Cognitive development US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cognitive development. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cognitive development US Medical PG Question 1: A 4-month-old boy is brought to the physician for a well-child examination. He was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. He weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, he appears well. His pulse is 146/min, the respirations are 39/min, and the blood pressure is 78/44 mm Hg. He weighs 7.5 kg (16 lb 9 oz) and measures 65 cm (25.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?
- A. Sits with support of pelvis
- B. Grasps small objects between thumb and finger
- C. Transfers objects from hand to hand
- D. Intentionally rolls over (Correct Answer)
- E. Bounces actively when held in standing position
Cognitive development Explanation: ***Intentionally rolls over***
- Rolling over is a common developmental milestone achieved between **4 to 6 months** of age.
- At 4 months, an infant typically has sufficient **head control** and **trunk strength** to intentionally roll from tummy to back or back to tummy.
*Sits with support of pelvis*
- Sitting with **pelvic support** (tripod sitting) is generally achieved around **6 to 7 months** of age.
- A 4-month-old typically lacks the necessary **trunk stability** and strength for this milestone.
*Grasps small objects between thumb and finger*
- This describes a **pincer grasp**, which is a fine motor skill usually developed around **9-12 months** of age.
- At 4 months, infants primarily use a **palmar grasp** (raking motion) to pick up objects.
*Transfers objects from hand to hand*
- Transferring objects from hand to hand is a fine motor milestone typically achieved between **5 and 7 months** of age.
- A 4-month-old is beginning to reach for objects but usually has difficulty with **smooth transfers** between hands.
*Bounces actively when held in standing position*
- Active bouncing when held in a standing position is typically seen around **6 months** when infants start putting more weight on their legs.
- At 4 months, while an infant might bear some weight, **active bouncing** is usually more rudimentary or absent.
Cognitive development US Medical PG Question 2: 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
Cognitive development 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.
Cognitive development US Medical PG Question 3: During the selection of subjects for a study on infantile vitamin deficiencies, a child is examined by the lead investigator. She is at the 75th percentile for head circumference and the 80th percentile for length and weight. She can lift her chest and shoulders up when in a prone position, but cannot roll over from a prone position. Her eyes follow objects past the midline. She coos and makes gurgling sounds. When the investigator strokes the sole of her foot, her big toe curls upward and there is fanning of her other toes. She makes a stepping motion when she is held upright and her feet are in contact with the examination table. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
- A. Cries when separated from her mother
- B. Smiles at her mother (Correct Answer)
- C. Rolls over from her back
- D. Responds to calling of own name
- E. Reaches out for objects
Cognitive development Explanation: ***Smiles at her mother***
- The child exhibits developmental milestones consistent with a **2-month-old infant**, such as lifting her chest in a prone position, following objects past the midline, cooing, and gurgling. Social smiling typically emerges around **2 months of age**.
- Primitive reflexes like the **Babinski reflex** (big toe curling upward and fanning of other toes) and **stepping reflex** are normally present at this age, supporting the approximate age of 2 months.
*Cries when separated from her mother*
- This behavior suggests **separation anxiety**, which typically develops much later, usually around **8-9 months of age**.
- A 2-month-old infant does not yet have the cognitive understanding or object permanence needed to exhibit true separation anxiety.
*Rolls over from her back*
- Rolling over from the back to the stomach is usually achieved between **4 and 6 months of age**.
- The child in the vignette cannot even roll over from a prone position, indicating she is not yet at the age for rolling from her back.
*Responds to calling of own name*
- Responding to one's own name is a more advanced auditory and cognitive milestone, generally developing between **6 and 9 months of age**.
- At 2 months, infants respond to voices and sounds but do not associate specific words with themselves.
*Reaches out for objects*
- Purposeful reaching and grasping for objects (palmar grasp) typically develops around **4 to 6 months of age**.
- A 2-month-old infant may swat at objects reflexively but does not exhibit coordinated, intentional reaching.
