Normal growth patterns US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Normal growth patterns. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Normal growth patterns US Medical PG Question 1: An investigator for a nationally representative health survey is evaluating the heights and weights of men and women aged 18–74 years in the United States. The investigator finds that for each sex, the distribution of heights is well-fitted by a normal distribution. The distribution of weight is not normally distributed. Results are shown:
Mean Standard deviation
Height (inches), men 69 0.1
Height (inches), women 64 0.1
Weight (pounds), men 182 1.0
Weight (pounds), women 154 1.0
Based on these results, which of the following statements is most likely to be correct?
- A. 86% of heights in women are likely to fall between 63.9 and 64.1 inches.
- B. 99.7% of heights in women are likely to fall between 63.7 and 64.3 inches. (Correct Answer)
- C. 68% of weights in women are likely to fall between 153 and 155 pounds.
- D. 95% of heights in men are likely to fall between 68.85 and 69.15 inches.
- E. 99.7% of heights in men are likely to fall between 68.8 and 69.2 inches.
Normal growth patterns Explanation: ***99.7% of heights in women are likely to fall between 63.7 and 64.3 inches.***
* For a **normal distribution**, approximately 99.7% of values fall within **±3 standard deviations** of the mean.
* For women's height: Mean = 64 inches, Standard Deviation = 0.1 inches. Therefore, 3 SD = 0.3 inches. The range is 64 ± 0.3, which is **63.7 to 64.3 inches**.
*86% of heights in women are likely to fall between 63.9 and 64.1 inches.*
* The range 63.9 to 64.1 inches represents **±1 standard deviation** (64 ± 0.1 inches).
* For a normal distribution, approximately **68%** (not 86%) of values fall within ±1 standard deviation of the mean.
*68% of weights in women are likely to fall between 153 and 155 pounds.*
* While 153 to 155 pounds represents **±1 standard deviation** (154 ± 1 pound), the problem states that the **distribution of weight is not normally distributed**.
* The **68-95-99.7 rule** (empirical rule) only applies to data that follows a normal distribution.
*95% of heights in men are likely to fall between 68.85 and 69.15 inches.*
* For a normal distribution, 95% of values fall within **±2 standard deviations**.
* For men's height: Mean = 69 inches, Standard Deviation = 0.1 inches. Therefore, 2 SD = 0.2 inches. The range for 95% should be 69 ± 0.2, which is **68.8 to 69.2 inches**, not 68.85 to 69.15 inches.
*99.7% of heights in men are likely to fall between 68.8 and 69.2 inches.*
* For a normal distribution, 99.7% of values fall within **±3 standard deviations**.
* For men's height: Mean = 69 inches, Standard Deviation = 0.1 inches. Therefore, 3 SD = 0.3 inches. The range for 99.7% should be 69 ± 0.3, which is **68.7 to 69.3 inches**, not 68.8 to 69.2 inches.
Normal growth patterns US Medical PG Question 2: A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 lbs, 9 oz), and his height is 30 inches (birth length 18 inches). Are there any aspects of this child's development that are delayed?
- A. Fine motor skill delay
- B. Language delay (Correct Answer)
- C. Inadequate growth
- D. Gross motor skill delay
- E. There are no developmental concerns
Normal growth patterns Explanation: ***Language delay***
- At 1 year of age, a child should typically be babbling with **specific sounds** and attempting to say their **first words**.
- The child's non-specific babbling suggests a delay in typical **expressive language development**.
*Fine motor skill delay*
- The child is able to pick up cereal using **two fingers**, indicating the development of a **pincer grasp**.
- This is an **age-appropriate fine motor skill** for a 1-year-old.
*Inadequate growth*
- The child has over **tripled his birth weight** (from 6 lbs, 9 oz to 22 lbs) and more than doubled his birth length (from 18 to 30 inches), which are **normal growth patterns** for the first year of life.
- While weight values can be plotted on growth charts, the provided information strongly suggests **adequate growth**.
*Gross motor skill delay*
- The child is taking **several steps independently**, which is an **age-appropriate gross motor milestone** for a 1-year-old.
- Many children take their first independent steps between 9 and 15 months.
*There are no developmental concerns*
- While many milestones are met, the **non-specific babbling** at 1 year strongly suggests a **language delay**.
- It is crucial to identify and address any potential delays early for intervention.
