Developmental and Behavioral Pediatrics Practice Questions

Q: Which is true about the reflex shown in the image?

Asymmetric tonic neck reflex. ***Asymmetric tonic neck reflex*** - The image shows the infant's head turned to one side, with the arm and leg on that side **extended**, and the arm and leg on the opposite side **flexed**, resembling a "fencer" pose. - This reflex is normally present from birth to 6 months of age and is important for developing **hand-eye coordination**. *Gallant reflex* - The Gallant reflex (or truncal incurvation reflex) is elicited by stroking the skin along one side of the infant's spine, causing the **trunk to flex** towards the stimulated side. - It is typically present at birth and integrates by 4-6 months, and is not demonstrated by the body posture in the image. *Parachute reflex* - The parachute reflex (or protective extension reflex) involves an infant extending their arms forward to **brace for a fall** when suddenly moved headfirst towards a surface. - This reflex develops later, typically around 6-9 months of age, and is crucial for **fall prevention**. *Symmetric tonic neck reflex* - The symmetric tonic neck reflex is elicited by **flexing or extending the infant's head**. - Head flexion causes the arms to flex and the legs to extend, while head extension causes the arms to extend and the legs to flex. This differs from the unilateral arm and leg movements shown.

Q: During evaluation of intellectual disability, characteristic facies of the child as below is noted. There is a family history of intellectual disability also. What is the probable diagnosis?

Fragile X syndrome. ***Fragile X syndrome*** - The image depicts a male with an **elongated face**, **prominent jaw**, and **large, protuberant ears**, which are classic facial features of Fragile X syndrome. - The presence of **intellectual disability** and a **family history** reinforces this diagnosis, as Fragile X is the most common inherited cause of intellectual disability. *Down syndrome* - Characterized by a **round face**, **upward-slanted palpebral fissures**, **epicanthal folds**, and a **flat nasal bridge**, none of which are evident in the image. - Typically results from **trisomy 21** and is not primarily linked to a family history of intellectual disability in an X-linked pattern. *Klinefelter syndrome* - While individuals with Klinefelter syndrome (XXY genotype) may have **intellectual disability** (usually mild), their characteristic features include **tall stature**, **small testes**, **gynecomastia**, and often a **less distinctive facial phenotype** compared to the one shown. - The facial features in the image (prominent jaw, large ears, elongated face) are not typical for Klinefelter syndrome. *Turner syndrome* - Affects females (XO genotype) and is associated with features such as **webbed neck**, **short stature**, **low posterior hairline**, and **gonadal dysgenesis**. - It does not present with the facial features shown in the image, nor does it typically manifest with a family history of intellectual disability in males.

Q: Which of the following are characteristic features of cerebral palsy? I. Disorder of movement II. Permanent nature III. Progressive course IV. Disorder of posture Select the correct answer using the code given below :

I, II and IV. ***Correct: I, II and IV*** - Cerebral palsy is defined as a group of **permanent disorders** that affect the development of **movement and posture**, causing activity limitations. - It is attributed to **non-progressive disturbances** that occurred in the developing fetal or infant brain. - Key characteristics: **Disorder of movement (I)** + **Permanent nature (II)** + **Disorder of posture (IV)** + Non-progressive course. *Incorrect: I, II and III* - While cerebral palsy is a **disorder of movement** and **permanent**, it is explicitly characterized by its **non-progressive** nature. - The underlying brain lesion does not worsen over time, though clinical manifestations may change as the child develops. - Statement III (Progressive course) is incorrect. *Incorrect: I, III and IV* - Cerebral palsy is fundamentally a **disorder of movement** and **posture**. - However, a key distinguishing characteristic is its **non-progressive** nature; the brain injury itself does not advance or worsen. - Statement III (Progressive course) contradicts the definition of cerebral palsy. *Incorrect: II, III and IV* - Cerebral palsy is **permanent** and affects **posture**, but it has a **non-progressive** course, not progressive. - It is also fundamentally a **disorder of movement**, which is a primary manifestation. - Statement III (Progressive course) is incorrect, making this combination wrong.

Q: Consider the following conditions: 1. Otitis media 2. Speech problems 3. Dentition abnormalities Which of the above is/are associated with cleft palate?