Cognitive development US Medical PG Question 4: A 3-year-old girl is brought to the physician for a well-child examination. She was born at term and has been healthy since. She can climb up and down the stairs and can pedal a tricycle. She has difficulty using a spoon to feed herself but can copy a line. She speaks in 2- to 3-word sentences that can be understood by most people. She is selfish while playing with children her age and throws tantrums quite often. She cannot put on her own shoes and socks. She does not tolerate separation from her parents. She is at 60th percentile for height and weight. Physical examination including neurologic examination reveals no abnormalities. Which of the following is the most appropriate assessment of her development?
- A. Fine motor: Normal | Gross motor: Normal | Language: Delayed | Social skills: Delayed
- B. Fine motor: Delayed | Gross motor: Delayed | Language: Normal | Social skills: Normal
- C. Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed (Correct Answer)
- D. Fine motor: Normal | Gross motor: Delayed | Language: Normal | Social skills: Delayed
- E. Fine motor: Normal | Gross motor: Delayed | Language: Delayed | Social skills: Normal
Cognitive development Explanation: ***Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed***
- The child can copy a line (expected at 3 years) and climb stairs and pedal a tricycle (expected for a 3-year-old), indicating **normal gross motor skills**. However, difficulty using a spoon and putting on shoes/socks suggests **delayed fine motor skills**.
- Speaking in 2- to 3-word sentences understood by most (expected for 2-3 years) indicates **normal language development**. Being selfish and throwing tantrums (normal for 2-3 years) but not tolerating separation (suggests earlier developmental stage for separation anxiety) point to **delayed social skills**.
*Fine motor: Normal | Gross motor: Normal | Language: Delayed | Social skills: Delayed*
- This option incorrectly assesses fine motor skills as normal when the child struggles with tasks like using a spoon and dressing herself.
- While language and social skills are correctly identified as delayed, the overall assessment of fine motor makes this option incorrect.
*Fine motor: Delayed | Gross motor: Delayed | Language: Normal | Social skills: Normal*
- This option incorrectly assesses gross motor skills as delayed, despite the child's ability to climb stairs and pedal a tricycle, which are age-appropriate.
- It also incorrectly assesses social skills as normal, overlooking the persistent separation anxiety and aggressive social play for her age.
*Fine motor: Normal | Gross motor: Delayed | Language: Normal | Social skills: Delayed*
- This option incorrectly describes fine motor skills as normal and gross motor skills as delayed.
- Her ability to pedal a tricycle and climb stairs indicates age-appropriate gross motor development, while her difficulty with a spoon suggests delayed fine motor skills.
*Fine motor: Normal | Gross motor: Delayed | Language: Delayed | Social skills: Normal*
- This option incorrectly states that both fine motor and gross motor skills are affected and also mischaracterizes social skills as normal.
- The child's language development is within the normal range for a 3-year-old, and her social behavior, particularly the separation anxiety, indicates a delay.
Cognitive development US Medical PG Question 5: A 3-year-old boy is brought for general developmental evaluation. According to his parents he is playing alongside other children but not in a cooperative manner. He has also recently begun to ride a tricycle. Upon questioning you also find that he is toilet trained and can stack 9 blocks. Upon examination you find that he can copy a circle though he cannot yet copy a triangle or draw stick figures. In addition he is currently speaking in two word phrases but cannot yet use simple sentences. Based on these findings you tell the parents that their child's development is consistent with which of the following?
- A. Normal social, normal motor, delayed language (Correct Answer)
- B. Normal social, delayed motor, delayed language
- C. Delayed social, normal motor, delayed language
- D. Delayed social, normal motor, normal language
- E. Normal social, normal motor, normal language
Cognitive development Explanation: ***Normal social, normal motor, delayed language***
- The child's ability to play alongside other children without direct cooperation is typical for a 3-year-old, indicating **normal social development**.
- His motor skills (riding a tricycle, stacking 9 blocks, copying a circle) are largely age-appropriate, but his language (two-word phrases instead of simple sentences) is mildly **delayed for a 3-year-old**.
