MCQs In Growth And Development

Q 1:

The probable age of a child who scribbles, walks alone, speaks one real word, and pretends to drink from a cup is:

A- 8 mo

B- 13 mo

C- 16 mo

D- 20 mo

E- 24 mo

Answer :

B

Most children begin to walk independently near their 1st birthday; some do not walk until 15 mo of age. Early walking is not associated with advanced development in other domains.


Receptive language precedes expressive language. By the time infants speak their first words around 12 mo of age, they already respond appropriately to several simple statements, such as “no,” “bye-bye,” and “give me.”

Nelson Textbook of pediatrics 2011

Q2 :

The probable age of a child who rolls back to front, has a thumb-finger grasp, self-inhibits to "no," and bangs two cubes is:

A- 7-8 mo

B- 10-12 mo

C- 12-15 mo

D- 3-4 mo

E- 15-18 mo

Answer :

A

Thumb-finger grasp (8-9 mo)

Nelson Textbook of pediatrics 2011

Q 3:

Growth between 3 and 4 mo of age is best characterized as:

A- Accelerating to a rate of 45 g/day

B- Slowing to a rate of 10 g/day

C- Slowing to a rate of 20 g/day

D- Accelerating to a rate of 20 g/day

E- Demonstrating no change compared with rate between 0 and 2 mo

Answer :

C

Somatic and brain growth slows by the end of the 2nd yr of life, with corresponding decreases in nutritional requirements and appetite, and the emergence of “picky” eating habits

Q4 :

Feeding between 6 and 12 mo of age is characterized by all of the following except:

A- Being willing to be fed by a stranger

B- Appearing autonomous

C- Eating finger foods

D- Turning away from the spoon

E- Holding a spoon

Answer :

A

Indeed, stranger anxiety may start to set in at this time.

Q 5:

The probable age of a child who skips, names four colors, and dresses and

undresses is:

A- 15 mo

B- 24 mo

C- 30 mo

D- 18 mo

E- 60 mo

Answer :

E

At 60 mo, the child can perform the following tasks :

Motor:	Skips
Adaptive:	Draws triangle from copy; names heavier of 2 weights
Language:	Names 4 colors; repeats sentence of 10 syllables; counts 10 pennies correctly
Social:	Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing

Nelson Textbook of pediatrics 2011

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Q 6:

Handedness is usually established by which age :

A - By the 3rd yr of life.
B- By the seco nd year of life.
C-  By the fifth  yr of life.
D-  By the 2rd yr of life.
E-  By the 4th  yr of life.

Answer :

A

Q 7:

Which of the following is a false statement regarding child development :

A-  Bed-wetting is normal up to age 4 yr in girls and age 5 yr in boys
B- Most children walk with a mature gait and run steadily before the end of their 3rd yr.
C-  Pincer grasp by achieved at 10 mo of age.
D- A child's vocabulary balloons from 10-15 words at 18 mo to between 50 and 100 at 2 yr.
E- Visual acuity reaches 20/30 by age 3 yr and 20/20 by age 4 yr.

Answer :

C

AT 1 YR
Motor:	Walks with one hand held (48 wk); rises independently, takes several steps (Knobloch)
Adaptive:	Picks up pellet with unassisted pincer movement of forefinger and thumb; releases object to other person on request or gesture
Language:	Says a few words besides “mama,” “dada”
Social:	Plays simple ball game; makes postural adjustment to dressing

Nelson Textbook of pediatrics 2011

Q 8:

All of the following statements regarding language development are true except:

A- Deaf children may create their own language
B- The basics for language may be "hard-wired" in the brain
C- Language has no role in behavior regulation
D- Delayed language may signify deafness
E- Delayed language may signify mental retardation

Answer :

C

Q 9:

Growth during the years between 6 and 12 yr is characterized by annual weight and height increments of :

A- 3.5 kg, 6 cm
B- 6 kg, 3.5 cm
C- 5 kg, 10 cm
D- 10 kg, 5 cm
E- 1.5 kg, 5 cm

Answer :

A

Q 10 :

Third-year medical students are rotating in the normal newborn nursery. The students learn that most neonates actually lose weight after birth. One student asks what the average rate of weight gain is following the initial period of weight loss. After 2 weeks of age, a term neonate will gain an average of which of the following increments of weight?

(A) 15 g/day or 1/2 oz/day
(B) 30 g/day or 1 oz/day
(C) 45 g/day or 11/2 oz/day
(D) 60 g/day or 2 oz/day
(E) 120 g/day or 4 oz/day

Answer : 

B


Newborns may lose up to 10% of their birth weight in the first few days of life, but with normal nutrition birth weight is regained in approximately 10 days. The infant subsequently gains approximately 30 g/day for the
first several months.

