Introduction of complementary foods US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Introduction of complementary foods. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Introduction of complementary foods US Medical PG Question 1: A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines. She does not walk yet but stands in place and can say a few words. The toddler drinks formula and eats a mixture of soft vegetables and pureed meals. She has no current medications. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/50 mm Hg, pulse 130/min, and respiratory rate 28/min. The patient is alert and responsive. The remainder of the exam is unremarkable. Which of the following is most appropriate for this patient at this visit?
- A. Meningococcal vaccine
- B. Gross motor workup and evaluation
- C. Rotavirus vaccine
- D. Referral for speech pathology
- E. MMR vaccine (Correct Answer)
Introduction of complementary foods Explanation: ***MMR vaccine***
- The **measles, mumps, and rubella (MMR) vaccine** is recommended for administration at **12-15 months of age**.
- This timing offers protection against these common childhood diseases, which is especially important for children attending **daycare**.
*Meningococcal vaccine*
- The routine **meningococcal vaccine (MenACWY)** is typically recommended for adolescents at **11-12 years of age**, with a booster at 16 years.
- While there are specific circumstances for earlier vaccination (e.g., high-risk conditions), it is **not routine** for a 12-month-old.
*Gross motor workup and evaluation*
- The patient's motor development, standing in place but not yet walking, is **within the normal range** for a 12-month-old.
- A definitive **gross motor workup** would generally be considered if there were more significant delays or regressions.
*Rotavirus vaccine*
- The **rotavirus vaccine** series is typically given at **2, 4, and 6 months of age**, with the final dose administered no later than **8 months of age**.
- A 12-month-old is **outside the recommended age range** for initiating or completing this vaccine series.
*Referral for speech pathology*
- Saying "a few words" at 12 months is **within the normal developmental milestone** for expressive language at this age.
- A referral for **speech pathology** would generally be indicated for more significant language delays.
Introduction of complementary foods US Medical PG Question 2: A 12-month-old boy presents for a routine checkup. The patient immigrated from the Philippines with his parents a few months ago. No prior immunization records are available. The patient’s mother claims that he had a series of shots at 6 months of age which gave him a severe allergic reaction with swelling of the tongue and the face. She also remembers that he had the same reaction when she introduced solid foods to his diet, including carrots, eggs, and bananas. Which of the following vaccinations are not recommended for this patient?
- A. Measles, mumps, and rubella (MMR) vaccine
- B. Hepatitis B vaccine
- C. Varicella vaccine
- D. Intranasal influenza vaccine
- E. Intramuscular influenza vaccine (Correct Answer)
Introduction of complementary foods Explanation: ***Important Note on Current Guidelines***
Based on **current CDC/ACIP guidelines (2023-2024)**, egg allergy alone is **no longer a contraindication** to influenza vaccines. However, this question tests knowledge of vaccine safety in the context of **severe anaphylaxis to a prior vaccination**.
