Delayed milestones evaluation US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Delayed milestones evaluation. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Delayed milestones evaluation 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
Delayed milestones evaluation 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.
Delayed milestones evaluation US Medical PG Question 2: 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
Delayed milestones evaluation 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.
Delayed milestones evaluation US Medical PG Question 3: During subject selection for an infant neurological development study, a child is examined by the primary investigator. She is at the 80th percentile for length and weight. She has started crawling. She looks for dropped objects. She says mama and dada non-specifically. She can perform the pincer grasp. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
- A. Pulls up to stand (Correct Answer)
- B. Says at least 1 word clearly
- C. Turns pages in a book
- D. Points to 3 body parts
- E. Engages in pretend play
Delayed milestones evaluation Explanation: ***Pulls up to stand***
- The child is reported to be crawling, performing a **pincer grasp**, and babbling "mama" and "dada" non-specifically, which suggests an age of **8-10 months**. Pulling to stand is a typical motor milestone expected around **9-11 months of age**.
- This milestone aligns with the gross motor development progressing from crawling to standing with support before independent walking.
*Says at least 1 word clearly*
- While "mama" and "dada" are spoken non-specifically, a child typically starts saying their **first meaningful word** around **12 months of age**.
- The described child's language development is consistent with an age where babbling is prominent, but specific, meaningful words are still developing.
*Turns pages in a book*
- This fine motor skill, especially turning multiple pages independently, is usually achieved around **12-18 months of age**, requiring more advanced dexterity than a pincer grasp alone.
- The child described is likely younger, based on other developmental markers like non-specific "mama/dada."
*Points to 3 body parts*
- Pointing to body parts on command indicates a higher level of receptive language and cognitive understanding, a skill typically emerging around **15-18 months of age**.
- The current language skills are more indicative of a younger infant who does not yet demonstrate this level of comprehension.
*Engages in pretend play*
- Engaging in **pretend play**, such as feeding a doll or talking on a toy phone, is a cognitive and social milestone typically observed in toddlers, starting around **18-24 months of age**.
- The behaviors described in the question indicate an earlier developmental stage, preceding symbolic play.
Delayed milestones evaluation US Medical PG Question 4: A 15-month-old boy is brought to the pediatrician’s office by his mother due to abnormal muscle tone and an inability to walk. He was able to control his head at 5 months of age, roll at 8 months of age, sit at 11 months of age, and develop hand preference at 13 months of age. On physical exam, he is observed to asymmetrically crawl. He has a velocity-dependent increase in tone and 3+ biceps and patellar reflexes. His startle, asymmetric tonic neck, and Babinski reflexes are present. Which of the following is the most common risk factor for developing this patient’s clinical presentation?
- A. Intrauterine growth restriction
- B. Prematurity (Correct Answer)
- C. Perinatal hypoxic injury
- D. Multiparity
- E. Stroke
Delayed milestones evaluation Explanation: ***Prematurity***
- **Cerebral palsy (CP)** is characterized by **delayed motor milestones**, **abnormal muscle tone (spasticity)**, **hyperreflexia**, and **persistent primitive reflexes** beyond the expected age.
- **Prematurity** (especially birth before 32 weeks' gestation) is the **most common risk factor** for CP overall, accounting for approximately 40-50% of cases.
- The developing brain of premature infants is particularly vulnerable to periventricular leukomalacia (PVL) and intraventricular hemorrhage (IVH), which can lead to various CP subtypes.
- While this patient's **early hand preference** and **asymmetric crawling** suggest hemiplegic CP (often associated with stroke), the question asks for the most common risk factor **epidemiologically**, not the most likely cause in this specific case.
*Intrauterine growth restriction*
- While **IUGR** can be associated with developmental delays and is a risk factor for CP, it is less common than prematurity as the primary risk factor.
- IUGR alone without complications (like prematurity or hypoxia) accounts for a smaller proportion of CP cases.
*Perinatal hypoxic injury*
- **Perinatal hypoxic-ischemic encephalopathy (HIE)** can cause CP, especially severe cases resulting in basal ganglia or watershed area damage.
- However, with modern obstetric monitoring and intervention, severe perinatal hypoxia accounts for only ~10% of CP cases—less common than prematurity.
