Developmental Surveillance and Screening — MCQs
In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-
A child is suspected of having an autistic disorder. All areTRUE about autism, EXCEPT:
A 6 years old child with development delay, can ride a tricycle, can climb upstairs with alternate feet, but downstairs with 2 feet per step, can tell his name, knows his own sex, but cannot narrate a story. What is his development age?
A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
Screening for nephropathy in prepubertal children with type 1 DM should be initiated after how many years of disease onset?
18 weeks pregnant female presents with no high risk of NTD and low risk of trisomy 21 on quad test. What is the most appropriate next step in management?
Microcephaly is seen in
A 5-year-old child is assessed to have a developmental age of one year. What is his developmental quotient?
CAGE questionnaire is used in:
Child starts speaking short sentences by the age of :
Developmental Surveillance and Screening Indian Medical PG Practice Questions and MCQs
Question 1: In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-
- A. Disturbances of intellectual development
- B. Disturbance of social interaction
- C. Disturbances of communication (Correct Answer)
- D. Restricted, repetitive patterns of behaviour
Explanation: ***Disturbances of communication*** - In DSM-5 and proposed ICD-11, **communication deficits** are now subsumed under the broader category of **social communication deficits**. - This change reflects the understanding that communication difficulties in ASD are primarily related to their social function rather than being a separate, general communication disorder. *Disturbances of intellectual development* - While many individuals with ASD also have **intellectual disabilities**, this has never been a core diagnostic criterion for autism itself. - **Intellectual development** is considered a co-occurring condition rather than a defining feature of the spectrum. *Disturbance of social interaction* - **Deficits in social interaction** remain a core diagnostic criterion for autism spectrum disorder in both DSM-5 and ICD-11. - This domain emphasizes difficulties with **social-emotional reciprocity**, nonverbal communicative behaviors, and developing social relationships. *Restricted, repetitive patterns of behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** also remain a core diagnostic criterion in both diagnostic systems. - This includes a range of symptoms such as **stereotyped motor movements**, insistence on sameness, and highly restricted fixated interests.
Question 2: A child is suspected of having an autistic disorder. All areTRUE about autism, EXCEPT:
- A. Repetitive behavior is seen
- B. Language is not well developed
- C. Child is able to interact (Correct Answer)
- D. Symptoms appear between 18-24 months
Explanation: ***Child is able to interact*** - Autism Spectrum Disorder (ASD) is characterized by **persistent deficits in social communication and social interaction**. - Children with autism typically have difficulty with **social reciprocity**, such as initiating or responding to social interactions, and often show limited interest in interacting with peers. - This statement is **FALSE** about autism, making it the correct answer to this EXCEPT question. *Repetitive behavior is seen* - **Restricted, repetitive patterns of behavior, interests, or activities** are a core diagnostic criterion for ASD. - This can manifest as **stereotyped or repetitive motor movements**, use of objects, or speech, as well as insistence on sameness or highly restricted, fixed interests. *Language is not well developed* - Many individuals with ASD experience **delays or difficulties in language development**, ranging from a complete lack of spoken language to difficulties with conversational skills and understanding nuances of speech. - While some may develop advanced vocabulary, their **pragmatic language skills** (social use of language) are often impaired. *Symptoms appear between 18-24 months* - Symptoms of ASD often become noticeable between **12 and 24 months** of age, though this can vary. - Early signs can sometimes be observed before 12 months, and in some cases, symptoms may not become clear until **social demands exceed limited capacities** in later childhood. - The typical age of symptom recognition is indeed in this developmental period.
Question 3: A 6 years old child with development delay, can ride a tricycle, can climb upstairs with alternate feet, but downstairs with 2 feet per step, can tell his name, knows his own sex, but cannot narrate a story. What is his development age?
- A. 5 years
- B. 4 years
- C. 2 years
- D. 3 years (Correct Answer)
Explanation: ***3 years*** - The child can **ride a tricycle**, a hallmark motor skill typically achieved around **3 years of age**. - **Climbing stairs with alternate feet going up but 2 feet per step coming down** is the classic stair-climbing pattern for a 3-year-old. - Knowing their **name** and **sex** are cognitive and language milestones usually reached by **3 years**. - While story-telling emerges around 3 years, it's variable—some 3-year-olds tell simple stories while others don't yet. The **preponderance of clear 3-year milestones** (especially motor skills) establishes this as the developmental age. *5 years* - A 5-year-old child would typically be able to **narrate a story** with a clear beginning, middle, and end, which this child cannot do. - They can usually **skip**, **hop on one foot**, and **ride a bicycle with training wheels**—more advanced motor skills than demonstrated here. *4 years* - A 4-year-old child should be able to **hop on one foot**, **throw ball overhand**, and **narrate simple stories**, which this child cannot fully demonstrate. - They typically **go down stairs with alternate feet**, not 2 feet per step as described. *2 years* - A 2-year-old child typically **walks and runs well**, but cannot **ride a tricycle** or **climb stairs with alternate feet** consistently. - Their language skills are more limited, usually consisting of **two-to-three-word phrases**, rather than knowing their full name and sex.