1, 2 and 3. ***1, 2 and 3*** - All three conditions—**otitis media, speech problems, and dentition abnormalities**—are commonly associated with **cleft palate** due to anatomical and functional disruptions. - The abnormal palatal structure affects Eustachian tube function, speech articulation, and proper tooth development and alignment. *1 and 3 only* - This option incorrectly excludes **speech problems**, which are a very common and significant consequence of cleft palate. - The inability of the palate to close off the nasal cavity during speech leads to hypernasality and articulatory difficulties. *2 and 3 only* - This option incorrectly excludes **otitis media**, which is a frequent complication in individuals with cleft palate due to impaired **Eustachian tube function**. - The muscle attachments involving the soft palate and Eustachian tube orifice are often anomalous, leading to chronic middle ear fluid and infections. *1 only* - This option is incomplete as it only includes **otitis media**, while **speech problems** and **dentition abnormalities** are also major and well-documented sequelae of cleft palate. - The structural defect impacts multiple orofacial and auditory functions.

Q: What are the reading and writing skills of a child with moderate intellectual disability?

Basic. ***Basic*** - Children with **moderate intellectual disability** can often achieve **basic reading and writing skills**, such as recognizing simple words and writing their name. - This level of skill might allow them to understand **simple written instructions** or basic functional communication. *Reasonable* - **"Reasonable"** reading and writing skills would imply a level of proficiency typically seen in individuals without intellectual disabilities or those with very mild forms, which is beyond the expected capabilities for **moderate intellectual disability**. - This term is **too vague** and generally implies a higher level of comprehension and expression than is characteristic of moderate intellectual impairment. *Minimal* - While their skills are limited, "minimal" often suggests an **even lower level of ability** — perhaps only recognizing a few letters or symbols. - Children with moderate intellectual disability can typically progress beyond this to acquiring a **functional basic literacy**. *None* - Stating "none" would be inaccurate, as most individuals with **moderate intellectual disability** are capable of acquiring some level of **functional literacy**, even if it is very basic. - Total absence of reading and writing skills is more commonly associated with **severe or profound intellectual disability**.

Q: A 10-year-old child has a mental age of 4 years, suggesting significantly impaired adaptive functioning. This most likely indicates which level of intellectual disability?

Moderate. ***Moderate*** - Mental age (4 years) ÷ Chronological age (10 years) × 100 = **IQ of 40** - IQ of 40 falls within the **moderate intellectual disability range (IQ 35-49)** - Individuals with moderate intellectual disability require **moderate support and supervision** in daily activities, have limited academic potential (typically 2nd-4th grade level), but can achieve some independence in structured settings *Mild* - Mild intellectual disability corresponds to **IQ 50-70** - The calculated IQ of 40 is **below this threshold**, ruling out mild intellectual disability - Individuals with mild ID can typically achieve **6th grade academic skills** and functional independence with minimal support *Severe* - Severe intellectual disability is characterized by **IQ 20-34** - An IQ of 40 is **above this range**, ruling out severe intellectual disability - Individuals with severe ID require extensive support and have very limited communication abilities *Profound* - Profound intellectual disability is defined as **IQ below 20** - An IQ of 40 is **significantly higher** than this range - Individuals with profound ID require constant care and have minimal cognitive and adaptive functioning

Q: A two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –

Rett's syndrome. ***Rett's syndrome*** - The constellation of **hand-wringing stereotype movements**, language impairment, poor social skills, and **deceleration of head growth** after 6 months of age in a female child is highly characteristic of Rett's syndrome. - This neurodevelopmental disorder is almost exclusively seen in girls and is caused by a mutation in the **MECP2 gene**. *Asperger's syndrome* - Asperger's syndrome (now part of **Autism Spectrum Disorder**) typically presents with difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. - However, it does not usually involve **seizures, loss of purposeful hand use, or acquired microcephaly**, which are key features of Rett's syndrome. *Fragile x–syndrome* - Fragile X syndrome is a genetic condition causing intellectual disability, most commonly in males, characterized by a **long face, prominent jaw and ears**, and **macroorchidism** (large testicles) in post-pubertal males. - It does not specifically feature the unique hand stereotypes or decelerated head growth seen in Rett's syndrome. *Colorado syndrome* - **Colorado syndrome** is not a recognized medical diagnosis for such a clinical presentation. - The symptoms described do not align with any known neurological or developmental disorder named "Colorado syndrome."

Q: All are used in the treatment of nocturnal enuresis except?

