Denver Developmental Screening Test US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Denver Developmental Screening Test. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Denver Developmental Screening Test 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
Denver Developmental Screening Test 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.
Denver Developmental Screening Test US Medical PG Question 2: A 12-month-old boy is brought to the physician for a well-child examination. He was born at 38 weeks' gestation and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hand held and can throw a small ball. He can pick up an object between his thumb and index finger. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to play with a stranger alone. Physical examination shows no abnormalities. Which of the following is most likely delayed in this child?
- A. Fine motor skills
- B. Language skills
- C. Growth (Correct Answer)
- D. Gross motor skills
- E. Social skills
Denver Developmental Screening Test Explanation: ***Growth***
- At 1 year of age, a child's **birth weight should triple**, and their **birth length should increase by 50%**.
- This child's birth weight was 3061 g (6 lb 12 oz), meaning his expected weight at 1 year should be around **9183 g (20 lb 4 oz)**, but he only weighs **7910 g (17 lb 7 oz)**, indicating **inadequate weight gain** (~1273 g below expected).
- This child's birth length was 48 cm (19 in), meaning his expected length at 1 year should be around **72 cm (28 in)**, but he is only **60 cm (24 in)**, indicating **poor linear growth** (12 cm below expected).
- Both **weight-for-age and length-for-age are delayed**, making growth the most likely delayed parameter.
*Fine motor skills*
- The child can **pick up an object between his thumb and index finger**, demonstrating a **pincer grasp**, which is an appropriate fine motor skill for a 12-month-old.
- He can also **throw a small ball**, further indicating age-appropriate fine motor development.
*Language skills*
- The child can say **'mama', 'dada'**, and **'uh-oh'**, which are appropriate first words for a 12-month-old.
- He also **waves 'bye-bye'**, showing appropriate receptive and expressive communication.
*Gross motor skills*
- The child can **walk with one hand held**, which is an expected gross motor milestone for a 12-month-old.
- Many 12-month-olds are just beginning to cruise or take their first independent steps.
*Social skills*
- The child **waves 'bye-bye'** and **cries if left with a stranger alone**, which are age-appropriate demonstrations of **social interaction** and **stranger anxiety**, respectively, for a 12-month-old.
- These behaviors indicate typical social and emotional development.
Denver Developmental Screening Test US Medical PG Question 3: A 35-year-old woman gravida 2, para 1, comes to the physician for her first prenatal visit. Pregnancy and delivery of her first child were uncomplicated. She is not sure about the date of her last menstrual period. Pelvic examination shows a uterus consistent in size with a 10-week gestation. An ultrasound examination confirms the gestational age and shows one fetus with no indication of multiple gestations. During counseling on pregnancy risks and possible screening and diagnostic tests, the patient states she would like to undergo screening for Down syndrome. She would prefer immediate and secure screening with a low risk to herself and the fetus. Which of the following is the most appropriate next step in management at this time?
- A. Nuchal translucency, pregnancy-associated plasma protein-A, human chorionic gonadotropin
- B. Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A
- C. Chorionic villus sampling
- D. Amniocentesis
- E. Cell-free fetal DNA testing (Correct Answer)
Denver Developmental Screening Test Explanation: ***Cell-free fetal DNA testing***
- This is the most appropriate choice given the patient's desire for **immediate and secure screening with low risk** because it is a **non-invasive prenatal screening (NIPS)** method offering high sensitivity and specificity for Down syndrome, particularly in higher-risk pregnancies.
- It involves a simple maternal blood draw and can be performed as early as **10 weeks of gestation**, perfectly aligning with the patient's current gestational age and desire for early screening.
*Nuchal translucency, pregnancy-associated plasma protein-A, human chorionic gonadotropin*
- This combination represents the **first-trimester combined screen**, which is typically performed between 11 and 14 weeks of gestation. While suitable for early screening, **cell-free DNA testing offers higher detection rates and lower false-positive rates** for Down syndrome.
- The patient specifically asked for the most **secure and least risky** screening, and NIPS outperforms the combined screen in terms of diagnostic accuracy for aneuploidies.
*Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A*
- This refers to the **quad screen**, which is typically performed in the **second trimester (15-20 weeks)**, making it too late for the patient's desire for immediate screening at 10 weeks gestational age.
- While a widely used screening tool, the quad screen has a **lower detection rate** for Down syndrome compared to cell-free DNA testing.