Normal growth patterns US Medical PG Question 3: A 2-month-old is brought to the physician for a well-child examination. She was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. She weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, she appears well. Her pulse is 136/min, the respirations are 41/min, and the blood pressure is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?
- A. Reaches for objects
- B. Stares at own hand
- C. Smiles in response to face (Correct Answer)
- D. Absence of asymmetric tonic neck reflex
- E. Monosyllabic babble
Normal growth patterns Explanation: ***Smiles in response to face***
- A 2-month-old infant typically achieves **social smiling**, often in response to a parent's face, indicating social engagement and developing emotional recognition.
- This milestone is an expected part of **normal social and emotional development** at this age.
*Reaches for objects*
- **Reaching for objects** is a more complex motor skill, generally expected around **4 to 6 months of age**, as fine motor control and hand-eye coordination develop.
- At 2 months, an infant may briefly swipe at objects but usually lacks the coordinated effort to intentionally reach and grasp.
*Stares at own hand*
- **Staring at one's own hand** is an early sign of self-discovery and visual exploration, typically emerging closer to **3 to 4 months of age** as vision matures.
- While a 2-month-old infant can focus on objects, sustained fascination with their own hands usually develops later.
*Absence of asymmetric tonic neck reflex*
- The **asymmetric tonic neck reflex (ATNR)**, or 'fencing reflex', is a primitive reflex normally present at 2 months of age and typically **disappears around 4 to 6 months**.
- Its presence is normal at 2 months, and its absence would be an abnormal finding, not a developmental milestone.
*Monosyllabic babble*
- **Monosyllabic babbling**, such as "ba" or "da", indicates developing language skills and typically begins around **6 to 9 months of age**.
- At 2 months, infants usually produce cooing sounds and simple vocalizations, but not structured babbling.
Normal growth patterns US Medical PG Question 4: 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
Normal growth patterns 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**.
Normal growth patterns US Medical PG Question 5: A 6-year-old boy is brought in by his mother for a well-visit. She reports that he is going to start kindergarten soon. She is worried that he doesn't like to play outside with the other kids on the block. When asked, the patient says "I like video games more than running. My big brother plays with me." His mother states that his teachers reported that he did well in pre-school and participated in group games. The patient is normally a good listener but has become more stubborn about wanting to "do things by himself," like getting dressed in the morning. The patient has no chronic medical conditions. He is allergic to peanuts. He takes no medications but has an epinephrine auto-injector for his allergy. His brother has asthma and his paternal grandfather died at age 56 of a myocardial infarction. The patient's blood pressure is 110/70 mmHg and pulse is 105/min. He is in the 50th percentile for height and weight. On physical examination, a grade II systolic murmur is heard. When the patient stands up, the murmur decreases. Capillary refill is less than 2 seconds. Which of the following is the most likely next step in management?
- A. Electrocardiogram
- B. Echocardiogram
- C. Chest radiograph
- D. Complete blood count
- E. Reassurance (Correct Answer)
Normal growth patterns Explanation: ***Reassurance***
- The murmur described is a **Still's murmur**, a common **innocent murmur** in children, characterized by its systolic nature, vibratory quality, and decrease in intensity with standing.
- Given the patient's anecdotally normal activity level, normal vital signs, absence of other cardiac symptoms, and the characteristics of the murmur, it is most likely benign, requiring no further workup.
*Electrocardiogram*
- An **ECG** is typically performed to evaluate electrical activity of the heart and detect arrhythmias or hypertrophy.
- For a suspected innocent murmur in an asymptomatic child with normal vital signs, an **ECG is not the most appropriate first step**, especially if the murmur disappears with standing.
*Echocardiogram*
- An **echocardiogram** is used to visualize the heart's structure and function.
- It would be indicated if the murmur had features suggestive of a **pathological cause**, such as being diastolic, loud, associated with symptoms (e.g., cyanosis, poor feeding, dyspnea), or other abnormal findings on physical exam, none of which are present here.
*Chest radiograph*
- A **chest radiograph** would visualize the size and shape of the heart and great vessels, as well as the lungs.
- It is **not a primary diagnostic tool for murmurs** and would be most useful in cases of suspected heart failure or significant cardiomegaly, neither of which are suggested by this presentation.
*Complete blood count*
- A **CBC** measures blood components and is useful for detecting anemia, infection, or other hematologic abnormalities.
