Early intervention services US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Early intervention services. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Early intervention services US Medical PG Question 1: A 6-month-old male infant is brought to a pediatrician by his guardian for scheduled immunizations. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The infant is generally healthy; however, the guardian is concerned about multiple patches of bluish discolorations on the skin overlying the lower back and sacrum. A review of medical records indicates that these patches have been present since birth. On further review the child was placed into protective services due to neglect and abuse by his biological family. On physical examination, his vital signs are normal. The pediatrician notes the presence of multiple blue-brown patches over the lumbosacral region, buttocks, and back. These patches are soft and nontender on palpation. Which of the following is the best next step in management of the infant?
- A. Radiographic skeletal survey
- B. Skin biopsy
- C. Reassurance (Correct Answer)
- D. Inform child protective services
- E. Topical hydrocortisone cream
Early intervention services Explanation: ***Reassurance***
- The blue-brown patches are most consistent with **Mongolian spots (congenital dermal melanocytosis)**, which are benign, flat, and typically resolve spontaneously. The presence since birth, characteristic location (lumbosacral region, buttocks), and non-tender nature are classic findings.
- Given the features, the infant's health, and appropriate development, **reassurance** to the guardian is the best next step, as no medical intervention or further diagnostic work-up is usually needed for these benign lesions.
*Radiographic skeletal survey*
- A **radiographic skeletal survey** is indicated when there are concerns for **child abuse** (e.g., fractures, periosteal reactions) or certain genetic conditions, especially when cutaneous findings are atypical or suggest a syndrome.
- In this case, the skin lesions are characteristic of benign Mongolian spots, and there are no other signs of abuse (e.g., pain, swelling, ecchymoses) or developmental delays that would warrant a skeletal survey.
*Skin biopsy*
- A **skin biopsy** is typically performed to definitively diagnose skin conditions when the clinical presentation is atypical, when there's concern for malignancy, or when inflammatory conditions need differentiation.
- Mongolian spots have a characteristic appearance that usually does not require a biopsy for diagnosis; it would be an **unnecessary invasive procedure** for a benign condition.
*Inform child protective services*
- **Child protective services (CPS)** should be informed if there is a **reasonable suspicion of child abuse or neglect**. While the child is currently in protective services due to a prior history, the current skin findings are benign Mongolian spots and do not themselves indicate new abuse.
- Informing CPS again based solely on these benign birthmarks would be inappropriate and potentially burdensome without additional signs of harm.
*Topical hydrocortisone cream*
- **Topical hydrocortisone cream** is a low-potency corticosteroid used to treat inflammatory skin conditions like eczema or dermatitis, reducing redness, itching, and swelling.
- Mongolian spots are **pigmentary lesions**, not inflammatory. Therefore, corticosteroids would be ineffective and unnecessary for their treatment.
Early intervention services US Medical PG Question 2: A 5-year-old child is brought to the emergency department after being hit by a motor vehicle on the way to school. According to paramedics, the child's right leg was severely crushed in the accident. After evaluation, the physician recommends immediate limb-saving surgery to preserve the leg and prevent complications. However, the parents refuse to consent to the surgery. They explain that they heard about a similar case where a child died after limb-saving surgery, and they believe the procedure might lead to amputation or death. Despite the physician's explanation that the surgery is intended to save the limb, the parents remain adamant in their refusal. What is the next best step?
- A. Contact the next of kin
- B. Ask for a court order
- C. Take into account the child’s wishes
- D. Take the parents' wishes into account
- E. Inform the hospital Ethics Committee, state authority, and child protective services, and obtain a court order to proceed with treatment (Correct Answer)
Early intervention services Explanation: ***Inform the hospital Ethics Committee, state authority, and child protective services, and obtain a court order to proceed with treatment***
- When parents refuse **life-saving or limb-saving treatment** for a child, and the medical team believes the treatment is in the child's best interest, the case becomes a legal and ethical concern requiring immediate institutional and legal intervention.
- The appropriate response involves **multiple parallel actions**: contacting the hospital **Ethics Committee** for guidance, notifying **Child Protective Services (CPS)** for suspected medical neglect, and seeking a **court order** to authorize treatment.
- This comprehensive approach protects the child's welfare while respecting legal procedures. **Medical neglect** constitutes a form of child abuse, and the state has parens patriae authority to protect minor citizens when parents' decisions threaten serious harm.
