Cultural influences on development US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cultural influences on development. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cultural influences on development US Medical PG Question 1: A 6-month-old boy is brought to the physician for a well-child examination. The boy was born at term, and the pregnancy was complicated by prolonged labor. There is no family history of any serious illnesses. He can sit upright but needs help to do so and cannot roll over from the prone to the supine position. He can grasp his rattle and can transfer it from one hand to the other. He babbles. He cries if anyone apart from his parents holds him or plays with him. He touches his own reflection in the mirror. Vital signs are within normal limits. He is at the 40th percentile for head circumference, 30th percentile for length, and 40th percentile for weight. Physical examination reveals no abnormalities. Which of the following developmental milestones is delayed in this infant?
- A. Gross motor (Correct Answer)
- B. Fine motor
- C. Social
- D. Language
- E. Cognitive
Cultural influences on development Explanation: ***Gross motor***
- The infant can sit upright with help but **cannot roll over** from prone to supine, which is typically achieved by 4-5 months.
- While he can pull himself to stand (an advanced skill for his age), the inability to roll over indicates a delay in fundamental **gross motor development**.
*Fine motor*
- The infant can grasp his rattle and **transfer it from one hand to the other**, which is an appropriate fine motor skill for a 6-month-old.
- This demonstrates adequate **hand-eye coordination** and manipulation abilities.
*Social*
- The infant **cries if anyone apart from his parents holds or plays with him**, indicating **stranger anxiety**, which is a normal social development milestone for this age.
- This shows appropriate attachment and social discrimination.
*Language*
- The infant **babbles**, which is a typical language milestone for a 6-month-old, indicating early vocalization and speech development.
- This suggests that his pre-linguistic skills are emerging as expected.
*Cognitive*
- The infant **touches his own reflection in the mirror**, which is a normal cognitive behavior for a 6-month-old, showing an interest in faces and self-recognition (even if not full understanding).
- This also encompasses the ability to transfer objects, demonstrating **object permanence** and problem-solving skills.
Cultural influences on development US Medical PG Question 2: A mother presents to the family physician with her 16-year-old son. She explains, "There's something wrong with him doc. His grades are getting worse, he's cutting class, he's gaining weight, and his eyes are often bloodshot." Upon interviewing the patient apart from his mother, he seems withdrawn and angry at times when probed about his social history. The patient denies abuse and sexual history. What initial test should be sent to rule out the most likely culprit of this patient's behavior?
- A. Complete blood count
- B. Sexually transmitted infection (STI) testing
- C. Blood culture
- D. Urine toxicology screen (Correct Answer)
- E. Slit lamp examination
Cultural influences on development Explanation: ***Urine toxicology screen***
- The patient's presentation with **declining grades**, **cutting class**, **weight gain**, **bloodshot eyes**, and **irritability** are classic signs of **substance abuse** in an adolescent.
- A **urine toxicology screen** is the most appropriate initial test to detect common illicit substances, especially given the clear signs pointing towards drug use.
*Slit lamp examination*
- This test is used to examine the **anterior segment of the eye**, including the conjunctiva, cornea, iris, and lens.
- While the patient has **bloodshot eyes**, this specific test would be more relevant for ruling out ocular infections or injuries, not for diagnosing the underlying cause of systemic behavioral changes.
*Complete blood count*
- A **complete blood count (CBC)** measures different components of the blood, such as red blood cells, white blood cells, and platelets.
- A CBC is a general health indicator and while it can detect infections or anemia, it is not specific or sensitive enough to identify the cause of the behavioral changes described.
*Sexually transmitted infection (STI) testing*
- Although the patient denies sexual history, all adolescents presenting with certain risk factors or symptoms may warrant STI testing in a broader health assessment.
- However, in this scenario, the primary cluster of symptoms (poor grades, cutting class, bloodshot eyes, irritability) points more directly to substance abuse than to an STI.
*Blood culture*
- A **blood culture** is used to detect the presence of bacteria or other microorganisms in the bloodstream, indicating a systemic infection (sepsis).
- The patient's symptoms are not indicative of an acute bacterial bloodstream infection, and a blood culture would not be the initial test for the presented behavioral changes.
Cultural influences on development US Medical PG Question 3: 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
Cultural influences on development 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.
Cultural influences on development US Medical PG Question 4: 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
Cultural influences on 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.
Cultural influences on development US Medical PG Question 5: 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)
Cultural influences on development 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.
Cultural influences on development US Medical PG Question 6: 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
Cultural influences on 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.
Cultural influences on development US Medical PG Question 7: 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
Cultural influences on 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.
Cultural influences on development US Medical PG Question 8: A two-year-old female presents to the pediatrician with her mother for a routine well-child visit. Her mother is concerned that the patient is a picky eater and refuses to eat vegetables. She drinks milk with meals and has juice sparingly. She goes to sleep easily at night and usually sleeps for 11-12 hours. The patient has trouble falling asleep for naps but does nap for 1-2 hours a few times per week. She is doing well in daycare and enjoys parallel play with the other children. Her mother reports that she can walk down stairs with both feet on each step. She has a vocabulary of 10-25 words that she uses in the form of one-word commands. She is in the 42nd percentile for height and 48th percentile for weight, which is consistent with her growth curves. On physical exam, she appears well nourished. She can copy a line and throw a ball. She can follow the command to “give me the ball and then close the door.”
This child is meeting her developmental milestones in all but which of the following categories?
- A. Social and receptive language skills
- B. Fine motor skills
- C. This child is developmentally normal
- D. Gross motor skills
- E. Expressive language skills (Correct Answer)
Cultural influences on development Explanation: ***Expressive language skills***
- At two years old, a child should typically have an **expressive vocabulary of 50-200 words** and be putting **two-word sentences** together.
- This child's vocabulary of 10-25 words, used primarily as one-word commands, is significantly below the expected range for her age.
*Social and receptive language skills*
- The child is reported to be doing well in daycare and enjoys **parallel play**, which reflects appropriate **social development** for her age.
- Her ability to follow the two-step command "give me the ball and then close the door" demonstrates intact **receptive language skills**.
*This child is developmentally normal*
- While many areas of her development appear normal, her **expressive language skills** are clearly delayed, indicating that she is not entirely developmentally normal.
- Identifying specific areas of delay is crucial for early intervention.
*Gross motor skills*
- The child's ability to **walk down stairs with both feet on each step** is a normal gross motor milestone for a two-year-old.
- Other gross motor skills like running and kicking a ball are typically present, and there is no information to suggest a deficit.
*Fine motor skills*
- The ability to **copy a line** is an expected fine motor skill for a two-year-old.
- Throwing a ball also involves fine motor coordination and is within the expected range for this age.
Cultural influences on development US Medical PG Question 9: 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)
Cultural influences on development 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.
Cultural influences on development US Medical PG Question 10: 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
Cultural influences on development 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**.
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