*Normal social, delayed motor, delayed language*
- This option is incorrect because the child's **motor skills** (riding a tricycle, stacking 9 blocks, copying a circle) are generally on track for a 3-year-old.
- While language is delayed, the motor development is not, making this option inconsistent with the overall clinical picture.
*Delayed social, normal motor, delayed language*
- This is incorrect because playing alongside peers (parallel play) is a **normal social behavior** for a 3-year-old, not a sign of delayed social development.
- The motor skills are normal, and language is indeed delayed, but the social assessment is inaccurate.
*Delayed social, normal motor, normal language*
- This option is incorrect due to an inaccurate assessment of both **social and language development**. Playing alongside peers is normal, not delayed social.
- The child's language use of only two-word phrases is considered delayed for a 3-year-old, not normal.
*Normal social, normal motor, normal language*
- This option is incorrect because the child's **language development** is not normal; 3-year-olds are typically using simple sentences, not just two-word phrases.
- While social and motor development appears normal, the language delay makes "normal language" an incorrect assessment.
Cognitive development US Medical PG Question 6: An infant boy is brought to the physician for a well-child examination. He was born at term and has been healthy since. He is beginning to crawl but can not yet walk or run. He feeds himself small foods and can bang 2 cubes together. He is just beginning to successfully use a pincer grasp. He has stranger anxiety. He is at the 40th percentile for height and weight. Physical examination shows no abnormalities. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
- A. Follows one-step commands
- B. Says mama or dada (Correct Answer)
- C. Enjoys peek-a-boo
- D. Gives objects to others
- E. Knows 3–6 words
Cognitive development Explanation: ***Says mama or dada***
- The infant is at roughly **9–10 months** based on developmental milestones like crawling, banging cubes, developing pincer grasp, and stranger anxiety.
- At this age, saying **"mama" or "dada" specifically** (not just babbling) is a common and expected **emerging language milestone**.
- This represents a NEW skill being acquired at this developmental stage.
*Follows one-step commands*
- Following one-step commands, especially without gestures, is typically a milestone achieved later, around **12–15 months** of age.
- The infant's current stage of development, particularly concerning language acquisition, indicates they are not yet at this level of comprehension.
*Enjoys peek-a-boo*
- While infants at **9–10 months** do enjoy peek-a-boo, this is not a NEW or emerging skill at this age.
- Peek-a-boo is typically enjoyed starting around **6–9 months** and represents an **already established** skill by this developmental stage.
- The question asks for "additional skills expected" at this age, and "mama/dada" is the emerging milestone, whereas peek-a-boo enjoyment is already well-developed.
*Gives objects to others*
- **Giving objects to others** as a communicative gesture or to share is a more complex social milestone, typically emerging around **12–15 months** of age.
- This action requires a greater understanding of social interaction and reciprocity than what's expected for this infant's current stage.
*Knows 3–6 words*
- Knowing and using **multiple specific words** (3-6 words) is a language milestone typically reached closer to **12–15 months**.
- At 9–10 months, the infant is just beginning to say specific words like "mama" or "dada", indicating an earlier stage of vocabulary development.
Cognitive development US Medical PG Question 7: At what age does maximum brain growth occur?
- A. 6 months (Correct Answer)
- B. 1 year
- C. 2 years
- D. 3 years
- E. 5 years
Cognitive development Explanation: ***6 months***
- **Brain growth** is most rapid during the early postnatal period, with the brain reaching almost **50% of its adult size by 6 months of age**.
- This period involves rapid **synaptogenesis** and myelination, crucial for early cognitive and motor development.
*1 year*
- While significant **brain growth** continues, the peak rate of increase in brain volume has typically passed by 1 year.
- At this age, the brain has reached approximately **75% of its adult size**.
*2 years*
- By 2 years, the brain is about **80% of its adult size**, indicating ongoing but slower growth compared to the first year.
- This period is more characterized by refinement of neural circuits rather than rapid volumetric expansion.