- In true life-threatening emergencies where delay would cause death or serious harm, physicians may proceed under emergency doctrine, but for urgent situations allowing time for legal process, a court order should be obtained.
*Contact the next of kin*
- While contacting other family members might provide support or alternative perspectives, it does not address the immediate legal and ethical obligations when parents refuse medically necessary care.
- The parents are the legal guardians, and their refusal necessitates formal institutional and legal intervention rather than informal family consultation.
*Ask for a court order*
- While obtaining a **court order** is essential when parental consent is refused for necessary treatment, this option alone is incomplete.
- The most appropriate immediate response involves the **comprehensive institutional approach**: simultaneously engaging the Ethics Committee for guidance, notifying CPS for child protection, and initiating the legal process for court authorization.
- This multi-pronged approach ensures all stakeholders are involved and the child's interests are protected through proper channels.
*Take into account the child's wishes*
- A 5-year-old child lacks the **developmental capacity and legal standing** for informed consent regarding complex medical procedures.
- While assent from older minors (typically 7+ years) may be considered for less critical decisions, a 5-year-old's wishes regarding limb-saving surgery are not determinative.
- The focus must remain on the child's **best medical interest** as determined by medical professionals and legal frameworks, not the child's limited understanding at this developmental stage.
*Take the parents' wishes into account*
- While parental autonomy in medical decision-making is generally respected, this principle has limits when parental decisions would result in **significant harm, neglect, or death** to the child.
- When parents refuse **medically indicated, life-saving, or limb-saving treatment**, their decision can and should be legally challenged through appropriate institutional and judicial channels to protect the child's welfare.
- The state's interest in protecting children overrides parental preferences when those preferences threaten serious harm.
Early intervention services 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
Early intervention services 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.
Early intervention services US Medical PG Question 4: A 4-year-old boy is brought to the physician because of non-fluent speech. His mother worries that his vocabulary is limited for his age and because he cannot use simple sentences to communicate. She says he enjoys playing with his peers and parents, but he has always lagged behind in his speaking and communication. His speech is frequently not understood by strangers. He physically appears normal. His height and weight are within the normal range for his age. He responds to his name, makes eye contact, and enjoys the company of his mother. Which of the following is the most appropriate next step in management?
- A. Referral to speech therapist
- B. Evaluate response to methylphenidate
- C. Psychiatric evaluation
- D. Audiology testing (Correct Answer)
- E. Thyroid-stimulating hormone
Early intervention services Explanation: ***Audiology testing***
- Before initiating any therapy for speech delay, it is crucial to rule out **hearing impairment**, as **undiagnosed hearing loss** is the most common organic cause of speech and language difficulties in children.
- **Standard practice guidelines** (AAP) recommend hearing assessment as the **first diagnostic step** in evaluating any child with speech or language delay.
- While other developmental aspects seem intact, the inability to use simple sentences at age 4 and speech that is "frequently not understood by strangers" strongly suggests the need to assess the child's ability to **receive auditory information**.
*Referral to speech therapist*
- While a **speech therapist referral** is highly appropriate for a child with significant speech delay, it should typically follow an assessment to rule out underlying organic causes like **hearing loss**.
- Without addressing potential hearing impairment, speech therapy may be less effective or miss the root cause of the communication difficulty.
*Evaluate response to methylphenidate*
- **Methylphenidate** is a stimulant medication used primarily for **attention-deficit/hyperactivity disorder (ADHD)**.
- There is no indication of ADHD symptoms in this child (e.g., inattention, hyperactivity, impulsivity), and it is not a treatment for **primary speech delay**.
*Psychiatric evaluation*
- The child's ability to respond to his name, make eye contact, and enjoy social interaction with family and peers makes a **primary psychiatric disorder** (like autism spectrum disorder) less likely to be the sole cause of the speech delay.
- Such an evaluation would typically be considered if **social communication deficits**, repetitive behaviors, or restricted interests were prominent.
*Thyroid-stimulating hormone*
- **Hypothyroidism** can cause developmental delays, including speech delay.
- However, the child's normal physical appearance, height, and weight make **congenital or acquired hypothyroidism** less likely to be the primary cause of his isolated speech delay.
Early intervention services US Medical PG Question 5: 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
Early intervention services 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.
Early intervention services US Medical PG Question 6: 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
Early intervention services 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.