*Multiparity*
- **Multiparity** (having multiple previous births) is generally not considered a direct or common risk factor for cerebral palsy.
- Any slight associations are typically due to confounding factors like increased risk of preterm birth in subsequent pregnancies, rather than multiparity itself.
*Stroke*
- **Perinatal stroke** can cause CP, typically presenting as **hemiplegic CP** with early hand preference and asymmetric motor findings—features seen in this patient.
- While stroke is a significant cause of hemiplegic CP specifically, it accounts for a smaller proportion of overall CP cases compared to prematurity, which causes various CP subtypes and is more prevalent.
Delayed milestones evaluation US Medical PG Question 5: 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
Delayed milestones evaluation 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.
Delayed milestones evaluation US Medical PG Question 6: A 3-year-old boy is brought to his pediatrician by his parents for a follow-up visit. Several concerning traits were observed at his last physical, 6 months ago. He had developmental delay, a delay in meeting gross and fine motor control benchmarks, and repetitive behaviors. At birth, he was noted to have flat feet, poor muscle tone, an elongated face with large, prominent ears, and enlarged testicles. He takes a chewable multivitamin every morning. There is one other member of the family, on the mother’s side, with a similar condition. Today, his blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0°C (98.6°F). On physical exam, the boy repetitively rocks back and forth and has difficulty following commands. His heart has a mid-systolic click, followed by a late systolic murmur and his lungs are clear to auscultation bilaterally. Several vials of whole blood are collected for analysis. Which of the following studies should be conducted as part of the diagnostic screening protocol?
- A. Northern blot with RNA probes
- B. Two-dimensional gel electrophoresis
- C. Southern blot with DNA probes (Correct Answer)
- D. Western blot
- E. PCR followed by northern blot with RNA probes
Delayed milestones evaluation Explanation: ***Southern blot with DNA probes***
- The patient's presentation with developmental delay, repetitive behaviors, flat feet, hypotonia, elongated face, prominent ears, and macroorchidism (*enlarged testicles*) is highly suggestive of **Fragile X syndrome**.
- **Fragile X syndrome** is caused by an abnormal expansion of a **CGG trinucleotide repeat** in the *FMR1* gene on the X chromosome, which leads to hypermethylation and silencing of the gene. **Southern blot analysis with DNA probes** is the gold standard for detecting these expansions, as it can measure the size of the *CGG* repeat and the methylation status of the gene.
*Northern blot with RNA probes*
- **Northern blot analysis** is used to detect and quantify specific **RNA molecules**.
- While the *FMR1* gene's mRNA expression is affected in Fragile X syndrome, northern blot is not the primary diagnostic test for detecting the underlying **DNA repeat expansion** and methylation.
*Two-dimensional gel electrophoresis*
- **Two-dimensional gel electrophoresis** is a technique used to separate **proteins** based on their **isoelectric point** and then by **molecular weight**.
- This method is used for proteomic studies and is not relevant for diagnosing a genetic disorder caused by a DNA repeat expansion.
*Western blot*
- **Western blot analysis** is used to detect specific **proteins** in a sample.
- In Fragile X syndrome, the *FMR1* gene product, **FMRP (Fragile X Mental Retardation Protein)**, is absent or reduced, which could be theoretically detected by Western blot. However, the definitive diagnosis relies on identifying the genetic mutation (CGG expansion and methylation) in the DNA, for which Southern blot is superior.
*PCR followed by northern blot with RNA probes*
- **PCR (Polymerase Chain Reaction)** is used to amplify specific **DNA sequences**. While *PCR* can detect smaller *CGG* expansions, it often fails to accurately size the full mutations found in Fragile X syndrome due to the large repeat numbers.
- Combining *PCR* with **northern blot (RNA detection)** would still not be the primary diagnostic approach for the DNA-based *CGG* repeat expansion and methylation status, which is essential for diagnosing Fragile X.
Delayed milestones evaluation US Medical PG Question 7: A male child is presented at the pediatric clinic for a well-child visit by his mother who reports previously normal developmental milestones. The child was born at 40 weeks with no complications during pregnancy or birth. The mother notes that the infant is able to sit without support. He is able to feed himself crackers and pureed food. He is constantly shaking his toy teddy bear but is able to stop when the mother says 'no'. Which of the following indicate the most likely language milestone the child presents with?
