Developmental screening in pediatrics US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Developmental screening in pediatrics. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Developmental screening in pediatrics US Medical PG Question 1: A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines. She does not walk yet but stands in place and can say a few words. The toddler drinks formula and eats a mixture of soft vegetables and pureed meals. She has no current medications. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/50 mm Hg, pulse 130/min, and respiratory rate 28/min. The patient is alert and responsive. The remainder of the exam is unremarkable. Which of the following is most appropriate for this patient at this visit?
- A. Meningococcal vaccine
- B. Gross motor workup and evaluation
- C. Rotavirus vaccine
- D. Referral for speech pathology
- E. MMR vaccine (Correct Answer)
Developmental screening in pediatrics Explanation: ***MMR vaccine***
- The **measles, mumps, and rubella (MMR) vaccine** is recommended for administration at **12-15 months of age**.
- This timing offers protection against these common childhood diseases, which is especially important for children attending **daycare**.
*Meningococcal vaccine*
- The routine **meningococcal vaccine (MenACWY)** is typically recommended for adolescents at **11-12 years of age**, with a booster at 16 years.
- While there are specific circumstances for earlier vaccination (e.g., high-risk conditions), it is **not routine** for a 12-month-old.
*Gross motor workup and evaluation*
- The patient's motor development, standing in place but not yet walking, is **within the normal range** for a 12-month-old.
- A definitive **gross motor workup** would generally be considered if there were more significant delays or regressions.
*Rotavirus vaccine*
- The **rotavirus vaccine** series is typically given at **2, 4, and 6 months of age**, with the final dose administered no later than **8 months of age**.
- A 12-month-old is **outside the recommended age range** for initiating or completing this vaccine series.
*Referral for speech pathology*
- Saying "a few words" at 12 months is **within the normal developmental milestone** for expressive language at this age.
- A referral for **speech pathology** would generally be indicated for more significant language delays.
Developmental screening in pediatrics US Medical PG Question 2: A 12-month-old boy is brought to the physician for a well-child examination. He was born at 38 weeks' gestation and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hand held and can throw a small ball. He can pick up an object between his thumb and index finger. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to play with a stranger alone. Physical examination shows no abnormalities. Which of the following is most likely delayed in this child?
- A. Fine motor skills
- B. Language skills
- C. Growth (Correct Answer)
- D. Gross motor skills
- E. Social skills
Developmental screening in pediatrics Explanation: ***Growth***
- At 1 year of age, a child's **birth weight should triple**, and their **birth length should increase by 50%**.
- This child's birth weight was 3061 g (6 lb 12 oz), meaning his expected weight at 1 year should be around **9183 g (20 lb 4 oz)**, but he only weighs **7910 g (17 lb 7 oz)**, indicating **inadequate weight gain** (~1273 g below expected).
- This child's birth length was 48 cm (19 in), meaning his expected length at 1 year should be around **72 cm (28 in)**, but he is only **60 cm (24 in)**, indicating **poor linear growth** (12 cm below expected).
- Both **weight-for-age and length-for-age are delayed**, making growth the most likely delayed parameter.
*Fine motor skills*
- The child can **pick up an object between his thumb and index finger**, demonstrating a **pincer grasp**, which is an appropriate fine motor skill for a 12-month-old.
- He can also **throw a small ball**, further indicating age-appropriate fine motor development.
*Language skills*
- The child can say **'mama', 'dada'**, and **'uh-oh'**, which are appropriate first words for a 12-month-old.
- He also **waves 'bye-bye'**, showing appropriate receptive and expressive communication.
*Gross motor skills*
- The child can **walk with one hand held**, which is an expected gross motor milestone for a 12-month-old.
- Many 12-month-olds are just beginning to cruise or take their first independent steps.
*Social skills*
- The child **waves 'bye-bye'** and **cries if left with a stranger alone**, which are age-appropriate demonstrations of **social interaction** and **stranger anxiety**, respectively, for a 12-month-old.
- These behaviors indicate typical social and emotional development.
Developmental screening in pediatrics US Medical PG Question 3: A 4-year-old boy is brought to a pediatrician by his parents for a consultation after his teacher complained about his inability to focus or make friends at school. They mention that the boy does not interact well with others at home, school, or daycare. On physical examination, his vital signs are stable with normal weight, height, and head circumference for his age and sex. His general examination and neurologic examination are completely normal. A recent audiological evaluation shows normal hearing, and intellectual disability has been ruled out by a clinical psychologist. Which of the following investigations is indicated as part of his diagnostic evaluation at present?