Early intervention services US Medical PG Question 7: A 26-year-old G1P0 female who is 39 weeks pregnant presents to the emergency department in labor. She reports following her primary care physician’s recommendations throughout her pregnancy and has not had any complications. During delivery, the baby’s head turtled back into the vaginal canal and did not advance any further. The neonatal intensivist was called for shoulder dystocia and a baby girl was able to be delivered vaginally 6 minutes later. Upon initial assessment, the baby appeared pale throughout, had her arms and legs flexed without active motion, and had some flexion of extremities when stimulated. Her pulse is 120/min and had irregular respirations. What is this baby’s initial APGAR score?
- A. 5 (Correct Answer)
- B. 6
- C. 7
- D. 4
- E. 3
Early intervention services Explanation: ***5***
- The APGAR score is calculated based on five criteria: **Appearance**, **Pulse**, **Grimace**, **Activity**, and **Respiration**.
- This baby's score is calculated as follows: **Appearance** (pale all over) = 0, **Pulse** (120/min) = 2, **Grimace** (some flexion of extremities with stimulation) = 1, **Activity** (arms and legs flexed without active motion) = 1, and **Respiration** (irregular) = 1.
- Total score: 0 + 2 + 1 + 1 + 1 = **5 points**
- A score of 5 indicates **moderate neonatal compromise** requiring close monitoring and possible intervention.
*4*
- A score of 4 would indicate more severe compromise, such as absent respirations (0 points) rather than irregular respirations (1 point).
- This baby has irregular respirations present, which earns 1 point, not 0 points.
*6*
- A score of 6 would require improvement in at least one category, such as **acrocyanosis** (blue extremities but pink body = 1 point for appearance) instead of pallor throughout.
- This baby's complete pallor limits the score to 5.
*7*
- A score of 7 or higher is generally considered reassuring and indicates a **healthy transition** from intrauterine to extrauterine life.
- This baby's concerning signs, including **complete pallor**, **irregular respirations**, and **poor muscle tone**, are inconsistent with a score of 7.
*3*
- A score of 3 would indicate severe depression with findings such as **heart rate less than 100 bpm**, completely absent reflexes, or flaccid muscle tone.
- This baby has a reassuring pulse of 120/min (2 points), some reflex response (1 point), and some muscle tone (1 point), making the total score higher than 3.
Early intervention services US Medical PG Question 8: A 1-minute-old newborn is being examined by the pediatric nurse. The nurse auscultates the heart and determines that the heart rate is 89/min. The respirations are spontaneous and regular. The chest and abdomen are both pink while the tips of the fingers and toes are blue. When the newborn’s foot is slapped the face grimaces and he cries loud and strong. When the arms are extended by the nurse they flex back quickly. What is this patient’s Apgar score?
- A. 5
- B. 10
- C. 8 (Correct Answer)
- D. 6
- E. 9
Early intervention services Explanation: ***8***
- The Apgar score is calculated by assigning 0, 1, or 2 points to five criteria: **Appearance**, **Pulse**, **Grimace (reflex irritability)**, **Activity (muscle tone)**, and **Respiration**.
- This newborn scores 1 point for **Appearance** (pink body, blue extremities/acrocyanosis), 1 point for **Pulse** (89/min, which is below 100), 2 points for **Grimace** (cries loud and strong), 2 points for **Activity** (arms flex back quickly), and 2 points for **Respiration** (spontaneous and regular), totaling **8**.
*5*
- An Apgar score of 5 would indicate a more compromised state, with lower scores in multiple categories.
- This newborn demonstrates strong respiratory effort, vigorous cry, and active muscle tone, all inconsistent with a score of 5.
*10*
- A perfect score of 10 is rare and would require the newborn to have a **pink appearance throughout** (including extremities), a heart rate over 100 bpm, strong cry, active movement, and vigorous breathing.
- This newborn has two findings preventing a score of 10: **acrocyanosis** (blue extremities) and **heart rate of 89/min** (below 100).
*6*
- An Apgar score of 6 would imply more significant compromise, such as weak respiratory effort, minimal response to stimulation, or poor muscle tone.
- This newborn's strong cry, vigorous grimace response, and quick flexion indicate better performance than a score of 6.
*9*
- A score of 9 would mean only one parameter scores 1 point, with all others scoring 2 points.
- This newborn has **two parameters scoring 1 point**: **Appearance** (acrocyanosis) and **Pulse** (89/min, below 100), making the maximum possible score 8, not 9.
Early intervention services 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)
Early intervention services 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.
Early intervention services 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
Early intervention services 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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