Language development US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Language development. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Language development US Medical PG Question 1: A 6-month-old boy is brought to the physician for a well-child examination. The boy was born at term, and the pregnancy was complicated by prolonged labor. There is no family history of any serious illnesses. He can sit upright but needs help to do so and cannot roll over from the prone to the supine position. He can grasp his rattle and can transfer it from one hand to the other. He babbles. He cries if anyone apart from his parents holds him or plays with him. He touches his own reflection in the mirror. Vital signs are within normal limits. He is at the 40th percentile for head circumference, 30th percentile for length, and 40th percentile for weight. Physical examination reveals no abnormalities. Which of the following developmental milestones is delayed in this infant?
- A. Gross motor (Correct Answer)
- B. Fine motor
- C. Social
- D. Language
- E. Cognitive
Language development Explanation: ***Gross motor***
- The infant can sit upright with help but **cannot roll over** from prone to supine, which is typically achieved by 4-5 months.
- While he can pull himself to stand (an advanced skill for his age), the inability to roll over indicates a delay in fundamental **gross motor development**.
*Fine motor*
- The infant can grasp his rattle and **transfer it from one hand to the other**, which is an appropriate fine motor skill for a 6-month-old.
- This demonstrates adequate **hand-eye coordination** and manipulation abilities.
*Social*
- The infant **cries if anyone apart from his parents holds or plays with him**, indicating **stranger anxiety**, which is a normal social development milestone for this age.
- This shows appropriate attachment and social discrimination.
*Language*
- The infant **babbles**, which is a typical language milestone for a 6-month-old, indicating early vocalization and speech development.
- This suggests that his pre-linguistic skills are emerging as expected.
*Cognitive*
- The infant **touches his own reflection in the mirror**, which is a normal cognitive behavior for a 6-month-old, showing an interest in faces and self-recognition (even if not full understanding).
- This also encompasses the ability to transfer objects, demonstrating **object permanence** and problem-solving skills.
Language development US Medical PG Question 2: A 4-year-old boy is brought to the physician by his parents because of concerns about his behavior during the past year. His parents report that he often fails to answer when they call him and has regular unprovoked episodes of crying and screaming. At kindergarten, he can follow and participate in group activities, but does not follow his teacher's instructions when these are given to him directly. He is otherwise cheerful and maintains eye contact when spoken to but does not respond when engaged in play. He gets along well with friends and family. He started walking at the age of 11 months and can speak in two-to-three-word phrases. He often mispronounces words. Which of the following is the most likely diagnosis?
- A. Selective mutism
- B. Hearing impairment (Correct Answer)
- C. Conduct disorder
- D. Specific-learning disorder
- E. Autistic spectrum disorder
Language development Explanation: ***Hearing impairment***
- The child's inconsistent response to being called, failure to follow direct instructions, and unprovoked crying and screaming, despite maintaining eye contact and having normal social interactions, are all suggestive of a **hearing impairment**.
- His delayed and unusual speech patterns (two-to-three-word phrases, mispronouncing words) for his age further points to **auditory processing difficulties** due to hearing loss.
*Selective mutism*
- This condition involves a consistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations. The child's issue is with comprehending and responding to speech, not with speaking itself.
- The behavior observed (not responding to calls or direct instructions) is more indicative of an inability to hear rather than a choice not to speak.
*Conduct disorder*
- Conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others and major societal norms appropriate for the individual's age.
- The child's symptoms do not include aggression, destruction of property, deceitfulness, or serious rule violations and he gets along well with friends and family.
*Specific-learning disorder*
- A specific learning disorder involves difficulties with academic skills, despite normal intelligence. While he has speech difficulties, he can participate in group activities, and there is no information about his academic performance.
- The primary concern here is his inability to respond to auditory input, which precedes and likely causes any potential learning difficulties rather than being a learning disorder itself.
*Autistic spectrum disorder*
- Autism spectrum disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities.
- This child maintains eye contact, is cheerful, gets along well with friends and family, and can participate in group activities, which argues against significant **social communication deficits** typical of autism.
Language development US Medical PG Question 3: 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
Language development 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.
Language development US Medical PG Question 4: A 2-month-old is brought to the physician for a well-child examination. She was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. She weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, she appears well. Her pulse is 136/min, the respirations are 41/min, and the blood pressure is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?
- A. Reaches for objects
- B. Stares at own hand
- C. Smiles in response to face (Correct Answer)
- D. Absence of asymmetric tonic neck reflex
- E. Monosyllabic babble
Language development Explanation: ***Smiles in response to face***
- A 2-month-old infant typically achieves **social smiling**, often in response to a parent's face, indicating social engagement and developing emotional recognition.
- This milestone is an expected part of **normal social and emotional development** at this age.
*Reaches for objects*
- **Reaching for objects** is a more complex motor skill, generally expected around **4 to 6 months of age**, as fine motor control and hand-eye coordination develop.
- At 2 months, an infant may briefly swipe at objects but usually lacks the coordinated effort to intentionally reach and grasp.
*Stares at own hand*
- **Staring at one's own hand** is an early sign of self-discovery and visual exploration, typically emerging closer to **3 to 4 months of age** as vision matures.
- While a 2-month-old infant can focus on objects, sustained fascination with their own hands usually develops later.
*Absence of asymmetric tonic neck reflex*
- The **asymmetric tonic neck reflex (ATNR)**, or 'fencing reflex', is a primitive reflex normally present at 2 months of age and typically **disappears around 4 to 6 months**.