- A. Magnetic resonance imaging (MRI) of brain
- B. Electroencephalography
- C. No further testing is needed
- D. Positron Emission Tomography (PET) scanning of head
- E. Autism spectrum disorder screening and developmental assessment (Correct Answer)
Developmental screening in pediatrics Explanation: ***Autism spectrum disorder screening and developmental assessment***
- The clinical presentation (inability to focus, difficulty making friends, poor social interaction across multiple settings) is **highly suggestive of Autism Spectrum Disorder (ASD)**.
- After ruling out **hearing impairment and intellectual disability**, the next appropriate step is **formal ASD screening using validated tools** such as the **Modified Checklist for Autism in Toddlers (M-CHAT)**, **Autism Diagnostic Observation Schedule (ADOS)**, or **Autism Diagnostic Interview-Revised (ADI-R)**.
- According to **AAP guidelines**, when developmental concerns suggestive of ASD are identified, formal screening and comprehensive developmental assessment are **essential components of the diagnostic evaluation**.
- ASD diagnosis is primarily **clinical**, based on standardized screening tools and developmental assessments, not neuroimaging or electrophysiological studies.
*No further testing is needed*
- This is **incorrect** because the patient has not yet undergone **formal ASD-specific screening and developmental assessment**.
- While hearing and intellectual disability have been ruled out, **diagnostic confirmation of ASD** requires structured evaluation using validated assessment tools.
- Simply observing symptoms without formal screening is inadequate for establishing an ASD diagnosis.
*Magnetic resonance imaging (MRI) of brain*
- Brain MRI is **not routinely indicated** for ASD diagnosis as it typically shows **normal findings** in children with ASD.
- Neuroimaging is reserved for cases with **focal neurological signs, regression, or atypical features** suggesting structural abnormalities.
- This patient has a **normal neurological examination**, making MRI unnecessary.
*Electroencephalography*
- EEG is indicated only when there is suspicion of **seizure disorder** or other specific neurological conditions.
- The patient has a **normal neurological examination** with no seizure-like symptoms, making EEG unnecessary at this stage.
*Positron Emission Tomography (PET) scanning of head*
- PET scans are **not part of routine ASD diagnostic workup** and are typically used in research settings or for evaluating specific metabolic or neoplastic conditions.
- The **radiation exposure and invasiveness** make PET scanning inappropriate for initial diagnostic evaluation in a child with developmental concerns.
Developmental screening in pediatrics US Medical PG Question 4: A 2-year-old girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age?
- A. Hops on one foot
- B. Engages in role-playing
- C. Separates easily from parents
- D. Pedals a tricycle
- E. Builds a tower of 6 cubes (Correct Answer)
Developmental screening in pediatrics Explanation: ***Builds a tower of 6 cubes***
- At 2 years old, children typically develop fine motor skills enabling them to stack **6 to 7 cubes** to build a tower, demonstrating good hand-eye coordination.
- This milestone aligns well with the described cognitive development, such as following multi-step commands and early language acquisition.
*Hops on one foot*
- **Hopping on one foot** is a gross motor skill usually achieved later, typically around **4 years of age**.
- A 2-year-old child is more likely to be developing skills like running, jumping with two feet, or walking up and down stairs.
*Engages in role-playing*
- While toddlers engage in **imitative play**, true imaginative **role-playing** with complex scenarios and multiple characters typically develops later, around **3 years of age or older**.
- At 2, play is often more focused on mimicking observed actions.
*Separates easily from parents*
- At 2 years old, many children are still experiencing **separation anxiety**, especially in unfamiliar situations.
- **Easy separation** from parents is a milestone typically achieved later as children develop more independence and social confidence, often closer to 3 or 4 years of age.
*Pedals a tricycle*
- **Pedaling a tricycle** requires coordinated gross motor skills, balance, and cognitive understanding that are typically developed around **3 years of age**.
- A 2-year-old may be able to sit on a tricycle and push with their feet, but not yet pedal efficiently.
Developmental screening in pediatrics US Medical PG Question 5: A child presents to his pediatrician’s clinic for a routine well visit. He can bend down and stand back up without assistance and walk backward but is not able to run or walk upstairs. He can stack 2 blocks and put the blocks in a cup. He can bring over a book when asked, and he will say “mama” and “dada” to call for his parents, as well as 'book', 'milk', and 'truck'. How old is this child if he is developmentally appropriate for his age?