Q 11 :
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During the health supervision visit for an infant, her mother mentions that the child has been
tolerating solid foods with no problem. When placed on her back to be examined, she brings her
feet to her mouth. Her mother holds a small mirror to the child’s face to distract her during your
examination, and the baby reaches for the mirror and pats her image.
Of the following, these developmental milestones are MOST typical for an infant whose age is

A. 2 months
B. 4 months
C. 6 months
D. 9 months
E. 12 monthsAnswer :

Answer :

C


Tolerating solid foods well, placing her feet to her mouth while supine, and reaching for a mirror and patting the image are socioemotional milestones most typical of a 6-month-old child.

 At 2 months of age, infants bring their hands to their mouths, swipe at dangling objects with their
hands, and grasp and shake hand toys.

 A 4-month-old infant has a spontaneous social smile and, when shown a mirror, smiles and vocalizes.

An infant of this age also brings items to his or her mouth, can maintain an upright position if placed upright with the assistance of pillows, and knows the difference between strangers and family.

A 9-month-old infant can imitate nursery games in response to a mother's demonstrations and may give a toy in response to a request.

 A 12-month-old infant points for requests, may throw a toy in play or refusal, helps with dressing,
may hug a stuffed animal, and may offer a toy to an image in a mirror.

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Q 12 :


A 2-month-old infant has lost the vision in both of his eyes due to bilateral retinoblastoma. His distressed parents ask how the infant’s blindness will affect his behavior and development.
Of the following, the child MOST likely will

A. begin saying single words at 16 to 20 months
B. begin walking between 18 and 22 months
C. display behaviors of an autism spectrum disorder
D. have a language-based learning disorder
E. have significant cognitive impairments

Answer :

B


Postnatal blindness, which accounts for approximately 8% to 11% of all childhood blindness, can be caused by infections, trauma, or tumors.

Children who have congenital or acquired (eg, due to retinoblastoma) blindness without associated neurologic abnormalities should not be at increased risk for motor or cognitive impairment.

They are not at increased risk for language-based learning disabilities or autism spectrum disorders.

However, children who have significant visual impairment may begin to walk at an older age (18 to 22 months) than sighted children due to different exposure to motor exploration.

 They typically develop language skills at the same time (12 months) as sighted children.

Children who have visual impairments should be provided with much physical contact that includes hugging and comforting. They should be encouraged to partake in self-help skills and exploration of their environment

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Q 13

An 11-year-old boy has had difficulty in school and is failing his language arts class. He complains of headaches several times per week, usually on examination days. He received the following scores on achievement testing and intelligence testing:

Weschler Individual Achievement Test (WIAT) 

            Listening Comprehension         105     

            Reading Comprehension           108     

            Oral Expression 95       

            Written Expression       83       

Intelligence Quotient (IQ)        

            Performance IQ            102     

            Verbal IQ          87       

Of the following, the MOST likely explanation for these scores is that the boy:

A.  has a learning disability

B.  has a perceptual-motor impairment

C.  has a visual impairment

D.  has migraine headaches

E.  is not giving full effort during testing

Answer :

A

The child presented in the vignette has good reading and listening skills, but has difficulty with written expression, as revealed by a significant discrepancy between his performance intelligence quotient (IQ) and written expression scores. Achievement tests provide a norm-referenced profile of the child’s academic skills compared with children of the same age. A subnormal score on an achievement test with a normal performance IQ is most likely due to a specific learning disability. Children who have difficulty with written expression often do well in the early grade school years because there is minimal reliance on written language. As the demand for written output increases with each school year, though, these children often become frustrated, and their achievement decreases.

            A learning disability is evaluated by comparing achievement test scores with IQ test scores. The most commonly used achievement tests in the educational system are the Wechsler Individual Achievement Test (WIAT), the Wide-Range Achievement Test, Revised (WRAT-R), and the Woodcock-Johnson-Revised (WJ-R). The WIAT correlates with the Wechsler Intelligence Scale for Children, Third Edition (WISC-III), a test of cognitive ability.

            The higher reading comprehension score of the boy in the vignette makes a visual impairment and lack of effort unlikely sources of his problems. It also discounts the probability that a perceptual-motor impairment (eg, difficulty copying written language or numbers) is contributing to his difficulty with written expression. His headaches are likely due to stress-related performance pressures, not migraine.

            There are many strategies for managing a learning disability to assist children in achieving academic success. A child’s educational strengths and weaknesses should be explained to the family to demystify the diagnosis. Strategies can be devised to circumvent weaknesses in some classroom settings while remediating skills in other settings. The curriculum can be modified to avoid overburdening the student’s skills with too many classes at one time in his or her area of difficulty. Areas of strength should be reinforced to maintain self-esteem and motivation.

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Q 14 :

Two months ago an infant girl began to smile in response to her mother. She now laughs out loud and initiates social interaction.