***Intramuscular influenza vaccine***
- **Historically**, this was considered the most concerning option for patients with severe egg allergy, as many influenza vaccines were produced using egg-based culture methods
- **Current practice**: Per CDC guidelines, persons with egg allergy of any severity can receive any age-appropriate influenza vaccine, as egg protein content is minimal or absent in modern formulations
- However, if this patient had a **documented anaphylactic reaction to the influenza vaccine itself** (not just eggs), then it would be contraindicated
- Given the timing (6 months) and symptoms described, this represents the **historically correct answer**, though modern practice has evolved
*Measles, mumps, and rubella (MMR) vaccine*
- MMR vaccine is grown in **chick embryo fibroblast cells**, NOT in eggs, and contains **no egg protein**
- **Safe for patients with egg allergy** - no contraindication based on egg allergy
- Should be administered on schedule for catch-up immunization
*Hepatitis B vaccine*
- Produced using **recombinant DNA technology in yeast cells**
- Contains **no egg protein** and no animal-derived proteins
- **No contraindication** for this patient - safe to administer
*Varicella vaccine*
- Grown in **human diploid cell cultures**, NOT in eggs
- Contains **no egg protein**
- **Safe for patients with egg allergy** - no contraindication
- Should be administered as part of catch-up immunization
*Intranasal influenza vaccine (LAIV)*
- Like the intramuscular formulation, **current guidelines allow administration** to patients with egg allergy of any severity
- Contains similar or less egg protein than inactivated vaccines in modern formulations
- **Not contraindicated** based solely on egg allergy per current CDC guidelines
Introduction of complementary foods US Medical PG Question 3: An 11-month-old boy is brought to a pediatrician by his parents for evaluation of vomiting and watery diarrhea over the last day. The mother informs the pediatrician that the boy had consumed an apple bought from a fruit vendor on the previous day, but that otherwise there has been no recent change in his diet. There is no history of blood in the stool, flatulence, irritability, or poor appetite. There is no history of recurrent or chronic diarrhea or any other gastrointestinal symptoms. On physical examination, his temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 24/min, and blood pressure is 92/60 mm Hg. General examination reveals a playful infant with normal skin turgor and no sunken eyes. The pediatrician explains to the parents that he most likely has acute gastroenteritis and that no specific medication is indicated at present. He also instructs the parents about his diet during the illness and reviews the danger signs of dehydration. He suggests a follow-up evaluation after 48 hours or earlier if any complications arise. Which of the following dietary recommendations did the pediatrician make?
- A. Plenty of juices and carbonated sodas
- B. Age-appropriate diet (Correct Answer)
- C. Diluted formula milk
- D. Lactose-free diet
- E. BRAT diet
Introduction of complementary foods Explanation: ***Age-appropriate diet***
- For **mild acute gastroenteritis** without significant dehydration, the latest recommendations advise continuing **age-appropriate feeding** to support nutritional requirements and promote gut recovery.
- This approach helps to prevent malnutrition and does not prolong the course of diarrhea.
*Plenty of juices and carbonated sodas*
- **High sugar content** in juices and sodas can worsen diarrhea due to their **osmotic effect**, drawing more water into the intestine.
- These beverages also lack essential **electrolytes** needed for rehydration.
*Diluted formula milk*
- Diluting formula can lead to **insufficient caloric intake** and nutritional deficiencies, which is generally not recommended for mild gastroenteritis.
- Undiluted formula is usually well-tolerated, as most infants with acute gastroenteritis do not develop significant **lactose intolerance**.
*Lactose-free diet*
- Routine use of **lactose-free diets** is generally not recommended unless there is strong evidence of **secondary lactase deficiency**, which typically presents with increased flatulence, bloating, and worsening diarrhea.
- The majority of children with acute gastroenteritis can tolerate their usual milk intake.
*BRAT diet*
- The **B**ananas, **R**ice, **A**pplesauce, **T**oast (BRAT) diet is **nutritionally restrictive**, providing inadequate protein and fat, which can hinder recovery and growth in infants.
- Current guidelines no longer recommend the BRAT diet for acute gastroenteritis.
Introduction of complementary foods US Medical PG Question 4: A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is 90/min, respirations are 23/min, and oxygen saturation is 99% on room air. The child is in the corner stacking blocks. He does not look the physician in the eye nor answer your questions. He continually tries to return to the blocks and becomes very upset when you move the blocks back to their storage space. The parents state that the child has not begun to speak and often exhibits similar behaviors with toy blocks he has at home. On occasion, they have observed him biting his elbows. Which of the following is the best next step in management?
- A. Risperidone
- B. Restructuring of the home environment
- C. Fluoxetine
- D. Hearing exam
- E. Educating the parents about autism spectrum disorder (Correct Answer)
Introduction of complementary foods Explanation: ***Educating the parents about autism spectrum disorder***
- The child exhibits several **red flags for autism spectrum disorder (ASD)**, including **lack of eye contact, delayed speech, repetitive behaviors** (stacking blocks, becoming upset when routine is disrupted), and **self-injurious behavior** (biting elbows).
- Since this is the child's **first medical visit**, the parents are unaware of these concerns. The physician's first step should be to **educate the parents** about ASD to initiate further evaluation and early intervention.