- A. 18 months
- B. 15 months (Correct Answer)
- C. 9 months
- D. 12 months
- E. 24 months
Developmental screening in pediatrics Explanation: ***15 months***
- A 15-month-old child typically **walks independently**, can **stoop and recover**, and **walks backward**.
- They can also use a **cup**, stack **2 blocks**, and have a vocabulary of **4-6 words**, consistent with the child's abilities.
*18 months*
- An 18-month-old child can usually **run well**, **walk up stairs with help**, and build a tower of **3-4 blocks**.
- Their vocabulary is also typically larger, around **10-20 words**.
*9 months*
- A 9-month-old child can usually **sit without support** and **crawl**, but is not yet walking independently.
- They also typically have a vocabulary of only **"mama" and "dada" nonspecifically**.
*12 months*
- A 12-month-old child often takes their **first steps** and may **cruise** while holding onto furniture, but independent walking backward is less common.
- Their manipulative skills are generally less developed, and their vocabulary is often limited to specific "mama" and "dada."
*24 months*
- A 24-month-old (2-year-old) child can typically **run and jump**, **walk up and down stairs independently**, and stack **6-7 blocks**.
- Their vocabulary is significantly larger, often combining **2-3 word phrases**.
Developmental screening in pediatrics US Medical PG Question 6: A 28-year-old asymptomatic pregnant woman at 12 weeks gestation presents for prenatal care. She has no personal or family history of diabetes. Her BMI is 32 kg/m². She had a random glucose of 118 mg/dL at her first visit. She asks about gestational diabetes screening. Considering her risk factors and current pregnancy, what is the most appropriate screening approach?
- A. Perform 3-hour oral glucose tolerance test at 16 weeks
- B. Diagnose gestational diabetes based on random glucose and begin treatment
- C. Perform 1-hour glucose challenge test now
- D. Perform fasting glucose and hemoglobin A1c now to assess for preexisting diabetes (Correct Answer)
- E. Defer screening until 24-28 weeks gestation per routine protocol
Developmental screening in pediatrics Explanation: ***Perform fasting glucose and hemoglobin A1c now to assess for preexisting diabetes***
- A **BMI ≥ 30 kg/m²** is a major risk factor necessitating early screening at the first prenatal visit to identify **pre-existing (overture) diabetes**.
- Identifying hyperglycemia early in pregnancy allows for immediate management to reduce the risk of **congenital anomalies** associated with pre-gestational diabetes.
*Perform 1-hour glucose challenge test now*
- While the **1-hour GCT** is a valid tool for early screening, standard biomarkers like **fasting plasma glucose** or **HbA1c** are also appropriate for detecting overt diabetes at the initial visit.
- The goal in the first trimester for high-risk patients is often to rule out **Type 2 Diabetes mellitus** that existed prior to pregnancy.
*Defer screening until 24-28 weeks gestation per routine protocol*
- Routine screening at **24-28 weeks** is reserved for women without significant risk factors; this patient's **obesity** mandates earlier evaluation.
- Delayed screening in obese patients may miss a window for intensive **glycemic control** during critical fetal organogenesis.
*Diagnose gestational diabetes based on random glucose and begin treatment*
- A **random glucose of 118 mg/dL** is within the normal range and is not diagnostic of either GDM (which requires >200 mg/dL with symptoms) or overt diabetes.
- Diagnosis requires structured testing such as an **HbA1c ≥ 6.5%**, fasting glucose ≥ 126 mg/dL, or a formal **oral glucose tolerance test (OGTT)**.
*Perform 3-hour oral glucose tolerance test at 16 weeks*
- The **3-hour OGTT** is typically the second step of a two-step screening process and is not indicated as an initial screening tool at 16 weeks.
- High-risk patients should be screened as soon as possible, often at the **first prenatal visit** (12 weeks in this case), rather than waiting until the second trimester.
Developmental screening in pediatrics US Medical PG Question 7: A 66-year-old man underwent screening colonoscopy which revealed a 1.2 cm tubular adenoma with low-grade dysplasia in the sigmoid colon that was completely removed. He has no family history of colorectal cancer. His colonoscopy 8 years ago was normal. He asks about surveillance recommendations. Considering current guidelines and competing risks, what is the most appropriate surveillance interval?