- A. Two-word combinations
- B. Saying words such as apple and cat, though limited to around 4 different words
- C. Able to say his first and last name
- D. Cooing
- E. Babbling (Correct Answer)
Delayed milestones evaluation Explanation: ***Babbling***
- The developmental milestones described (sitting without support, feeding himself, responding to "no") are consistent with an infant around **6-9 months of age**.
- **Babbling** (e.g., "bababa", "dadada") is the primary language milestone expected at this age, as infants begin to experiment with sounds.
*Two-word combinations*
- This milestone typically emerges around **18-24 months of age**, when infants start to combine words like "more milk" or "mama up."
- The child's overall developmental stage, especially his motor skills, suggests he is significantly younger than the age at which two-word combinations are expected.
*Saying words such as apple and cat, though limited to around 4 different words*
- Saying a few distinct words usually occurs around **12-18 months of age**, after a period of extensive babbling.
- The child's other milestones place him in an earlier developmental period.
*Able to say his first and last name*
- Knowing and saying one's first and last name is a more advanced language and cognitive skill, typically seen in children around **2-3 years of age**.
- This milestone is far beyond the developmental stage indicated by the child's motor and social skills.
*Cooing*
- **Cooing**, characterized by vowel sounds like "ooh" and "aah," is an early vocalization skill typically observed in infants aged **2-4 months**.
- The child's ability to sit unsupported, feed himself, and respond to commands indicates a more advanced developmental stage than cooing.
Delayed milestones evaluation US Medical PG Question 8: A mother brings her infant for a regular well-child check-up with the pediatrician. During the routine developmental examination, the physician notes that the child is looking at him with his head lifted upwards when he is about to pick up the child from the table. At what age is it common to begin to observe this finding in a child, assuming that the child is developmentally normal?
- A. 2 months
- B. 6 months
- C. 12 months
- D. 9 months
- E. 4 months (Correct Answer)
Delayed milestones evaluation Explanation: ***4 months***
- By **4 months of age**, infants typically develop good **head control** and can hold their head steady while looking around, including when being picked up.
- This signifies strengthening neck muscles and improved coordination, allowing them to **lift their head against gravity** to maintain eye contact with an approaching person.
*2 months*
- At **2 months**, infants can lift their head briefly while on their tummy but generally have limited and **unsteady head control** when pulled to a sitting position or lifted.
- They are unlikely to consistently hold their head up in anticipation of being picked up.
*6 months*
- By **6 months**, infants have excellent head control and can often **sit with support**, and even briefly without it.
- While they can certainly lift their head, this milestone is usually observed earlier, around 4 months.
*12 months*
- At **12 months**, infants are typically **pulling to stand** and cruising, with fully developed head control.
- Observing this specific behavior at 12 months would indicate a significant delay in gross motor development.
*9 months*
- By **9 months**, infants are often crawling, pulling themselves to stand, and have very strong head and neck muscles.
- This developmental stage is well past the initial acquisition of head control needed for the described action.
Delayed milestones evaluation US Medical PG Question 9: A six-year-old male presents to the pediatrician for a well child visit. The patient’s parents report that they are struggling to manage his temper tantrums, which happen as frequently as several times per day. They usually occur in the morning before school and during mealtimes, when his parents try to limit how much he eats. The patient often returns for second or third helpings at meals and snacks throughout the day. The patient’s parents have begun limiting the patient’s food intake because he has been gaining weight. They also report that the patient recently began first grade but still struggles with counting objects and naming letters consistently. The patient sat without support at 11 months of age and walked at 17 months of age. He is in the 99th percentile for weight and 5th percentile for height. On physical exam, he has almond-shaped eyes and a downturned mouth. He has poor muscle tone.
Which of the following additional findings would most likely be seen in this patient?