- While a **formal diagnosis** requires more extensive evaluation (including developmental screening tools like M-CHAT-R and comprehensive assessment), educating the parents is crucial for obtaining their consent and cooperation for subsequent steps, which would include referral to a developmental specialist and early intervention services.
*Risperidone*
- **Risperidone** is an atypical antipsychotic medication sometimes used to manage severe **irritability** or **aggressiveness** in children with ASD, but it is not a first-line treatment for initial diagnosis or typical symptoms.
- Administering medication without a formal diagnosis, comprehensive behavioral management plan, and parental understanding is premature and inappropriate.
*Restructuring of the home environment*
- While **environmental modifications** can be beneficial for children with ASD, suggesting this as the first step without a clear diagnosis or parental understanding of specific needs is insufficient.
- The priority is to establish a diagnosis through proper evaluation and then tailor interventions, which may include home modifications in conjunction with other therapies like applied behavior analysis (ABA).
*Fluoxetine*
- **Fluoxetine** is a selective serotonin reuptake inhibitor (SSRI) used for anxiety, depression, and obsessive-compulsive disorder. It may be used in ASD to address **comorbid anxiety** or **repetitive behaviors**, but it is not a primary diagnostic tool or initial treatment.
- Like risperidone, prescribing medication without a proper diagnosis and understanding of the child's specific psychiatric needs is not the appropriate first step.
*Hearing exam*
- Although **hearing impairment** can cause **delayed speech** and affect social interaction, the child's other symptoms, such as **lack of eye contact, repetitive behaviors, and self-injurious actions**, are not typical of isolated hearing loss.
- While a hearing exam might be part of a comprehensive developmental workup later (as hearing and vision screening are standard in evaluating developmental delays), addressing the more pervasive signs suggestive of ASD takes precedence in the initial discussion with parents.
Introduction of complementary foods US Medical PG Question 5: A 3-month-old African American boy presents to his pediatrician’s office for his routine well visit. He was born full-term from an uncomplicated vaginal delivery. He is exclusively breastfeeding and not receiving any medications or supplements. Today, his parents report no issues or concerns with their child. He is lifting his head for brief periods and smiling. He has received only 2 hepatitis B vaccines. Which of the following is the correct advice for this patient’s parents?
- A. He should be sleeping more.
- B. He should have his serum lead level checked to screen for lead intoxication.
- C. He should start vitamin D supplementation. (Correct Answer)
- D. He should start rice cereal.
- E. He needs a 3rd hepatitis B vaccine.
Introduction of complementary foods Explanation: ***He should start vitamin D supplementation.***
- **Exclusively breastfed** infants, regardless of maternal vitamin D intake, require **vitamin D supplementation** due to insufficient amounts in breast milk.
- The recommended daily dose is **400 IU** starting from the first few days of life, to prevent **rickets** and promote bone health.
- **African American infants** have an additional risk factor due to increased skin melanin content, which reduces cutaneous vitamin D synthesis from sunlight exposure.
*He should be sleeping more.*
- A 3-month-old infant typically sleeps between **14-17 hours per day**, with **waking periods to feed** and interact.
- The case description does not indicate any concerns with the child's sleep patterns, and **developmental milestones** like lifting his head and smiling are being met.
*He should have his serum lead level checked to screen for lead intoxication.*
- **Lead screening** is not routinely recommended for all infants unless specific **risk factors** are present, such as living in an older home with lead paint, or having siblings with elevated lead levels.
- There are no reported risk factors for lead exposure in this patient's history.
*He should start rice cereal.*
- Introduction of solid foods, such as rice cereal, is typically recommended around **6 months of age**, when the infant shows signs of **developmental readiness**.
- These signs include **head control**, sitting with support, and showing interest in food.
*He needs a 3rd hepatitis B vaccine.*
- The **third dose of the hepatitis B vaccine** is typically administered between **6 and 18 months of age**.
- At 3 months old, the infant is not yet due for his third dose.