- A. Annual fecal immunochemical testing
- B. Repeat colonoscopy in 3 years
- C. Repeat colonoscopy in 10 years
- D. Repeat colonoscopy in 1 year
- E. Repeat colonoscopy in 5-10 years (Correct Answer)
Developmental screening in pediatrics Explanation: ***Repeat colonoscopy in 5-10 years***
- According to the **USMSTF 2020 guidelines**, patients with **1 to 2 small (<10 mm) tubular adenomas** should have a surveillance colonoscopy in **7-10 years**; however, for a single adenoma **≥ 10 mm** (like this 1.2 cm lesion) with low-grade dysplasia, the recommended interval is **5-10 years**.
- This recommendation balances the slightly higher risk of a **larger lesion** against the **low-grade pathology** and the patient's age and overall risk profile.
*Repeat colonoscopy in 10 years*
- A strictly **10-year interval** is reserved for patients with a **normal colonoscopy** or those with only **distal hyperplastic polyps**.
- While 10 years is the upper limit of the recommended range, the presence of a **1.2 cm adenoma** requires a surveillance designation rather than a standard screening interval.
*Repeat colonoscopy in 3 years*
- The **3-year interval** is indicated for **high-risk findings** such as **≥3 adenomas**, adenomas with **villous histology**, or those with **high-grade dysplasia**.
- This patient only had a single lesion with **low-grade dysplasia**, making 3-year surveillance an over-utilization of resources.
*Repeat colonoscopy in 1 year*
- A **1-year interval** is generally only indicated for cases of **incomplete resection**, piece-meal removal of large sessile polyps, or **inadequate bowel preparation**.
- It is not appropriate for a **completely removed** 1.2 cm tubular adenoma.
*Annual fecal immunochemical testing*
- **Fecal immunochemical testing (FIT)** is a primary **screening modality**, not a surveillance tool for patients who have already been diagnosed with adenomas via colonoscopy.
- Once an adenoma is identified, the patient enters a **colonoscopy-based surveillance** program to directly monitor for recurrent or advancing lesions.
Developmental screening in pediatrics US Medical PG Question 8: A 32-year-old woman presents for preconception counseling. She is healthy with no medical problems. Her mother and maternal aunt both had breast cancer diagnosed at ages 38 and 42, respectively. Her maternal grandmother died of ovarian cancer at age 52. The patient tested negative for BRCA1 and BRCA2 mutations 2 years ago through a commercial genetic testing panel. She asks about breast cancer screening recommendations. What is the most appropriate evaluation and management?
- A. Begin mammography at age 35 and annually thereafter
- B. Recommend clinical breast exam every 6 months only
- C. Begin annual mammography now
- D. Refer for genetic counseling and consider expanded testing with breast MRI screening (Correct Answer)
- E. Reassure that negative BRCA testing indicates average risk
Developmental screening in pediatrics Explanation: ***Refer for genetic counseling and consider expanded testing with breast MRI screening***
- Despite a negative **BRCA1/2** result, the patient's pedigree shows a **high-risk family history** (early-onset breast and ovarian cancer), which may indicate other **high-penetrance mutations** like **PALB2, TP53, or PTEN**.
- Women with a **lifetime risk >20%** based on models (e.g., **Tyrer-Cuzick**) or those with hereditary risk require **supplemental screening with Breast MRI** in addition to mammography.
*Begin annual mammography now*
- **Annual mammography alone** is insufficient for patients with a significant hereditary risk profile; **Breast MRI** is required to improve sensitivity in high-risk populations.
- Screening usually begins at age 30 or **10 years earlier** than the youngest diagnosis in the family, but current guidelines prioritize comprehensive **risk assessment** first.
*Reassure that negative BRCA testing indicates average risk*
- A negative test in the patient (without a known familial mutation) is **uninformative**; it does not rule out other genetic drivers or a strong **polygenic risk**.
- Reassuring her as "average risk" ignores the significant **familial clustering** of cancer, potentially delaying lifesaving early detection measures.
*Recommend clinical breast exam every 6 months only*
- **Clinical breast exams** lack the sensitivity to serve as a standalone management strategy for women with high **familial risk**.
- Evidence suggests that clinical exams do not significantly reduce **mortality** compared to advanced imaging protocols in hereditary cancer syndromes.
*Begin mammography at age 35 and annually thereafter*
- This delay is inappropriate; for high-risk families, screening often starts at **age 25 to 30** depending on the specific history and risk models.
- Starting at age 35 without incorporating **MRI screening** or updated **multi-gene panel testing** fails to address her specific hereditary risk profile.
Developmental screening in pediatrics US Medical PG Question 9: A 45-year-old woman presents requesting colorectal cancer screening after her sister was recently diagnosed with colon cancer at age 48. Further history reveals her sister's cancer was found to have microsatellite instability-high (MSI-H) features. The patient has no personal history of polyps or cancer and no gastrointestinal symptoms. Her sister is undergoing genetic testing for Lynch syndrome. What is the most appropriate next step in screening for this patient?