- A. Webbed neck
- B. Macroorchidism
- C. Ataxia
- D. Hemihyperplasia
- E. Hypogonadism (Correct Answer)
Delayed milestones evaluation Explanation: ***Hypogonadism***
- The patient's presentation, including **hyperphagia**, **obesity**, developmental delay, and distinctive facial features (almond-shaped eyes, downturned mouth, poor muscle tone), is highly suggestive of **Prader-Willi Syndrome**.
- **Hypogonadism** (undescended testes in males, delayed puberty) is a classic feature of **Prader-Willi Syndrome** due to hypothalamic dysfunction, which also causes the voracious appetite.
*Webbed neck*
- A **webbed neck** is characteristic of **Turner Syndrome** (45, XO), which affects females and is associated with short stature, but not typically with the hyperphagia and obesity seen here.
- The patient is a male, making Turner Syndrome an unlikely diagnosis.
*Macroorchidism*
- **Macroorchidism** (enlarged testes) is a hallmark feature of **Fragile X Syndrome**, which is associated with intellectual disability and developmental delays.
- While fragile X syndrome involves developmental delay, it does not typically present with the extreme hyperphagia, obesity, and specific facial features described in the patient.
*Ataxia*
- **Ataxia** (lack of voluntary coordination of muscle movements) in conjunction with developmental delays can be seen in various neurological disorders such as **Friedreich's ataxia** or **cerebral palsy**.
- This symptom is not a primary or characteristic finding in Prader-Willi Syndrome, and the other described features point away from ataxia as the most likely additional finding.
*Hemihyperplasia*
- **Hemihyperplasia** (overgrowth of one side of the body) is associated with conditions like **Beckwith-Wiedemann Syndrome**, which also involves macroglossia and an increased risk of tumors.
- This finding is not typically associated with the constellation of symptoms (hyperphagia, obesity, intellectual disability, hypotonia) seen in Prader-Willi Syndrome.
Delayed milestones evaluation US Medical PG Question 10: A 3-year-old boy is brought to the physician for evaluation of developmental delay. He could sit alone at 12 months and started walking with support at the age of 2 years. He can name only very few familiar objects and uses simple two-word sentences. He cannot stack more than 2 blocks. His parents report that he does not like playing with other children. He is at the 80th percentile for head circumference, 85th percentile for height, and 50th percentile for weight. He has a long and narrow face as well as large protruding ears. His thumbs can be passively flexed to the ipsilateral forearm. This patient is at increased risk of developing which of the following conditions?
- A. Mitral regurgitation (Correct Answer)
- B. Type 2 diabetes mellitus
- C. Acute myeloid leukemia
- D. Aortic dissection
- E. Hyperuricemia
Delayed milestones evaluation Explanation: ***Mitral regurgitation***
- The patient's presentation with **developmental delay**, **relatively large head circumference** (80th percentile), **long narrow face**, **large protruding ears**, and **hyperextensible joints** (thumbs to forearm) is highly suggestive of **fragile X syndrome**.
- **Mitral valve prolapse** leading to **mitral regurgitation** is a common cardiac manifestation of fragile X syndrome, occurring in **50-80% of adult males** with the condition, due to **connective tissue dysplasia**.
*Type 2 diabetes mellitus*
- This condition is primarily associated with **obesity**, **insulin resistance**, and genetic predispositions unrelated to the features presented in this patient.
- While fragile X patients may have general health concerns, there is **no specific increased risk** of developing type 2 diabetes mellitus directly linked to the syndrome's pathology.
*Acute myeloid leukemia*
- There is **no established association** between fragile X syndrome and an increased risk of developing **acute myeloid leukemia**.
- AML is a **hematologic malignancy** with different risk factors, such as exposure to certain chemicals or prior chemotherapy.
*Aortic dissection*
- Aortic dissection is typically associated with conditions affecting **connective tissue** like **Marfan syndrome** or **Ehlers-Danlos syndrome**, or with **hypertension**.
- While fragile X syndrome involves connective tissue abnormalities, **aortic dissection is not a typical or significantly increased risk** compared to other connective tissue disorders.
*Hyperuricemia*
- **Hyperuricemia** is most commonly associated with conditions like **gout**, **kidney disease**, or certain **genetic metabolic disorders** (e.g., Lesch-Nyhan syndrome).
- There is **no direct link** between fragile X syndrome and an increased risk of hyperuricemia.
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