Of the following, her present age MOST likely is:

A.  2months

B.   4months

C.6   months

D.   8months

E.  10months

Answer :

B

At 2 months of age, infants begin to appreciate the power of a smile to elicit parental response and to maintain proximity. The newborn can perform facial expressions such as happiness, sadness, surprise, interest, disgust, fear, and anger, but these expressions are much more obvious at age 2 to 3 months. Two-month-olds can identify the facial expressions and vocalizations of their caregivers and smile responsively and spontaneously coo.

            In the next stage of language and social development, the infant begins to initiate the social interaction with caregivers instead of simply responding. At 3 months of age, infants respond to parental displays of pleasure by cooing, smiling, and moving. As this response matures at age 4 months, infants begin to initiate the interactions and anticipate parents’ response. Language maturation is marked by squeals and laughs that invite interaction with caregivers, as described for the infant in the vignette.

            By 6 months of age, the infant has a preference for his or her primary caretakers and begins to look to those people for clues on how to respond to different situations. Language skills vary, but there is continued maturation of skills, with babbling, blowing bubbles, and imitation of sounds such as a cough. At 8 to 9 months, infants begin to develop stranger anxiety and protest separation from a primary caretaker. They enjoy social games such as peek-a-boo and pat-a-cake. They continue to imitate sounds and begin polysyllabic babbling such as nonspecific “dada.”

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Q 15

A 6-year-old girl can write her name and can count 10 objects.

Of the following, the MOST likely additional activity of which she is capable is:

A.  hitting a baseball

B.  knowing her right hand from her left

C.  making a simple meal

D.  printing neatly in small letters

E.  sounding out words while reading

Answer

B

At age 6 years (finishing kindergarten or starting first grade), a child has mastered the simple skills needed for an academic base. Children at this age demonstrate a transition from “preoperational” thinking to “operational” thinking, as described by Piaget. Preoperational thinking is characterized by magical and egocentric thinking. The child who has preoperational skills is very centered in his or her perspective and finds it difficult to understand that other people can look at things differently. In contrast, concrete operational thought is characterized by the ability to consider multiple variables, understand serial relationships (alphabet, word formation) and classification systems (handedness), and perform mental operations relating to objects (counting). Accordingly, the child described in the vignette most likely knows her right hand from her left.

            Most 6-year-olds do not yet have the visuomotor coordination to hit a baseball, although they may be able to play t-ball. These children may be able to obtain a drink or open a packaged meal, but they cannot yet organize and cook a meal. Letter formation is still awkward at this age, with large letters. Reading is primarily by word recognition, although 6-year-old children may be starting to use phonetics.

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The parents of a 6-month-old infant have brought him to see the pediatrician several times per month since birth and have called weekly with medical and developmental concerns. He was delivered by cesarean section due to fetal distress and had Apgar scores of 6 and 8 at 1 and 5 minutes, respectively. He went home with his mother on his second day of life and is now in child care. Since birth, he has had intermittent symptoms of upper respiratory tract infection that last approximately 1 week. He had colic symptoms that resolved at age 3 months, but he continues to have small amounts of daily emesis. He has no rash or diarrhea. He rolls well, babbles, and sits with support, but does not yet crawl.

Of the following, the MOST appropriate intervention indicated at this time is:

A. evaluation by a developmental pediatrician

B. institution of a lactose-free diet

C. reassurance of the parents that his development is normal

D. referral to a pediatric gastroenterologist for further testing

E. referral to a pediatric immunologist for further testing

Answer

C

Some parental anxiety regarding a child’s health and development is normal, especially for first-time parents. If a child has disabilities or if a sibling has died, parents may have a higher level of anxiety. Parents may seek medical attention in response to a real or perceived vulnerability.

            The parents of the child described in the vignette can be reassured that he exhibits normal growth and development. Although he had some distress at birth, he adjusted well in the postpartum period. His motor and language skills are normal.

            Upper respiratory congestion is common in the first several months of life, especially for children who have older siblings or who are in child care. Because he has not had any serious infections and his growth is normal, a referral to a pediatric immunologist is not indicated. His colic resolved as expected, and his emesis is most likely due to mild gastroesophageal reflux that is common until 1 year of age. Thus, there is no need for a lactose-free diet or referral to a pediatric gastroenterologist.

            Continued parental anxiety can lead to what is known as the “vulnerable child syndrome.” In most of the families who experience this complex condition, the child has had a life-threatening illness. Sometimes referring anxious parents to an appropriate specialist can be reassuring to them. However, although these evaluations may help to clarify the needs of the child, multiple referrals can cause anxiety and fuel the perceived need for further studies. Knowledge of normal infant/child development can help the primary care physician to reassure parents and avoid unnecessary testing and evaluation.