*3 years*
- At 3 years, the brain has attained around **90% of its adult size**, though important developmental changes continue.
- The rate of **neural development** at this stage largely focuses on strengthening existing connections and pruning less used ones.
*5 years*
- By 5 years, the brain has reached approximately **90-95% of its adult size**, with growth significantly slower than in earlier years.
- Development at this age focuses primarily on **synaptic pruning** and refinement of neural networks rather than volumetric growth.
Cognitive development US Medical PG Question 8: A mother brings her 10 month-old boy to the pediatrician for a check-up. His birth was without complications and his development to-date has been progressing normally. He currently crawls, pulls himself up to standing, says 'mama' and 'dada' nonspecifically, and responds when called by his name. However, his mother is concerned, as she has noted over the past several weeks that he has periods where he stops breathing when he gets frightened or upset. These episodes last for 20-30 seconds and are accompanied by his lips and face becoming bluish. His breathing has always resumed normally within 45 seconds after the start of the episode, and he acts normally afterwards. One instance resulted in the child passing out for a 5-10 seconds before a spontaneous recovery. Which of the following is the most appropriate management of this patient's condition?
- A. Education and reassurance of the mother (Correct Answer)
- B. Basic metabolic panel
- C. Electroencephalogram
- D. Echocardiogram
- E. Lung spirometry
Cognitive development Explanation: ***Education and reassurance of the mother***
- The described episodes are classic for **breath-holding spells**, which are benign, self-limited events common in children aged 6 months to 6 years.
- The key management involves **reassuring parents** that these spells are not dangerous and providing guidance on how to respond calmly during an episode.
*Basic metabolic panel*
- A **basic metabolic panel** generally screens for electrolyte imbalances or kidney dysfunction, which are not indicated by the typical presentation of breath-holding spells.
- While **iron deficiency anemia** can sometimes exacerbate breath-holding spells, a complete blood count (CBC) would be a more appropriate initial blood test to evaluate for this.
*Electroencephalogram*
- An **electroencephalogram (EEG)** is used to detect abnormal brain activity associated with seizure disorders.
- Although some breath-holding spells can be followed by a brief loss of consciousness, they are generally distinguishable from seizures by the **triggering event (fear/upset)**, cyanosis, and the rapid return to normal.
*Echocardiogram*
- An **echocardiogram** evaluates the structure and function of the heart.
- While cardiac causes of syncope can present with similar symptoms, the clear precipitating factors (fear/upset), cyanosis, and the described pattern of spontaneous recovery make a cardiac origin less likely in this context.
*Lung spirometry*
- **Lung spirometry** measures lung function and is typically used to diagnose and monitor respiratory conditions like asthma.
- The child's transient respiratory arrest is not due to a primary lung or airway problem, but rather a reflex response related to the **autonomic nervous system** during emotional distress.
Cognitive development US Medical PG Question 9: A 13-month-old girl is brought to the physician for a well-child examination. She was born at 38 weeks' gestation. There is no family history of any serious illnesses. She cannot pull herself to stand from a sitting position. She can pick an object between her thumb and index finger but cannot drink from a cup or feed herself using a spoon. She comes when called by name and is willing to play with a ball. She cries if she does not see her parents in the same room as her. She coos “ma” and “ba.” She is at the 50th percentile for height and weight. Physical examination including neurologic examination shows no abnormalities. Which of the following is the most appropriate assessment of her development?
- A. Fine motor: normal | Gross motor: delayed | Language: normal | Social skills: delayed
- B. Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normal (Correct Answer)
- C. Fine motor: delayed | Gross motor: normal | Language: delayed | Social skills: normal
- D. Fine motor: delayed | Gross motor: delayed | Language: normal | Social skills: normal
- E. Fine motor: delayed | Gross motor: normal | Language: normal | Social skills: delayed
Cognitive development Explanation: ***Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normal***
- **Fine motor** is normal because she demonstrates **pincer grasp** (picking up objects between thumb and index finger), which is the key fine motor milestone expected by 9-12 months. The inability to drink from a cup or self-feed with a spoon represents more complex feeding skills that develop later (12-18 months) and are not primary fine motor milestones at 13 months.
