Fine motor milestones US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Fine motor milestones. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Fine motor milestones US Medical PG Question 1: A 4-month-old boy is brought to the physician for a well-child examination. He was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. He weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, he appears well. His pulse is 146/min, the respirations are 39/min, and the blood pressure is 78/44 mm Hg. He weighs 7.5 kg (16 lb 9 oz) and measures 65 cm (25.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?
- A. Sits with support of pelvis
- B. Grasps small objects between thumb and finger
- C. Transfers objects from hand to hand
- D. Intentionally rolls over (Correct Answer)
- E. Bounces actively when held in standing position
Fine motor milestones 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.
Fine motor milestones US Medical PG Question 2: 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
Fine motor milestones 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.
Fine motor milestones 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
Fine motor milestones 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.
Fine motor milestones US Medical PG Question 4: A 3-year-old girl is brought to the physician for a well-child examination. She was born at term and has been healthy since. She can climb up and down the stairs and can pedal a tricycle. She has difficulty using a spoon to feed herself but can copy a line. She speaks in 2- to 3-word sentences that can be understood by most people. She is selfish while playing with children her age and throws tantrums quite often. She cannot put on her own shoes and socks. She does not tolerate separation from her parents. She is at 60th percentile for height and weight. Physical examination including neurologic examination reveals no abnormalities. Which of the following is the most appropriate assessment of her development?
- A. Fine motor: Normal | Gross motor: Normal | Language: Delayed | Social skills: Delayed
- B. Fine motor: Delayed | Gross motor: Delayed | Language: Normal | Social skills: Normal
- C. Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed (Correct Answer)
- D. Fine motor: Normal | Gross motor: Delayed | Language: Normal | Social skills: Delayed
- E. Fine motor: Normal | Gross motor: Delayed | Language: Delayed | Social skills: Normal
Fine motor milestones 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.
Fine motor milestones US Medical PG Question 5: A 3-year-old boy is brought for general developmental evaluation. According to his parents he is playing alongside other children but not in a cooperative manner. He has also recently begun to ride a tricycle. Upon questioning you also find that he is toilet trained and can stack 9 blocks. Upon examination you find that he can copy a circle though he cannot yet copy a triangle or draw stick figures. In addition he is currently speaking in two word phrases but cannot yet use simple sentences. Based on these findings you tell the parents that their child's development is consistent with which of the following?
- A. Normal social, normal motor, delayed language (Correct Answer)
- B. Normal social, delayed motor, delayed language
- C. Delayed social, normal motor, delayed language
- D. Delayed social, normal motor, normal language
- E. Normal social, normal motor, normal language
Fine motor milestones 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.
Fine motor milestones US Medical PG Question 6: 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
Fine motor milestones 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**.
Fine motor milestones US Medical PG Question 7: 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
Fine motor milestones 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.
Fine motor milestones US Medical PG Question 8: An 8-year-old boy is brought to the physician by his parents because of repeated episodes of “daydreaming.” The mother reports that during these episodes the boy interrupts his current activity and just “stares into space.” She says that he sometimes also smacks his lips. The episodes typically last 1–2 minutes. Over the past 2 months, they have occurred 2–3 times per week. The episodes initially only occurred at school, but last week the patient had one while he was playing baseball with his father. When his father tried to talk to him, he did not seem to listen. After the episode, he was confused for 10 minutes and too tired to play. The patient has been healthy except for an episode of otitis media 1 year ago that was treated with amoxicillin. Vital signs are within normal limits. Physical and neurological examinations show no other abnormalities. Further evaluation of this patient is most likely to show which of the following findings?
- A. Temporal lobe spikes on EEG (Correct Answer)
- B. Defiant behavior towards figures of authority
- C. Conductive hearing loss on audiometry
- D. Impairment in communication and social interaction
- E. Normal neurodevelopment
Fine motor milestones Explanation: ***Temporal lobe spikes on EEG***
- The description of staring spells, lip smacking, post-ictal confusion, and the duration of 1-2 minutes are highly suggestive of **temporal lobe epilepsy**, specifically **focal seizures with impaired awareness**.