- It has **no relevance** to the initial assessment or workup of a cardiac murmur unless other systemic symptoms are present.
Normal growth patterns US Medical PG Question 6: A 4-year-old boy is brought to the pediatrician by his mother for a routine medical examination. His medical history is relevant for delayed gross motor milestones. The mother is concerned about a growth delay because both of his brothers were twice his size at this age. Physical examination reveals a well-groomed and healthy boy with a prominent forehead and short stature, in addition to shortened upper and lower extremities with a normal vertebral column. The patient’s vitals reveal: temperature 36.5°C (97.6°F); pulse 60/min; and respiratory rate 17/min and a normal intelligence quotient (IQ). A mutation in which of the following genes is the most likely cause underlying the patient’s condition?
- A. Runt-related transcription factor 2
- B. Alpha-1 type I collagen
- C. Fibroblast growth factor receptor 3 (Correct Answer)
- D. Insulin-like growth factor 1 receptor
- E. Fibrillin-1
Normal growth patterns Explanation: ***Fibroblast growth factor receptor 3***
- The constellation of **short stature**, prominent forehead, and **shortened upper and lower extremities** with a normal vertebral column in a child with normal intelligence is characteristic of **achondroplasia**.
- Achondroplasia is caused by a gain-of-function mutation in the **fibroblast growth factor receptor 3 (FGFR3)** gene, which inhibits chondrocyte proliferation and differentiation, leading to impaired endochondral ossification.
*Runt-related transcription factor 2*
- Mutations in **Runt-related transcription factor 2 (RUNX2)** are associated with **cleidocranial dysplasia**, a condition characterized by absent or hypoplastic clavicles, delayed closure of fontanelles, and dental abnormalities, which are not described in this patient.
- While it affects bone development, the specific features of achondroplasia, such as rhizomelic dwarfism and a prominent forehead, are not typical of RUNX2 mutations.
*Alpha-1 type I collagen*
- Mutations in **collagen genes**, particularly type I collagen (COL1A1, COL1A2), are linked to **osteogenesis imperfecta**, characterized by **fragile bones**, blue sclera, and hearing loss.
- The patient's presentation does not include these features, and the primary issue is disproportionate short stature due to impaired cartilage growth, not bone fragility.
*Insulin-like growth factor 1 receptor*
- Mutations in the **insulin-like growth factor 1 receptor (IGF1R)** can lead to **pre- and postnatal growth retardation** and microcephaly, often associated with developmental delay and feeding difficulties.
- While IGF1R mutations cause short stature, the specific skeletal dysmorphology (e.g., prominent forehead, shortened limbs) and normal intelligence are much more suggestive of achondroplasia.
*Fibrillin-1*
- Mutations in **fibrillin-1** are responsible for **Marfan syndrome**, which typically presents with **tall stature**, long limbs (dolichostenomelia), joint hypermobility, and cardiovascular abnormalities such as aortic root dilation.
- The patient's short stature and shortened limbs directly contradict the clinical picture of Marfan syndrome.
Normal growth patterns US Medical PG Question 7: An 18-month-old boy is brought to the physician by his mother because of concern that he has not yet begun to walk. He was born at term and exclusively breastfed until 15 months of age. His mother says he has been well, apart from an episode of high fever and seizure 4 months ago for which she did not seek medical attention. He has an older brother who is currently receiving medical treatment for failure to thrive. His parents have no history of serious illness; they are of normal height. His last vaccine was at the age of 4 months. He is at the 20th percentile for length, 10th percentile for weight, and 50th percentile for head circumference. Physical examination shows dry mucous membranes and erosion of the enamel on the lingual surface of the incisors and carious molars. He has frontal bossing. His wrists are widened, his legs seem bent, and there is beading of the ribs. Which of the following is the most likely underlying cause of this patient's delay in walking?
- A. Deficiency of osteoclasts to reabsorb bone
- B. Osteoid proliferation in the subperiosteal bone
- C. Defect in type I collagen
- D. Mutation of fibroblast growth factor receptor 3
- E. Defective growth plate mineralization (Correct Answer)
Normal growth patterns Explanation: ***Defective growth plate mineralization***
- The patient's symptoms, including **delayed walking**, **frontal bossing**, **widened wrists**, **bowed legs** (bent legs), and **rachitic rosary** (beading of the ribs), are classic signs of **rickets**.
