Developmental Delays — MCQs

10 questions

Second most common cause of chromosomal abnormality causing mental retardation

Absence of which of the given milestones in a 3 year old child should be called delayed development?

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?

Best therapy suited to teach daily life skill to a mentally challenged child:

A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

A child is able to build a tower of 5 cubes. The developmental age is:

Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

A 5-year-old child is assessed to have a developmental age of one year. What is his developmental quotient?

A child can ride a tricycle, copies a circle, knows name and gender. The developmental age of this child is

Q10

All of the following syndromes are seen with obesity except:

Developmental Delays Indian Medical PG Practice Questions and MCQs

Question 1: Second most common cause of chromosomal abnormality causing mental retardation

A. Fragile X syndrome
B. Patau syndrome
C. Edward syndrome (Correct Answer)
D. Down syndrome
E. Klinefelter syndrome

Explanation: ***Edward syndrome*** - Edward syndrome, or **Trisomy 18**, is the second most common autosomal trisomy after Down syndrome, and a significant cause of **mental retardation** and severe developmental abnormalities. - It involves an extra copy of chromosome 18, leading to a high mortality rate, with most affected individuals not surviving beyond the first year of life. *Fragile X syndrome* - This is the most common inherited cause of **intellectual disability** and the second most common genetic cause overall after Down syndrome. - It is caused by a mutation in the **FMR1 gene** on the X chromosome, not a chromosomal abnormality in terms of numerical or large structural changes. *Patau syndrome* - Patau syndrome, or **Trisomy 13**, is a less common but very severe chromosomal abnormality, typically leading to early mortality. - While it causes profound intellectual disability, its incidence is lower than Edward syndrome. *Down syndrome* - Down syndrome, or **Trisomy 21**, is the most common chromosomal abnormality and the leading genetic cause of **intellectual disability**. - It is caused by an extra copy of chromosome 21, resulting in characteristic physical features and developmental delays. *Klinefelter syndrome* - Klinefelter syndrome (47,XXY) is a sex chromosome abnormality affecting males, with an incidence of approximately 1 in 500-1,000 male births. - While it may be associated with mild learning difficulties or cognitive impairment, it is not primarily known for causing significant intellectual disability and is less common as a cause of mental retardation compared to the major autosomal trisomies.

Question 2: Absence of which of the given milestones in a 3 year old child should be called delayed development?

A. Hopping on one leg
B. Catching a ball reliably
C. Drawing a square
D. Feeding by spoon (Correct Answer)

Explanation: ***Feeding by spoon*** - The ability to **feed oneself with a spoon** is typically achieved by **15 to 18 months of age**, making its absence in a 3-year-old a sign of delayed development. - This milestone reflects both **fine motor coordination** and **self-help skills**. *Hopping on one leg* - **Hopping on one leg** is a gross motor skill usually developed between **4 and 5 years of age**, so a 3-year-old not yet doing this is within the normal developmental range. - This skill requires advanced **balance** and **coordination**. *Catching a ball reliably* - **Catching a ball reliably** typically emerges around **4 to 5 years of age**, as it requires good **hand-eye coordination** and **anticipation skills**. - A 3-year-old's inability to catch a ball reliably is not considered delayed. *Drawing a square* - The ability to **draw a square** is usually achieved by **4 to 5 years of age**, requiring fine motor precision and visuomotor integration. - At 3 years, children are more likely to be able to copy a **circle** or **vertical line**.

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: Best therapy suited to teach daily life skill to a mentally challenged child:

A. Contingency management (Correct Answer)
B. Cognitive reconstruction
C. Self instruction
D. CBT (Cognitive behavior therapy)

Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Question 5: A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

A. Malnutrition
B. Familial short stature
C. Constitutional short stature (Correct Answer)
D. Cretinism

Explanation: ***Constitutional short stature*** - This condition is characterized by a **delayed bone age** compared to chronological age, indicating a delay in skeletal maturation. - Children with constitutional short stature typically have **normal parental height** and will eventually reach a normal adult height, although puberty and growth spurts are often delayed. *Malnutrition* - While malnutrition causes **short stature** and **delayed bone age**, it would also likely present with other signs of nutritional deficiency such as **weight loss** or failure to thrive. - The case does not mention any dietary issues or poor socioeconomic conditions typically associated with malnutrition. *Familial short stature* - In familial short stature, the child's height is typically proportional to the parents' height, indicating a strong genetic component to their shorter stature. - It is characterized by a **normal bone age** for chronological age, unlike the delayed bone age seen in this child. *Cretinism* - Cretinism, or congenital hypothyroidism, results in **severe growth retardation** and **delayed bone age**. - However, it is also associated with distinct features like **coarse facial features**, macroglossia, umbilical hernia, and severe developmental delays, which are not mentioned in this case.