Introduction of complementary foods US Medical PG Question 6: During the selection of subjects for a study on infantile vitamin deficiencies, a child is examined by the lead investigator. She is at the 75th percentile for head circumference and the 80th percentile for length and weight. She can lift her chest and shoulders up when in a prone position, but cannot roll over from a prone position. Her eyes follow objects past the midline. She coos and makes gurgling sounds. When the investigator strokes the sole of her foot, her big toe curls upward and there is fanning of her other toes. She makes a stepping motion when she is held upright and her feet are in contact with the examination table. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
- A. Cries when separated from her mother
- B. Smiles at her mother (Correct Answer)
- C. Rolls over from her back
- D. Responds to calling of own name
- E. Reaches out for objects
Introduction of complementary foods Explanation: ***Smiles at her mother***
- The child exhibits developmental milestones consistent with a **2-month-old infant**, such as lifting her chest in a prone position, following objects past the midline, cooing, and gurgling. Social smiling typically emerges around **2 months of age**.
- Primitive reflexes like the **Babinski reflex** (big toe curling upward and fanning of other toes) and **stepping reflex** are normally present at this age, supporting the approximate age of 2 months.
*Cries when separated from her mother*
- This behavior suggests **separation anxiety**, which typically develops much later, usually around **8-9 months of age**.
- A 2-month-old infant does not yet have the cognitive understanding or object permanence needed to exhibit true separation anxiety.
*Rolls over from her back*
- Rolling over from the back to the stomach is usually achieved between **4 and 6 months of age**.
- The child in the vignette cannot even roll over from a prone position, indicating she is not yet at the age for rolling from her back.
*Responds to calling of own name*
- Responding to one's own name is a more advanced auditory and cognitive milestone, generally developing between **6 and 9 months of age**.
- At 2 months, infants respond to voices and sounds but do not associate specific words with themselves.
*Reaches out for objects*
- Purposeful reaching and grasping for objects (palmar grasp) typically develops around **4 to 6 months of age**.
- A 2-month-old infant may swat at objects reflexively but does not exhibit coordinated, intentional reaching.
Introduction of complementary foods US Medical PG Question 7: A 4-month-old girl is brought to the physician because she has been regurgitating and vomiting 10–15 minutes after feeding for the past 3 weeks. She is breastfed and formula-fed. She was born at 38 weeks' gestation and weighed 2966 g (6 lb 9 oz). She currently weighs 5878 g (12 lb 15 oz). She appears healthy. Vital signs are within normal limits. Examination shows a soft and nontender abdomen and no organomegaly. Which of the following is the most appropriate next best step in management?
- A. Upper endoscopy
- B. Ultrasound of the abdomen
- C. Esophageal pH monitoring
- D. Positioning therapy (Correct Answer)
- E. Pantoprazole therapy
Introduction of complementary foods Explanation: ***Positioning therapy***
- This infant is thriving, as evidenced by her significant weight gain, despite her regurgitation and vomiting. Her examination is also benign. These features make **gastroesophageal reflux (GER)**, a physiological process, the most likely diagnosis.
- **Positioning therapy** (e.g., keeping the infant upright during and after feeds) is a first-line, conservative management strategy for GER in infants who are otherwise healthy and gaining weight well.
*Upper endoscopy*
- **Upper endoscopy** is an invasive procedure and is typically reserved for evaluating patients with suspected complicated gastroesophageal reflux disease (GERD), such as those with **poor weight gain**, **hematemesis**, or **esophagitis**, none of which are seen here.
- It would not be the initial step in a thriving infant with symptoms consistent with uncomplicated GER.
*Ultrasound of the abdomen*
- An **abdominal ultrasound** is primarily used to diagnose **pyloric stenosis** in infants, which typically presents with **projectile, non-bilious vomiting** and **poor weight gain** or weight loss, usually between 3 and 6 weeks of age.
- This infant's symptoms are different in character (regurgitation/vomiting 10-15 minutes after feeding, not projectile) and she is gaining weight well, making pyloric stenosis less likely.
