This may be detrimental to Cordelia’s development, as infants are totally dependent on their main caregiver. Her older brother may have speech delay because he is not receiving enough stimulation to develop his own language skills or there may be an underlying problem causing his speech delay

7

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Herbert can transfer objects from one hand to the other whilst sitting without support and with a straight back.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

8 months

8

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Rita’s father is thrilled that she has just said her first word – says ‘dada’ to her father only.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

10 months

9

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Grace enjoys drawing. She has just learnt to copy drawing a square, and can build steps using blocks after being shown.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

4 yrs

10

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Anthony has a friend at nursery, and they enjoy playing with toy cars together.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

3 yrs

11

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Rosette can build a three-cube tower and can point to her nose.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

12 months

12

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Peace has just taken her first steps!

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

12 months

13

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Ivan can tie his shoe laces all by himself.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

5yrs

14

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Rinah can follow her mother’s two-step commands, such as ‘fetch your red shoes from the cupboard’.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

3 yrs

15

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Lizzie has just started crawling.

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

8 months

16

At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.

Blessing’s mother is so pleased; her baby has just learnt to smile when she smiles at her!

6 weeks
6 months
8 months
10 months
12 months
18 months
2 yrs
3 yrs
4 yrs
5yrs

6 weeks

17

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

Hearing test using audiometry

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

13 months

18

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

An orthoptist assessment for visual impairment

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

4-5 years (pre-school)

19

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

Guthrie test (biochemical screening test)

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

5-6 days

20

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

First routine immunisation with 5 in 1 immunisation - DTaP/IPV, Hib, PCV (diphtheria, tetanus, pertussis, polio, Haemophilus influenza, pneumococcal)

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

8 weeks

21

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

Hearing test using evoked otoacoustic emission or auditory brainstem response audiometry

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

Newborn

22

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

Advice on reducing the risk of sudden infant death syndrome by ‘Back to sleep’, avoiding overheating and avoiding parental smoking

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

Newborn

23

At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.

First MMR (measles/mumps/rubella) immunisation

Newborn
5-6 days
12 days
8 weeks
3 months
4 months
8 months
12 months
13 months
2-3 years
4-5 years (pre-school)
5 years (school entry)

13 months

24

Jonathan is 4 years old and lives in a small village in southern England. He attends a paediatric outpatient clinic with his grandmother who is his legal guardian. She is concerned that he only seems to like to play with his toy train and insists on watching the same DVD every night before he goes to bed. He attends nursery where he plays with the toys but not with other children. His behaviour can be very difficult to manage at times. He does not say any words whereas the grandmother’s children were speaking in sentences at his age. On examination you notice he does not make eye contact with you and pushes his toy train back and forth on the floor. The rest of his examination is normal.

What is the most likely diagnosis?

ADHD
Autistic spectrum disorder
Developmental coordination disorder (dyspraxia)
Asperger syndrome
Expressive language disorder

Autistic Spectrum Disorder

Autism is a triad of impaired social interaction, speech and language disorder and ritualistic and repetitive behaviour.

25

At what age does autistic spectrum disorder usually become evident?

0-12 months
12-24 months
2-4yrs
4-8yrs
>8yrs

2-4yrs

Autistic spectrum disorder usually presents at this age because this is when language and social skills rapidly develop.

26

At what age would you expect the clinical features of cerebral palsy to become evident?

0-12 months
12-24 months
2-4 years
4-8yrs
>8yrs

0-12 months

Cerebral palsy most often presents during this time when acquisition of motor skills occurs most rapidly.

27

Fortunate is an 8-month-old black African girl who was born at term. She is seen in the paediatric outpatient department. She can roll over. She does not crawl. She can say ‘dada’, but says it to everyone not just her father. She reaches out and grasps objects with her left hand but not with her right, and puts objects in her mouth. She smiles, but is not able to wave bye-bye.

Select the option that concerns you most about Fortunate’s development.

Unable to crawl
Left hand preference
Unable to use sounds discriminately to parents
Unable to wave bye-bye
None of the above

Left hand preference

Fortunate has developed a preference for using her left hand at 8 months. Development of a hand preference before 1 year of age is abnormal, and she needs to be assessed for hemiplegic cerebral palsy affecting her right side.

28

Gloria is a 19-month-old white British girl whose health visitor is concerned because she is still only babbling and says no distinct words. She is able to walk, scribbles with crayons and feeds herself with a spoon.

What is the most appropriate first action?

Hearing test
Assessment by a team specialising in autistic spectrum disorders
Reassure the health visitor
Refer to ENT surgeon
Refer to a paediatrician for a full developmental assessment

Hearing test

Speech delay can be due to hearing impairment, and this should be assessed first prior to referring her to a specialist.

29

Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.

Clarissa, a cheerful 20-month-old white British girl, is referred to the child development clinic by her health visitor because she is not yet walking. She was born at term with no complications. She learnt to sit without support at 10 months, and is able to crawl, although she drags her right leg behind her. Her mother says that she has always been left-handed. Examination revealed reduced power and reflexes but increased tone in the right arm.

Chromosome karyotype
DNA FISH analysis
TFTs
Maternal amino acids for raised phenylalanine
Creatine kinase
Blood lactate
Congenital infection screen
Cranial US
CT or MRI of the brain
Electroencephalography (EEG)

CT or MRI of the brain

30

Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.

Darren is a 3-year-old boy who has difficulty climbing stairs. He always needs to hold on to the railings or to have a supporting hand. He walked unsupported at 14 months. His development is otherwise normal. On examination the power in his legs is reduced, he is somewhat hypotonic but the reflexes are normal.

Chromosome karyotype
DNA FISH analysis
TFTs
Maternal amino acids for raised phenylalanine
Creatine kinase
Blood lactate
Congenital infection screen
Cranial US
CT or MRI of the brain
Electroencephalography (EEG)

Creatine kinase