Question 6: A child is able to build a tower of 5 cubes. The developmental age is:

A. 12 months
B. 15 months
C. 18 months
D. 24 months (Correct Answer)

Explanation: ***24 months*** - A child typically develops the fine motor skill to build a tower of **5-6 cubes** by the age of **24 months (2 years)**. - This milestone reflects increasing control over hand-eye coordination and manipulation. *12 months* - At **12 months**, a child can usually **bang two cubes together** and may attempt to build a tower of **2 cubes** but rarely 5. - Their primary fine motor skills involve pincer grasp and exploring objects. *15 months* - A child at **15 months** can typically build a tower of **2-3 cubes**. - They are starting to refine their building skills but usually haven't reached 5 cubes. *18 months* - By **18 months**, a child can often build a tower of **3-4 cubes**. - While showing significant progress, building a tower of 5 cubes is usually just beyond this age.

Question 7: Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

A. Vitamin D deficiency
B. Severe acute malnutrition
C. Vitamin A deficiency
D. Zinc deficiency (Correct Answer)

Explanation: ***Zinc deficiency*** - **Rashtriya Bal Swasthya Karyakram (RBSK)** under the 4Ds framework (Defects, Deficiencies, Diseases, Development delays) screens for specific nutritional deficiencies, but **zinc deficiency is NOT included** in the standard screening protocol. - RBSK focuses on identifying **severe acute malnutrition, vitamin A deficiency, and anemia (iron deficiency)** as priority nutritional deficiencies. - While zinc supplementation may be provided during diarrhea management, routine zinc deficiency screening is not part of RBSK. *Vitamin D deficiency* - **Vitamin D deficiency screening is NOT explicitly part of RBSK protocol**, though clinical manifestations like **rickets** may be identified during general examination. - RBSK does not conduct routine biochemical screening for vitamin D levels in the 0-18 years age group. - However, some sources may consider rickets under skeletal abnormalities, making this option potentially debatable. *Severe acute malnutrition* - **Severe acute malnutrition (SAM)** is a **major screening target** under RBSK's deficiency category. - Children are screened using **mid-upper arm circumference (MUAC), weight-for-height Z-scores**, and clinical signs of malnutrition. - Identified SAM cases are referred to **Nutrition Rehabilitation Centers (NRCs)** for management. *Vitamin A deficiency* - **Vitamin A deficiency** is a **key screening target** under RBSK, particularly to identify **xerophthalmia** and prevent childhood blindness. - RBSK teams screen for clinical signs including **Bitot's spots, night blindness**, and corneal involvement. - This aligns with national programs for vitamin A supplementation and prevention of nutritional blindness.

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: A child can ride a tricycle, copies a circle, knows name and gender. The developmental age of this child is

A. 4 years
B. 5 years
C. 2 years
D. 3 years (Correct Answer)

Explanation: ***3 years*** - A child who can **ride a tricycle**, **copy a circle**, and knows their **name and gender** has achieved developmental milestones typically seen around **3 years of age**. - **Riding a tricycle** demonstrates advanced gross motor skills, while **copying a circle** indicates fine motor skill development. **Knowing name and gender** points to cognitive and social-emotional understanding. *4 years* - By 4 years, a child can typically **hop on one foot**, **draw a square**, and **tell stories**. - While they might refine skills acquired at 3, the listed milestones are primary for the 3-year mark. *5 years* - A 5-year-old usually can **skip**, **draw a triangle**, and **count 10 or more objects**. - These milestones represent further advancements beyond those described in the question. *2 years* - At 2 years, a child typically starts to **kick a ball**, **draw a straight line**, and can say **two-to-four-word sentences**. - The skills described (tricycle, circle) are generally too advanced for a 2-year-old.

Question 10: All of the following syndromes are seen with obesity except:

A. Laurence Moon - Biedl syndrome
B. Cohen syndrome
C. Prader - Willi syndrome
D. Carcinoid syndrome (Correct Answer)

Explanation: ***Carcinoid syndrome*** - Carcinoid syndrome is caused by **neuroendocrine tumors** that secrete **serotonin** and other vasoactive substances, leading to symptoms like flushing, diarrhea, and bronchospasm [2]. **Obesity is not a primary feature** of this syndrome. - The symptoms are directly related to the **hormonal effects** of the secreted substances, not to metabolic alterations associated with obesity. *Laurence Moon - Biedl syndrome* - This is a **rare genetic disorder** characterized by **obesity**, retinitis pigmentosa, polydactyly, intellectual disability, and hypogonadism [1]. - Obesity is a **consistent and prominent feature** of this syndrome, often present from childhood. *Cohen syndrome* - Cohen syndrome is a rare genetic disorder characterized by **obesity** (especially truncal obesity), intellectual disability, microcephaly, characteristic facial features, and hypotonia. - While not as universally severe as in some other syndromes, **obesity is a common clinical feature** of Cohen syndrome. *Prader - Willi syndrome* - Prader-Willi syndrome is a genetic disorder caused by a deletion on chromosome 15, leading to **insatiable hunger (hyperphagia)** and chronic overeating, which results in **severe obesity** [1]. - **Obesity is a cardinal feature** of this syndrome, developing in early childhood due to hypothalamic dysfunction affecting appetite control.

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