*Esophageal pH monitoring*
- **Esophageal pH monitoring** is used to quantify acid reflux episodes and is typically reserved for infants with atypical symptoms, suspected **complicated GERD**, or those who have failed empirical therapy.
- It is not indicated as a primary diagnostic or management step in a healthy, thriving infant with typical GER symptoms.
*Pantoprazole therapy*
- **Proton pump inhibitors (PPIs)** like pantoprazole are used to treat **GERD** by reducing stomach acid production, especially in cases with evidence of **esophagitis** or significant symptoms impacting growth or comfort.
- Given this infant is thriving and has no signs of complications, acid-suppressing medication is not appropriate as the initial management step; conservative measures should be tried first.
Introduction of complementary foods US Medical PG Question 8: A 6-month-old girl is brought to the physician for a well-child examination. She was born at 37 weeks' gestation. Pregnancy and the neonatal period were uncomplicated. The infant was exclusively breastfed and received vitamin D supplementation. She can sit unsupported and can transfer objects from one hand to the other. She babbles and is uncomfortable around strangers. She is at 40th percentile for length and at 35th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. In addition to continuing breastfeeding, which of the following is the most appropriate recommendation at this time?
- A. Continue vitamin D
- B. Introduce solid foods
- C. Introduce solid foods and add vitamin C
- D. Introduce solid foods and cow milk
- E. Introduce solid foods and continue vitamin D (Correct Answer)
Introduction of complementary foods Explanation: ***Introduce solid foods and continue vitamin D***
- At **6 months of age**, infants typically show developmental readiness for **solid foods**, such as the ability to sit unsupported and transfer objects, while **breastfeeding** continues to be important.
- **Vitamin D supplementation** should continue as it is crucial for bone health and is not adequately supplied by breast milk or early solid foods alone.
*Continue vitamin D*
- While vitamin D supplementation is important, this option **misses the crucial developmental milestone** of introducing solid foods at 6 months.
- At this age, infants' **iron stores** begin to dwindle, and solid foods are needed to provide essential nutrients not sufficiently met by breast milk alone.
*Introduce solid foods*
- This option correctly identifies the need to introduce solid foods but **fails to mention the continued importance of vitamin D supplementation**.
- Breastfed infants require continued **vitamin D supplementation** to prevent **rickets**, as breast milk does not contain sufficient amounts.
*Introduce solid foods and add vitamin C*
- While **vitamin C** is important, the primary focus at 6 months should be on **iron-rich solid foods** and continued **vitamin D supplementation**.
- Breast milk contains adequate vitamin C, and introducing diverse solid foods typically provides enough, making dedicated vitamin C supplementation usually unnecessary unless a deficiency is identified.
*Introduce solid food and cow milk*
- **Cow's milk** should **not be introduced** as a primary drink before **12 months of age** because it can cause **gastrointestinal bleeding**, **iron-deficiency anemia**, and is difficult for infants to digest.
- Introducing cow's milk too early can also interfere with the absorption of essential nutrients from breast milk or formula.
Introduction of complementary foods US Medical PG Question 9: A 19-year-old African female refugee has been granted asylum in Stockholm, Sweden and has been living there for the past month. She arrived in Sweden with her 2-month-old infant, whom she exclusively breast feeds. Which of the following deficiencies is the infant most likely to develop?
- A. Vitamin E
- B. Vitamin A
- C. Vitamin C
- D. Vitamin B1
- E. Vitamin D (Correct Answer)
Introduction of complementary foods Explanation: ***Vitamin D***
- The combination of exclusive breastfeeding, a 2-month-old infant, being of African heritage (darker skin), and living in a high-latitude region like Stockholm, Sweden, significantly increases the risk of **vitamin D deficiency**. Darker skin pigmentation reduces the efficiency of **cutaneous vitamin D synthesis** from sunlight, and insufficient sun exposure in northern latitudes further exacerbates this.
- Breast milk is a relatively poor source of **vitamin D**, and infants specifically require supplementation, especially when they have risk factors for deficiency such as being of African descent and living in an area with limited sunshine.