*Chorionic villus sampling*
- **Chorionic villus sampling (CVS)** is a **diagnostic, invasive procedure** that carries a small risk of miscarriage (approximately 1 in 455 or 0.22%) and is not a screening test.
- Although it can be performed earlier (typically between 10 and 13 weeks), the patient specifically requested a **low-risk screening** option, which CVS is not.
*Amniocentesis*
- **Amniocentesis** is also an **invasive diagnostic procedure** with a risk of miscarriage (approximately 1 in 900 or 0.11%) and is typically performed in the **second trimester (15-20 weeks)**.
- This option is unsuitable because the patient is at 10 weeks gestation and desires **immediate and low-risk screening**, not a diagnostic procedure with procedural risks a few weeks later.
Denver Developmental Screening Test US Medical PG Question 4: A student health coordinator plans on leading a campus-wide HIV screening program that will be free for the entire undergraduate student body. The goal is to capture as many correct HIV diagnoses as possible with the fewest false positives. The coordinator consults with the hospital to see which tests are available to use for this program. Test A has a sensitivity of 0.92 and a specificity of 0.99. Test B has a sensitivity of 0.95 and a specificity of 0.96. Test C has a sensitivity of 0.98 and a specificity of 0.93. Which of the following testing schemes should the coordinator pursue?
- A. Test A on the entire student body followed by Test B on those who are positive
- B. Test A on the entire student body followed by Test C on those who are positive
- C. Test C on the entire student body followed by Test B on those who are positive
- D. Test C on the entire student body followed by Test A on those who are positive (Correct Answer)
- E. Test B on the entire student body followed by Test A on those who are positive
Denver Developmental Screening Test Explanation: ***Test C on the entire student body followed by Test A on those who are positive***
- To "capture as many correct HIV diagnoses as possible" (maximize true positives), the initial screening test should have the **highest sensitivity**. Test C has the highest sensitivity (0.98).
- To "capture as few false positives as possible" (maximize true negatives and confirm diagnoses), the confirmatory test should have the **highest specificity**. Test A has the highest specificity (0.99).
*Test A on the entire student body followed by Test B on those who are positive*
- Starting with Test A (sensitivity 0.92) would miss more true positive cases than starting with Test C (sensitivity 0.98), failing the goal of **capturing as many cases as possible**.
- Following with Test B (specificity 0.96) would result in more false positives than following with Test A (specificity 0.99).
*Test A on the entire student body followed by Test C on those who are positive*
- This scheme would miss many true positive cases initially due to Test A's lower sensitivity compared to Test C.
- Following with Test C would introduce more false positives than necessary, as it has a lower specificity (0.93) than Test A (0.99).
*Test C on the entire student body followed by Test B on those who are positive*
- While Test C is a good initial screen for its high sensitivity, following it with Test B (specificity 0.96) is less optimal than Test A (specificity 0.99) for minimizing false positives in the confirmation step.
- This combination would therefore yield more false positives in the confirmatory stage than using Test A.
*Test B on the entire student body followed by Test A on those who are positive*
- Test B has a sensitivity of 0.95, which is lower than Test C's sensitivity of 0.98, meaning it would miss more true positive cases at the initial screening stage.
- While Test A provides excellent specificity for confirmation, the initial screening step is suboptimal for the goal of capturing as many diagnoses as possible.
Denver Developmental Screening Test US Medical PG Question 5: A 4-year-old boy is brought to a pediatrician by his parents for a consultation after his teacher complained about his inability to focus or make friends at school. They mention that the boy does not interact well with others at home, school, or daycare. On physical examination, his vital signs are stable with normal weight, height, and head circumference for his age and sex. His general examination and neurologic examination are completely normal. A recent audiological evaluation shows normal hearing, and intellectual disability has been ruled out by a clinical psychologist. Which of the following investigations is indicated as part of his diagnostic evaluation at present?
- A. Magnetic resonance imaging (MRI) of brain
- B. Electroencephalography
- C. No further testing is needed
- D. Positron Emission Tomography (PET) scanning of head
- E. Autism spectrum disorder screening and developmental assessment (Correct Answer)
Denver Developmental Screening Test Explanation: ***Autism spectrum disorder screening and developmental assessment***
- The clinical presentation (inability to focus, difficulty making friends, poor social interaction across multiple settings) is **highly suggestive of Autism Spectrum Disorder (ASD)**.