- **Gross motor** is delayed because she cannot pull herself to stand, a milestone typically achieved by 9-12 months. At 13 months, she should be cruising along furniture or beginning to walk independently.
- **Language** is delayed because she only coos "ma" and "ba" without meaningful words. By 13 months, children should typically say 1-2 words with meaning (like "mama" or "dada" used specifically) and have varied babbling patterns.
- **Social skills** are normal as she responds to her name, engages in play (willing to play with a ball), and demonstrates appropriate **separation anxiety** when her parents are not in the room—all expected social-emotional milestones for this age.
*Fine motor: normal | Gross motor: delayed | Language: normal | Social skills: delayed*
- Language is delayed, not normal—cooing "ma" and "ba" without meaningful words does not meet the expected milestone of 1-2 words with meaning by 13 months.
- Social skills are normal, not delayed—responding to her name and showing separation anxiety are appropriate for her age.
*Fine motor: delayed | Gross motor: normal | Language: delayed | Social skills: normal*
- Fine motor is normal, not delayed—the presence of **pincer grasp** is the key indicator, and feeding difficulties reflect more complex coordination rather than delayed fine motor development.
- Gross motor is delayed, not normal—inability to pull to stand at 13 months represents a significant delay.
*Fine motor: delayed | Gross motor: delayed | Language: normal | Social skills: normal*
- Fine motor is normal—**pincer grasp** is present and appropriate for age.
- Language is delayed, not normal—she lacks meaningful words expected at 13 months.
*Fine motor: delayed | Gross motor: normal | Language: normal | Social skills: delayed*
- Fine motor is normal—**pincer grasp** is the key milestone and is present.
- Gross motor is delayed, not normal—cannot pull to stand, which should have been achieved months earlier.
- Social skills are normal, not delayed—separation anxiety and responding to name are age-appropriate behaviors.
Cognitive development US Medical PG Question 10: A female child presents to her pediatrician for a well child visit. Her mother reports that she is eating well at home and sleeping well throughout the night. She can jump and walk up and down stairs with both feet on each step. In the doctor’s office, the patient builds a six-cube tower and imitates a circle. She seems to have a vocabulary of over 50 words that she uses in two-word sentences. Her mother reports that the patient enjoys playing near other children and sometimes argues over toys with her older brother. On physical exam, she appears well developed and well nourished, and she is following along her growth curves. The child is assessed as developmentally normal.
Which of the following is an additional milestone associated with this child’s age?
- A. Balances on one foot
- B. Copies a cross
- C. Cuts with scissors
- D. Follows two-step commands (Correct Answer)
- E. Points to one body part
Cognitive development Explanation: ***Follows two-step commands***
- The child is exhibiting developmental milestones consistent with a **24-month-old (2-year-old)**, which include following two-step commands.
- At this age, children can typically understand and execute simple directives like "pick up the ball and bring it to me."
*Balances on one foot*
- **Balancing on one foot** is typically a milestone achieved later, around **3 years of age** (36 months).
- While the child at 2 years can jump and walk stairs, sustained balance on one foot is still developing.
*Copies a cross*
- **Copying a cross** is a fine motor milestone typically achieved around **4 years of age** (48 months).
- At 2 years, children can imitate a circle but cannot yet copy more complex shapes like crosses or squares.
*Cuts with scissors*
- **Cutting with scissors** is a more advanced fine motor skill usually developed between **3 and 4 years of age**, requiring increased hand-eye coordination and precision.
- A 2-year-old would not typically have the dexterity to cut effectively.
*Points to one body part*
- **Pointing to one body part** is an earlier milestone, typically achieved around **15-18 months of age**.
- A 2-year-old child would likely be able to point to several body parts and identify them.
More Cognitive development US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