- **Rickets** is caused by a deficiency of vitamin D, leading to impaired mineralization of the cartilage and newly formed bone at the growth plates, resulting in soft and weak bones. The prolonged **exclusive breastfeeding** in this case, without vitamin D supplementation, increases the risk.
*Deficiency of osteoclasts to reabsorb bone*
- This describes conditions like **osteopetrosis** (Albers-Schonberg disease), which typically presents with **dense, brittle bones**, prone to fractures, and often associated with **bone marrow failure**.
- While osteopetrosis can cause skeletal deformities and delayed milestones, the specific findings of widened wrists, bowed legs, and rachitic rosary are not characteristic of osteopetrosis, which involves increased bone density.
*Osteoid proliferation in the subperiosteal bone*
- This is a feature of conditions like **secondary hyperparathyroidism** or some bone tumors, which do not typically present with the widespread skeletal deformities and growth plate abnormalities seen in rickets.
- While it can lead to bone pain and fragility, it does not explain the characteristic signs of rickets, such as widened growth plates and bone softening.
*Defect in type I collagen*
- A defect in type I collagen is characteristic of **osteogenesis imperfecta**, a genetic disorder leading to **brittle bones** that are prone to frequent fractures.
- Patients with osteogenesis imperfecta often have **blue sclerae** and **dentinogenesis imperfecta** (which can cause dental issues, but not specifically enamel erosion and caries in the manner described), but not the specific rickets-like skeletal deformities.
*Mutation of fibroblast growth factor receptor 3*
- A mutation in **fibroblast growth factor receptor 3 (FGFR3)** causes **achondroplasia**, the most common form of dwarfism.
- Achondroplasia is characterized by **short limbs**, a **normal trunk size**, and a **large head with frontal bossing**, but it does not cause the specific skeletal findings of widely spaced growth plates, bowed legs, and rachitic rosary associated with defective mineralization.
Normal growth patterns US Medical PG Question 8: A 6-month-old girl is brought to the physician because of drooling and excessive crying for 3 days. She calms down when cuddled or with a pacifier in her mouth. She feeds well and has no vomiting or diarrhea. She was breastfed exclusively for 5 months. She is given no medications and was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. At the clinic, her weight is 7.3 kg (16 lb 1 oz) and her height is 65.8 cm (25.9 in) in length. She appears irritable. Her pulse is 124/min, the respirations are 32/min, the blood pressure is 92/63 mm Hg, and the temperature is 36.8°C (98.2°F). On physical examination, she has no conjunctivitis, cervical lymphadenopathy, or pharyngeal erythema. Which element of the physical examination is most likely to be present in this patient?
- A. The rooting reflex
- B. Crying on frontal sinus palpation
- C. Eruption of mandibular incisors (Correct Answer)
- D. Closure of the anterior fontanel
- E. Erythema and fluctuance of the submandibular area
Normal growth patterns Explanation: ***Eruption of mandibular incisors***
- The patient's age (6 months), **drooling**, and **irritability** strongly suggest **teething**, which commonly involves the eruption of the mandibular incisors.
- Teething pain and discomfort can be relieved by pacifiers or cuddling, consistent with the patient's presentation.
*The rooting reflex*
- The **rooting reflex** is a primitive reflex typically present at birth and usually disappears by **4 months of age**; this patient is 6 months old.
- Its presence would not explain the current symptoms of irritability and drooling.
*Crying on frontal sinus palpation*
- **Frontal sinuses** are typically underdeveloped or absent in infants and children until later ages (around 6-10 years old), so their palpation is not clinically relevant in a 6-month-old.
- Crying on palpation would only be significant if the sinuses were developed and inflamed, which is unlikely and not indicated by other symptoms.
*Closure of the anterior fontanel*
- The **anterior fontanel** typically remains open until **12-18 months of age**, allowing for brain growth; abnormal closure at 6 months would be a concerning finding but is not indicated by the drooling and irritability.
- Premature closure of the fontanel is usually associated with microcephaly or other cranial abnormalities, not teething symptoms.
*Erythema and fluctuance of the submandibular area*
- **Erythema** and **fluctuance** in the submandibular area suggest an **infection or abscess**, which would likely be accompanied by fever and other signs of systemic illness not present in this patient.
- While teething can cause local inflammation, it does not typically lead to a submandibular abscess without other contributing factors.