Question 4: A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
- A. Autism
- B. Selective mutism (Correct Answer)
- C. Expressive language disorder
- D. School phobia
Explanation: ***Selective mutism*** - This condition is characterized by a **consistent failure to speak in specific social situations** (e.g., school) despite speaking in other situations (e.g., at home with close family). - The child's **appropriate participation in class activities** and use of alternative communication methods (gestures, drawings) are typical features. *Autism* - Children with autism spectrum disorder often exhibit **deficits in social-emotional reciprocity** and may have **restricted, repetitive patterns of behavior or interests**. - While they may have communication challenges, the selective nature of the mutism and otherwise appropriate social engagement in the classroom argue against autism. *Expressive language disorder* - This disorder involves difficulty **producing spoken language**, regardless of the setting. - The fact that the child speaks normally at home suggests her expressive language abilities are intact, making this diagnosis unlikely. *School phobia* - School phobia, now often referred to as **school refusal**, is characterized by symptoms of anxiety or panic when attending or anticipating school. - While the child might be anxious, her ability to participate in class activities and communicate nonverbally suggests the primary issue is not an avoidance of school itself but a selective inability to speak.
Question 5: Screening for nephropathy in prepubertal children with type 1 DM should be initiated after how many years of disease onset?
- A. 3 years
- B. 4 years
- C. 2 years
- D. 5 years (Correct Answer)
Explanation: ***5 years*** - The **American Diabetes Association (ADA)** recommends initiating screening for **diabetic nephropathy** in type 1 DM patients starting at **5 years after diagnosis**, provided the patient has reached **puberty (Tanner stage 2-3) or age ≥11 years**. - In prepubertal children, even with 5+ years of disease duration, screening is typically **deferred until puberty** because microvascular complications are exceedingly rare before pubertal onset. - The **5-year duration threshold** is the standard timeframe, but it is coupled with pubertal status as a key criterion. *3 years* - This duration is too early according to current **ADA guidelines**, which recommend screening after **5 years** of disease duration. - The risk of **nephropathy** developing within 3 years in type 1 DM patients, especially prepubertal children, is very low. *4 years* - While closer to the guideline, **4 years** is still premature compared to the evidence-based **5-year threshold** recommended by major diabetes organizations. - Early screening before 5 years would increase false positives and unnecessary interventions. *2 years* - Initiating screening after only **2 years** is far too early and not supported by current evidence. - **Microvascular complications** including nephropathy require longer disease duration to develop, making 2-year screening inefficient and not cost-effective.
Question 6: 18 weeks pregnant female presents with no high risk of NTD and low risk of trisomy 21 on quad test. What is the most appropriate next step in management?
- A. Repeat non-invasive screening test.
- B. Perform invasive diagnostic testing.
- C. Perform amniotic fluid analysis.
- D. Perform a detailed fetal ultrasound. (Correct Answer)
Explanation: ***Perform a detailed fetal ultrasound.*** - A **detailed fetal ultrasound** (often referred to as an **anatomy scan**) at around 18-22 weeks is a standard component of prenatal care for all pregnant women, regardless of screening test results. - This ultrasound evaluates fetal anatomy for structural anomalies, assesses fetal growth, and confirms gestational age, providing crucial information even with low-risk screening. *Repeat non-invasive screening test.* - Repeating a non-invasive screening test (like another quad screen or NIPT) is generally **not indicated** when initial results show a low risk and there are no other clinical concerns. - Such tests are primarily for screening purposes, and a second low-risk result would offer little additional actionable information, as their positive predictive value is low. *Perform invasive diagnostic testing.* - **Invasive diagnostic testing**, such as **amniocentesis** or **chorionic villus sampling (CVS)**, carries a risk of miscarriage and is reserved for situations with a high risk of chromosomal abnormalities or genetic conditions. - Given the low-risk quad screen results for trisomy 21 and no high risk for NTDs, invasive testing is **not warranted** at this stage. *Perform amniotic fluid analysis.* - **Amniotic fluid analysis** is part of an amniocentesis, an **invasive diagnostic procedure** designed to detect chromosomal abnormalities or genetic disorders. - This procedure is typically reserved for cases where screening tests indicate a high risk or there is a clinical suspicion of a genetic condition; it's **not a routine step** after a low-risk quad screen.