- **EEG** is the gold standard for diagnosing epilepsy and would likely show characteristic **epileptiform discharges** or spikes originating from the temporal lobe.
*Defiant behavior towards figures of authority*
- This symptom is suggestive of oppositional defiant disorder or conduct disorder, which are **behavioral disorders** and not typically associated with the described seizure activity.
- While a child with epilepsy might experience behavioral changes, isolated defiant behavior is not the primary expected finding for the described episodes.
*Conductive hearing loss on audiometry*
- Conductive hearing loss is a result of problems in the outer or middle ear and would be suggested by a history of **recurrent otitis media** or other ear pathology.
- Although the patient had otitis media previously, his current symptoms of "daydreaming" and lip smacking are neurological, not indicative of hearing impairment.
*Impairment in communication and social interaction*
- This constellation of symptoms, along with repetitive behaviors, is characteristic of **autism spectrum disorder**.
- The described episodes are acute, paroxysmal events with a distinct post-ictal phase, making a developmental disorder less likely to be the primary finding for these specific occurrences.
*Normal neurodevelopment*
- While the patient's past medical history is otherwise unremarkable, the presence of these "daydreaming" or staring spells with associated motor phenomena (lip smacking) and post-ictal confusion indicates an **abnormal neurological event** (seizure).
- Therefore, further evaluation would likely reveal an underlying neurological abnormality rather than completely normal neurodevelopment.
Fine motor milestones US Medical PG Question 9: 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
Fine motor milestones 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.
Fine motor milestones US Medical PG Question 10: A 3-year-old boy is brought to the office by his mother because of a large head contusion and altered mental status. At first, the mother says her son got injured when a “pot fell from a shelf onto his head.” Later, she changes the story and says that he hit his head after “tripping over a football.” Physical examination shows cracks in the suture lines of the skull, and there is a flattened appearance to the bone. The patient’s father arrives to inquire on how his son is “recovering from his fall down the stairs.” Upon request to interview the patient alone, the parents refuse, complaining loudly about the request. Which of the following is the most likely diagnosis in this patient?
- A. Rickets
- B. Cranioschisis
- C. Osteogenesis imperfecta
- D. Child abuse (Correct Answer)
- E. Paget disease of bone
Fine motor milestones Explanation: ***Child abuse***
- The multiple, **inconsistent histories** of injury provided by both parents, ranging from a falling pot to tripping over a football and falling down stairs, are a major red flag for **non-accidental trauma**.
- The physical findings of **cracks in the suture lines** and a **flattened skull bone**, combined with **altered mental status**, are concerning for severe head injury. The parents' refusal to allow a private interview further raises suspicion of child abuse.
*Rickets*
- **Rickets** is characterized by defective bone mineralization leading to soft and weakened bones, often presenting as bowed legs or delayed fontanelle closure.
- It does not typically present with acute **skull cracks** or a flattened skull due to trauma, nor does it involve inconsistent histories of injury which points away from child abuse.
*Cranioschisis*
- **Cranioschisis** is a severe congenital anomaly where the skull fails to close completely, leading to extrusion of brain tissue.
- This condition is a **birth defect** apparent at or shortly after birth and is not an acquired injury in a 3-year-old child due to trauma.
*Osteogenesis imperfecta*
- **Osteogenesis imperfecta** (brittle bone disease) is a genetic disorder causing fragile bones that fracture easily. While this condition might involve bone fragility, there would be a **pattern of recurrent fractures** and often other features like blue sclera.
- However, the inconsistencies in the parents' stories and the specific skull findings are more indicative of physical trauma rather than an underlying genetic condition.
*Paget disease of bone*
- **Paget disease of bone** is a chronic disorder of abnormal bone remodeling, typically affecting older adults, causing localized areas of enlarged and weakened bone.
- It is extremely **rare in children** and would not present with acute traumatic skull fractures or inconsistent injury narratives.
More Fine motor milestones US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