- Its presence is normal at 2 months, and its absence would be an abnormal finding, not a developmental milestone.
*Monosyllabic babble*
- **Monosyllabic babbling**, such as "ba" or "da", indicates developing language skills and typically begins around **6 to 9 months of age**.
- At 2 months, infants usually produce cooing sounds and simple vocalizations, but not structured babbling.
Language development US Medical PG Question 5: A 2-year-old girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age?
- A. Hops on one foot
- B. Engages in role-playing
- C. Separates easily from parents
- D. Pedals a tricycle
- E. Builds a tower of 6 cubes (Correct Answer)
Language development Explanation: ***Builds a tower of 6 cubes***
- At 2 years old, children typically develop fine motor skills enabling them to stack **6 to 7 cubes** to build a tower, demonstrating good hand-eye coordination.
- This milestone aligns well with the described cognitive development, such as following multi-step commands and early language acquisition.
*Hops on one foot*
- **Hopping on one foot** is a gross motor skill usually achieved later, typically around **4 years of age**.
- A 2-year-old child is more likely to be developing skills like running, jumping with two feet, or walking up and down stairs.
*Engages in role-playing*
- While toddlers engage in **imitative play**, true imaginative **role-playing** with complex scenarios and multiple characters typically develops later, around **3 years of age or older**.
- At 2, play is often more focused on mimicking observed actions.
*Separates easily from parents*
- At 2 years old, many children are still experiencing **separation anxiety**, especially in unfamiliar situations.
- **Easy separation** from parents is a milestone typically achieved later as children develop more independence and social confidence, often closer to 3 or 4 years of age.
*Pedals a tricycle*
- **Pedaling a tricycle** requires coordinated gross motor skills, balance, and cognitive understanding that are typically developed around **3 years of age**.
- A 2-year-old may be able to sit on a tricycle and push with their feet, but not yet pedal efficiently.
Language development US Medical PG Question 6: 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)
Language development 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.
Language development US Medical PG Question 7: 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
Language development Explanation: ***Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normal***
- **Fine motor** is normal because she demonstrates **pincer grasp** (picking up objects between thumb and index finger), which is the key fine motor milestone expected by 9-12 months. The inability to drink from a cup or self-feed with a spoon represents more complex feeding skills that develop later (12-18 months) and are not primary fine motor milestones at 13 months.
- **Gross motor** is delayed because she cannot pull herself to stand, a milestone typically achieved by 9-12 months. At 13 months, she should be cruising along furniture or beginning to walk independently.
- **Language** is delayed because she only coos "ma" and "ba" without meaningful words. By 13 months, children should typically say 1-2 words with meaning (like "mama" or "dada" used specifically) and have varied babbling patterns.
- **Social skills** are normal as she responds to her name, engages in play (willing to play with a ball), and demonstrates appropriate **separation anxiety** when her parents are not in the room—all expected social-emotional milestones for this age.
*Fine motor: normal | Gross motor: delayed | Language: normal | Social skills: delayed*
- Language is delayed, not normal—cooing "ma" and "ba" without meaningful words does not meet the expected milestone of 1-2 words with meaning by 13 months.
- Social skills are normal, not delayed—responding to her name and showing separation anxiety are appropriate for her age.
*Fine motor: delayed | Gross motor: normal | Language: delayed | Social skills: normal*
- Fine motor is normal, not delayed—the presence of **pincer grasp** is the key indicator, and feeding difficulties reflect more complex coordination rather than delayed fine motor development.
- Gross motor is delayed, not normal—inability to pull to stand at 13 months represents a significant delay.
*Fine motor: delayed | Gross motor: delayed | Language: normal | Social skills: normal*
- Fine motor is normal—**pincer grasp** is present and appropriate for age.
- Language is delayed, not normal—she lacks meaningful words expected at 13 months.
*Fine motor: delayed | Gross motor: normal | Language: normal | Social skills: delayed*
- Fine motor is normal—**pincer grasp** is the key milestone and is present.
- Gross motor is delayed, not normal—cannot pull to stand, which should have been achieved months earlier.
- Social skills are normal, not delayed—separation anxiety and responding to name are age-appropriate behaviors.
Language development US Medical PG Question 8: 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
Language development 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.
Language development US Medical PG Question 9: 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
Language development 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.
Language development US Medical PG Question 10: 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
Language development Explanation: ***Language delay***
- At 1 year of age, a child should typically be babbling with **specific sounds** and attempting to say their **first words**.
- The child's non-specific babbling suggests a delay in typical **expressive language development**.
*Fine motor skill delay*
- The child is able to pick up cereal using **two fingers**, indicating the development of a **pincer grasp**.
- This is an **age-appropriate fine motor skill** for a 1-year-old.
*Inadequate growth*
- The child has over **tripled his birth weight** (from 6 lbs, 9 oz to 22 lbs) and more than doubled his birth length (from 18 to 30 inches), which are **normal growth patterns** for the first year of life.
- While weight values can be plotted on growth charts, the provided information strongly suggests **adequate growth**.
*Gross motor skill delay*
- The child is taking **several steps independently**, which is an **age-appropriate gross motor milestone** for a 1-year-old.
- Many children take their first independent steps between 9 and 15 months.
*There are no developmental concerns*
- While many milestones are met, the **non-specific babbling** at 1 year strongly suggests a **language delay**.
- It is crucial to identify and address any potential delays early for intervention.
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