Question 7: Microcephaly is seen in
- A. Asperger's syndrome
- B. Heller's disease
- C. Autistic disorder
- D. Rett's disease (Correct Answer)
Explanation: ***Rett's disease*** - **Microcephaly** is a characteristic feature of Rett's disease, typically developing between 6 months and 4 years of age as brain growth decelerates. - This neurodevelopmental disorder primarily affects girls and is caused by mutations in the **MECP2 gene**, leading to severe intellectual disability, communication problems, and loss of purposeful hand use. *Asperger's syndrome* - Individuals with Asperger's syndrome typically have **average or above-average intelligence** and normal head circumference. - It is characterized by difficulties in social interaction and nonverbal communication, with restricted and repetitive patterns of behavior and interests, but not microcephaly. *Heller's disease* - Also known as Childhood Disintegrative Disorder, Heller's disease is a rare condition where a child develops normally for at least two years before suffering a **severe regression** in multiple areas of development. - It does not specifically cause microcephaly; rather, it involves a loss of previously acquired skills in language, social function, and motor skills. *Autistic disorder* - While some studies have shown an increased head circumference (macrocephaly) in a subset of individuals with autism, **microcephaly is not a typical finding** in autistic disorder. - Autistic disorder is characterized by persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities.
Question 8: A 5-year-old child is assessed to have a developmental age of one year. What is his developmental quotient?
- A. 100
- B. 80
- C. 60
- D. 20 (Correct Answer)
Explanation: ***20*** - The **developmental quotient (DQ)** is calculated as (developmental age ÷ chronological age) × 100. In this case, (1 year ÷ 5 years) × 100 = 20. - A DQ of 20 indicates a significant **developmental delay**, as the child's developmental age is much lower than their chronological age. *100* - A developmental quotient of 100 would mean the child's **developmental age is equal to their chronological age**, indicating typical development. - In this scenario, it would imply a 5-year-old child having a developmental age of 5 years, which is not the case. *80* - A developmental quotient of 80 would mean the child's developmental age is 80% of their chronological age, or (4 years ÷ 5 years) × 100. - This would still indicate some developmental delay, but not as severe as observed, as the child's developmental age is only 1 year. *60* - A developmental quotient of 60 would mean the child's developmental age is 60% of their chronological age, or (3 years ÷ 5 years) × 100. - While indicating a delay, it is not consistent with a 1-year developmental age for a 5-year-old child.
Question 9: CAGE questionnaire is used in:
- A. Opiate poisoning
- B. Alcohol dependence (Correct Answer)
- C. Dhatura poisoning
- D. Barbiturate poisoning
Explanation: ***Alcohol dependence*** - The **CAGE questionnaire** is a widely used screening tool for identifying potential **alcohol dependence** or abuse. - The acronym CAGE stands for cut down, annoyed, guilty, and eye-opener, referring to specific questions asked about drinking habits. *Opiate poisoning* - **Opiate poisoning** is typically diagnosed based on clinical presentation (e.g., **miosis**, respiratory depression, altered mental status) and toxicology screens. - The CAGE questionnaire is not designed for the diagnosis or screening of opiate use disorder. *Dhatura poisoning* - **Dhatura poisoning** is characterized by anticholinergic symptoms (e.g., dry mouth, blurred vision, tachycardia, delirium) and is diagnosed clinically. - It is not related to alcohol use or dependence, and therefore the CAGE questionnaire is not applicable. *Barbiturate poisoning* - **Barbiturate poisoning** presents with central nervous system depression (e.g., sedation, respiratory depression, coma) and is diagnosed via toxicology screens. - The CAGE questionnaire is specific to alcohol use and not used for screening or diagnosing other substance intoxications or dependencies.
Question 10: Child starts speaking short sentences by the age of :
- A. 15 months
- B. 12 months
- C. 24 months (Correct Answer)
- D. 36 months
Explanation: ***24 months*** - By **24 months (2 years old)**, children typically begin to combine two or more words into **short sentences** and use about 50 words or more. - They also start to follow simple instructions and point to named objects and pictures. *15 months* - At **15 months**, children usually say a few words and can point to show what they want, but **short sentences** are not yet typical. They might use gestures more often. - Their vocabulary is still developing and usually consists of single words like "mama" or "dada." *12 months* - At **12 months (1 year old)**, most children are just starting to say their first words and are primarily communicating through gestures and sounds. - They are generally not forming combinations of words into sentences at this stage. *36 months* - By **36 months (3 years old)**, children have more advanced language skills, using **3-4 word sentences**, understanding most of what they hear, and having a vocabulary of several hundred words. - This age represents a more mature stage of language development than the initial formation of short sentences.
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