Voiding of urine before sleeping. ***Voiding of urine before sleeping*** - **Voiding before sleep** is a **general hygiene measure and preventive advice** rather than a specific therapeutic intervention for nocturnal enuresis. - While it may reduce bladder volume at bedtime, it does **not address the underlying pathophysiology** of nocturnal enuresis (arousal deficit, nocturnal polyuria, or detrusor overactivity). - It is **routine advice** given to all children, not a targeted treatment modality for curing enuresis. *Imipramine* - **Imipramine**, a tricyclic antidepressant, is an established **pharmacological treatment** for nocturnal enuresis. - Its mechanisms include: **anticholinergic effects** (increasing bladder capacity and functional bladder capacity), **alpha-adrenergic effects** (increasing bladder outlet resistance), and **antidiuretic effects**. - Typical dosing: **25-50 mg at bedtime**, with success rates of 40-60%. *Alarm setup* - **Bed-wetting alarms** are the **first-line behavioral therapy** with the highest long-term cure rates (60-70% success). - Works through **classical conditioning**: the alarm triggers when moisture is detected, training the child to either wake to void or develop nocturnal bladder control. - Requires **8-12 weeks** of consistent use and has the lowest relapse rates among treatments. *Maintenance of calendar of day night wetting* - **Voiding diary/calendar** is an essential **behavioral intervention** for monitoring and managing nocturnal enuresis. - Helps identify patterns, track treatment progress, and provides **positive reinforcement** through visual feedback. - Part of comprehensive behavioral management alongside fluid restriction and scheduled voiding during daytime.

Q: In a child with IQ 50, which of the following is true:

Can follow simple verbal commands. ***Can follow simple verbal commands*** - An IQ of 50 typically falls into the **moderate intellectual disability** range (IQ 35-50), where individuals can understand and follow **simple instructions** and commands. - This level often allows for some degree of **communication and basic learning** with appropriate support and training. *Can look after himself independently* - While individuals with an IQ of 50 may achieve some level of independence with training, **full self-care** in complex situations typically requires ongoing support or supervision. - They may struggle with **complex problem-solving** or managing all aspects of independent living without guidance. *Can handle money* - Handling money, including budgeting, making change, or understanding financial transactions, is a **complex skill** that is often challenging for individuals with an IQ of 50 without significant training and support. - They may understand the basic concept of money but struggle with its practical application in varied scenarios. *All of the options* - While simple verbal commands are usually manageable, the other options (full independent self-care and complex money handling) are typically beyond the general capabilities of an individual with an IQ of 50 without substantial support or specific, intensive training. - Therefore, not all listed options accurately describe the expected functional abilities.

Q: Microcephaly is seen in

Rett's disease. ***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 1

Which is true about the reflex shown in the image?

Accepted Answer

Asymmetric tonic neck reflex

Answer

Gallant reflex

Answer

Parachute reflex

Answer

Symmetric tonic neck reflex

Question 2

During evaluation of intellectual disability, characteristic facies of the child as below is noted. There is a family history of intellectual disability also. What is the probable diagnosis?

Accepted Answer

Fragile X syndrome

Answer

Down syndrome

Answer

Klinefelter syndrome

Answer

Turner syndrome

Question 3

Which of the following are characteristic features of cerebral palsy?
I. Disorder of movement
II. Permanent nature
III. Progressive course
IV. Disorder of posture

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

I, III and IV

Answer

II, III and IV

Question 4

Consider the following conditions:

1. Otitis media
2. Speech problems
3. Dentition abnormalities
Which of the above is/are associated with cleft palate?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 only

Question 5

What are the reading and writing skills of a child with moderate intellectual disability?

Accepted Answer

Basic

Answer

Reasonable

Answer

Minimal

Answer

None

Question 6

A 10-year-old child has a mental age of 4 years, suggesting significantly impaired adaptive functioning. This most likely indicates which level of intellectual disability?

Accepted Answer

Moderate

Answer

Mild

Answer

Severe

Answer

Profound

Question 7

A two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –

Accepted Answer

Rett's syndrome

Answer

Asperger's syndrome

Answer

Fragile x–syndrome

Answer

Colorado syndrome

Question 8

All are used in the treatment of nocturnal enuresis except?

Accepted Answer

Voiding of urine before sleeping

Answer

Imipramine

Answer

Alarm setup

Answer

Maintenance of calendar of day night wetting

Question 9

In a child with IQ 50, which of the following is true:

Accepted Answer

Can follow simple verbal commands

Answer

Can look after himself independently

Answer

Can handle money

Answer

All of the options

Question 10

Microcephaly is seen in

Accepted Answer

Rett's disease

Answer

Asperger's syndrome

Answer

Heller's disease

Answer

Autistic disorder

Developmental and Behavioral Pediatrics — MCQs

Developmental and Behavioral Pediatrics — MCQs

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