Normal growth patterns US Medical PG Question 9: A laborer's younger child is brought to the OPD with a swollen belly and dull face. He has been fed rice water (rice milk) in his diet mostly. On investigations, the child is found to have low serum protein and low albumin. What is the probable diagnosis?
- A. Kwashiorkor (Correct Answer)
- B. Kawasaki disease
- C. Marasmus
- D. Indian childhood cirrhosis
- E. Nephrotic syndrome
Normal growth patterns Explanation: ***Kwashiorkor***
- The symptoms of a **swollen belly** (due to **edema** from low albumin), **dull face**, and a diet primarily of **rice water** (low in protein) are classic signs of Kwashiorkor.
- Kwashiorkor is a form of severe protein-energy malnutrition characterized by **protein deficiency** that is greater than the calorie deficit, leading to **hypoalbuminemia** and fluid retention.
- The **dietary history** of rice water (carbohydrate-rich but protein-poor) is the key distinguishing feature.
*Kawasaki disease*
- This is an **acute vasculitis** primarily affecting young children, presenting with fever, rash, conjunctivitis, mouth changes, and lymphadenopathy.
- It does not involve a swollen belly or dull face as primary symptoms, nor is it linked to dietary protein deficiency.
*Marasmus*
- Marasmus is a form of severe malnutrition characterized by an **overall deficiency of calories** and nutrients, resulting in severe **wasting** of muscle and fat.
- While it involves low weight and energy deficit, the prominent **edema** (swollen belly) seen in this case points away from marasmus.
*Indian childhood cirrhosis*
- This is a rare, **fatal liver disease** in young children, often characterized by jaundice, hepatosplenomegaly, and liver failure.
- It is not primarily caused by protein deficiency and its symptoms are distinct from the presentation described.
*Nephrotic syndrome*
- While nephrotic syndrome also presents with **hypoalbuminemia and edema**, it would show **proteinuria** (>3.5 g/day), hyperlipidemia, and lipiduria on urinalysis.
- The **dietary history** and absence of urinary findings distinguish kwashiorkor from nephrotic syndrome.
Normal growth patterns US Medical PG Question 10: A 10-year-old male presents with generalized edema. His cholesterol level is $238 \mathrm{mg} / \mathrm{dl}$, urine protein is $3+$, and stool microscopy shows fat in the stool. What is the most likely diagnosis?
- A. Nephritic syndrome
- B. Goodpasture syndrome
- C. Nephrotic syndrome (Correct Answer)
- D. Urine infection
- E. Minimal change disease
Normal growth patterns Explanation: ***Nephrotic syndrome***
- **Nephrotic syndrome** is characterized by **generalized edema**, **massive proteinuria** (3+ in urine protein), and **hyperlipidemia** (elevated cholesterol).
- **Fat in the stool** (steatorrhea) can be an associated finding due to malabsorption or metabolic derangements, though not a primary diagnostic criterion for nephrotic syndrome.
- This is the **syndrome** that encompasses the entire clinical presentation.
*Minimal change disease*
- **Minimal change disease** is the **most common etiology** of nephrotic syndrome in children (accounting for ~80% of cases in this age group).
- While this child likely has minimal change disease as the underlying cause, the question asks for the **syndrome/diagnosis** based on the clinical presentation, which is **nephrotic syndrome**.
- Minimal change disease is the pathologic diagnosis that would be confirmed on **renal biopsy**.
*Nephritic syndrome*
- **Nephritic syndrome** typically presents with **hematuria**, **hypertension**, **azotemia**, and mild to moderate proteinuria, rather than massive proteinuria and generalized edema.
- It is characterized by inflammation of the glomeruli, often leading to a decrease in **glomerular filtration rate (GFR)**.
*Goodpasture syndrome*
- **Goodpasture syndrome** is an autoimmune disease characterized by **rapidly progressive glomerulonephritis** and **pulmonary hemorrhage**.
- While it causes renal involvement, its distinct feature is the presence of **anti-glomerular basement membrane (GBM) antibodies**, and the clinical picture does not align with the given symptoms.
*Urine infection*
- A **urine infection** (urinary tract infection) typically presents with dysuria, frequency, urgency, and sometimes fever, with positive urine cultures and pyuria.
- It does not explain the presence of **generalized edema**, **hyperlipidemia**, or **massive proteinuria**.
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