*Vitamin E*
- **Vitamin E deficiency** in infants is rare and typically seen in premature infants or those with severe malabsorption, neither of which is indicated in this scenario.
- While breast milk contains vitamin E, deficiency is not directly linked to geographic location, skin color, or a 2-month-old infant.
*Vitamin A*
- **Vitamin A deficiency** can be a concern in developing countries, but it is less likely to be the primary concern under these specific circumstances in a 2-month-old exclusively breastfed infant unless the mother herself is severely deficient.
- Breast milk usually provides adequate **vitamin A** if the mother's nutritional status is sufficient.
*Vitamin C*
- **Vitamin C deficiency** (scurvy) is rare in breastfed infants because breast milk typically contains adequate vitamin C if the mother has adequate dietary intake.
- Scurvy would be more likely in infants fed with improperly prepared formula or after 6 months if complementary foods lack vitamin C.
*Vitamin B1*
- **Vitamin B1 (thiamine) deficiency** is uncommon in exclusively breastfed infants in developed countries.
- It is often associated with maternal malnutrition in endemic areas or specific genetic disorders, which are not suggested here.
Introduction of complementary foods US Medical PG Question 10: A 4-week-old infant is brought to the physician by his mother because of blood-tinged stools for 3 days. He has also been passing whitish mucoid strings with the stools during this period. He was delivered at 38 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. He was monitored in the intensive care unit for a day prior to being discharged. His 6-year-old brother was treated for viral gastroenteritis one week ago. The patient is exclusively breastfed. He is at the 50th percentile for height and 60th percentile for weight. He appears healthy and active. His vital signs are within normal limits. Examination shows a soft and nontender abdomen. The liver is palpated just below the right costal margin. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. A complete blood count and serum concentrations of electrolytes and creatinine are within the reference range. Which of the following is the most appropriate next step in management?
- A. Perform stool antigen immunoassay
- B. Perform an air enema on the infant
- C. Assess for IgA (anti‑)tissue transglutaminase antibodies (tTG)
- D. Stop breastfeeding and switch to soy-based formula
- E. Continue breastfeeding and advise mother to avoid dairy and soy products (Correct Answer)
Introduction of complementary foods Explanation: ***Continue breastfeeding and advise mother to avoid dairy and soy products***
- The infant's symptoms of **blood-tinged stools** and **mucoid strings**, along with a positive occult blood test, in an otherwise healthy, exclusively breastfed infant point towards **food protein-induced proctocolitis (FPIAP)**.
- The most common triggers for FPIAP are **cow's milk protein** and **soy protein** from the maternal diet transmitted through breast milk. The initial management involves the mother eliminating these proteins from her diet.
*Perform stool antigen immunoassay*
- This test is used to detect specific viral, bacterial, or parasitic antigens in stool, often for conditions like **rotavirus, giardiasis, or C. difficile**.
- The infant's clinical presentation with **no fever, vomiting, or diarrhea**, and an otherwise healthy appearance, makes an infectious cause less likely compared to FPIAP.
*Perform an air enema on the infant*
- An air enema is primarily a diagnostic and therapeutic intervention for **intussusception**, a condition where one segment of the intestine telescopes into another.
- Intussusception typically presents with sudden onset of severe, colicky abdominal pain, **"currant jelly" stools**, and often a palpable abdominal mass, none of which are described in this infant.
*Assess for IgA (anti‑)tissue transglutaminase antibodies (tTG)*
- This test is used to screen for **celiac disease**, an autoimmune disorder triggered by gluten consumption.
- Celiac disease typically presents after the introduction of **gluten-containing foods** into the diet, usually around 6-12 months of age, and is characterized by malabsorption symptoms like diarrhea, weight loss, and failure to thrive, which are absent here.
*Stop breastfeeding and switch to soy-based formula*
- Stopping breastfeeding is generally **not recommended** as breast milk provides numerous benefits.
- Switching to a **soy-based formula** may not resolve the issue, as many infants with cow's milk protein allergy also have a **soy protein allergy**. The preferred approach is to eliminate allergens from the maternal diet while continuing breastfeeding.
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