- After ruling out **hearing impairment and intellectual disability**, the next appropriate step is **formal ASD screening using validated tools** such as the **Modified Checklist for Autism in Toddlers (M-CHAT)**, **Autism Diagnostic Observation Schedule (ADOS)**, or **Autism Diagnostic Interview-Revised (ADI-R)**.
- According to **AAP guidelines**, when developmental concerns suggestive of ASD are identified, formal screening and comprehensive developmental assessment are **essential components of the diagnostic evaluation**.
- ASD diagnosis is primarily **clinical**, based on standardized screening tools and developmental assessments, not neuroimaging or electrophysiological studies.
*No further testing is needed*
- This is **incorrect** because the patient has not yet undergone **formal ASD-specific screening and developmental assessment**.
- While hearing and intellectual disability have been ruled out, **diagnostic confirmation of ASD** requires structured evaluation using validated assessment tools.
- Simply observing symptoms without formal screening is inadequate for establishing an ASD diagnosis.
*Magnetic resonance imaging (MRI) of brain*
- Brain MRI is **not routinely indicated** for ASD diagnosis as it typically shows **normal findings** in children with ASD.
- Neuroimaging is reserved for cases with **focal neurological signs, regression, or atypical features** suggesting structural abnormalities.
- This patient has a **normal neurological examination**, making MRI unnecessary.
*Electroencephalography*
- EEG is indicated only when there is suspicion of **seizure disorder** or other specific neurological conditions.
- The patient has a **normal neurological examination** with no seizure-like symptoms, making EEG unnecessary at this stage.
*Positron Emission Tomography (PET) scanning of head*
- PET scans are **not part of routine ASD diagnostic workup** and are typically used in research settings or for evaluating specific metabolic or neoplastic conditions.
- The **radiation exposure and invasiveness** make PET scanning inappropriate for initial diagnostic evaluation in a child with developmental concerns.
Denver Developmental Screening Test US Medical PG Question 6: 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
Denver Developmental Screening Test 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.
Denver Developmental Screening Test US Medical PG Question 7: A home drug screening test kit is currently being developed. The cut-off level is initially set at 4 mg/uL, which is associated with a sensitivity of 92% and a specificity of 97%. How might the sensitivity and specificity of the test change if the cut-off level is changed to 2 mg/uL?
- A. Sensitivity = 92%, specificity = 97%
- B. Sensitivity = 95%, specificity = 98%
- C. Sensitivity = 100%, specificity = 97%
- D. Sensitivity = 90%, specificity = 99%
- E. Sensitivity = 97%, specificity = 96% (Correct Answer)
Denver Developmental Screening Test Explanation: ***Sensitivity = 97%, specificity = 96%***
- Lowering the cut-off from 4 mg/uL to 2 mg/uL means that more individuals will be classified as **positive** (anyone with drug levels ≥2 mg/uL instead of ≥4 mg/uL). This change will **increase the sensitivity** (capturing more true positives, fewer false negatives) but **decrease the specificity** (more false positives among those without the condition).
- Therefore, sensitivity will increase (e.g., to 97%), and specificity will decrease (e.g., to 96%), reflecting the fundamental trade-off between these metrics.
*Sensitivity = 92%, specificity = 97%*
- This option reflects the **original values** at the 4 mg/uL cut-off and does not account for the change in the threshold.
- A change in the cut-off level will inherently alter the test's performance characteristics.
*Sensitivity = 95%, specificity = 98%*
- This option suggests an increase in **both sensitivity and specificity**, which is generally not possible by simply changing the cut-off level in the same direction.
- There is typically an **inverse relationship** between sensitivity and specificity when adjusting the cut-off threshold.
*Sensitivity = 100%, specificity = 97%*
- Reaching **100% sensitivity** while maintaining a high specificity is highly unlikely with a simple cut-off adjustment.
- While sensitivity would increase with a lower cut-off, achieving perfect sensitivity is unrealistic in clinical practice.
*Sensitivity = 90%, specificity = 99%*
- This option suggests a **decrease in sensitivity** and an **increase in specificity**.
- A lower cut-off would lead to more positive results, thus increasing sensitivity and reducing specificity, which contradicts the proposed values.
Denver Developmental Screening Test US Medical PG Question 8: 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
Denver Developmental Screening Test 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.
Denver Developmental Screening Test US Medical PG Question 9: 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)
Denver Developmental Screening Test 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.
Denver Developmental Screening Test 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
Denver Developmental Screening Test 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.
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