- A. Begin colonoscopy screening at age 50 per routine guidelines
- B. Defer screening until sister's genetic testing results are available
- C. Begin colonoscopy screening now and repeat in 10 years if normal
- D. Refer for genetic counseling and consider colonoscopy (Correct Answer)
- E. Begin annual FIT testing
Developmental screening in pediatrics Explanation: ***Refer for genetic counseling and consider colonoscopy***
- The sister's diagnosis at age 48 and **MSI-H** status strongly suggest **Lynch syndrome** (Hereditary Nonpolyposis Colorectal Cancer), necessitating specialized **genetic counseling** to evaluate family risk.
- While awaiting genetic results, guidelines for a **first-degree relative** diagnosed before age 60 require **colonoscopy** starting at age 40 or 10 years earlier than the relative's diagnosis (here, age 38).
*Begin colonoscopy screening now and repeat in 10 years if normal*
- For a patient with a **first-degree relative** diagnosed before age 60, the screening interval must be every **5 years**, not 10 years.
- A **10-year interval** is only appropriate for average-risk individuals or those with a single second-degree relative with cancer.
*Begin annual FIT testing*
- **Stool-based tests** like FIT or guaiac-based FOBT are not recommended as the primary screening modality for high-risk individuals with significant **family history**.
- **Colonoscopy** is the gold standard for these patients as it allows for the detection and removal of lesions in the **proximal colon**, which is often involved in Lynch syndrome.
*Defer screening until sister's genetic testing results are available*
- Screening should not be delayed while awaiting genetic testing; since the patient is already 45 and her sister was diagnosed at 48, she is already **past the recommended start date** (age 38).
- Immediate action is required based on the known **family history** regardless of whether a specific mutation is identified.
*Begin colonoscopy screening at age 50 per routine guidelines*
- Routine guidelines for **average-risk** individuals have been lowered to age 45, but this patient is **high-risk** due to her sister's early-onset cancer.
- Waiting until age 50 ignores the **10-year rule** (screening 10 years prior to a relative's diagnosis), which would have mandated screening to begin at age 38 for this patient.
Developmental screening in pediatrics US Medical PG Question 10: A 72-year-old woman with well-controlled hypertension and hyperlipidemia presents for follow-up. She has been getting annual mammograms since age 40. Her most recent mammogram 10 months ago was normal. She has no family history of breast cancer and has never had an abnormal mammogram. She asks if she should continue screening. Her life expectancy is estimated at 12 years based on comorbidity indices. What is the most appropriate recommendation?
- A. Perform breast MRI instead of mammography
- B. Discontinue mammography screening
- C. Continue annual mammography indefinitely
- D. Continue mammography with shared decision-making about life expectancy (Correct Answer)
- E. Switch to biennial mammography
Developmental screening in pediatrics Explanation: ***Continue mammography with shared decision-making about life expectancy***
- Major guidelines recommend continuing screening mammography as long as the patient is in good health and has a **life expectancy of at least 10 years**.
- Since her life expectancy is **12 years**, the decision to continue should involve **shared decision-making**, weighing the benefits of early detection against the potential for overdiagnosis and treatment-related harms.
*Continue annual mammography indefinitely*
- Screening should not be continued **indefinitely**; it becomes less beneficial when **life expectancy falls below 10 years** due to competing causes of mortality.
- Age alone is not the deciding factor, but the focus shifts toward **functional status and comorbidities** rather than chronological age.
*Switch to biennial mammography*
- While some organizations (like the USPSTF) support **screening every two years** for older women, the primary consideration for discontinuing or continuing is the **10-year life expectancy threshold**.
- Switching frequency does not address the core clinical question of whether the patient still benefits from screening based on her **prognostic outlook**.
*Discontinue mammography screening*
- Breast cancer screening should generally be discontinued only when **life expectancy is less than 10 years**, which is not the case for this patient.
- Given her **well-controlled hypertension** and good health status, she is still likely to benefit from the detection of **early-stage malignancies**.
*Perform breast MRI instead of mammography*
- **Breast MRI** is not used for routine screening in average-risk women and is generally reserved for those with a **high lifetime risk (>20%)** or specific genetic mutations.
- This patient has **no family history** and no high-risk features that would justify the use of MRI over **standard screening mammography**.
More Developmental screening in pediatrics US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
