Growth and Development — MCQs

Growth and Development Indian Medical PG Practice Questions and MCQs

Question 551: The parachute reflex disappears at what age?

A. 3 months
B. 6 months
C. birth and reappears at 9 months
D. Never (Correct Answer)

Explanation: The **parachute reflex** is a protective primitive reflex that is essential for preventing injury during a fall. Unlike many other neonatal reflexes that are integrated (disappear) as the central nervous system matures, the parachute reflex is an **acquired postural response** that persists throughout life. ### **Explanation of the Correct Answer** The parachute reflex typically appears between **6 to 9 months** of age. It is elicited by holding the child in ventral suspension and tilting them forward toward the ground. The child responds by extending the arms and spreading the fingers to "break the fall." Because this is a protective mechanism required for balance and safety during upright locomotion, it **never disappears** (Option D). ### **Analysis of Incorrect Options** * **A & B (3 and 6 months):** These are incorrect because the reflex has either not yet appeared or is just beginning to emerge at these stages. Most primitive reflexes (like the Moro or Rooting reflex) disappear by 4–6 months, but the parachute reflex is an exception. * **C (Birth/9 months):** The parachute reflex is not present at birth. Its appearance at 9 months signifies maturing motor pathways (specifically the corticospinal tract) necessary for sitting and crawling. ### **NEET-PG Clinical Pearls** * **Sequence of Development:** The parachute reflex is the **last** of the postural reflexes to appear. * **Clinical Significance:** A delayed appearance of the parachute reflex may indicate a delay in motor development or a neurological abnormality. * **Asymmetry:** An asymmetric parachute reflex (one arm extending less than the other) is a highly specific sign of **spastic hemiplegia** (Cerebral Palsy) or a localized nerve injury. * **High-Yield Rule:** Remember: "Primitive reflexes disappear, Postural reflexes persist."

Question 552: Which of the following is NOT characteristic of autism?

A. Onset after 6 years of age (Correct Answer)
B. Repetitive behaviour
C. Delayed language development
D. Severe deficit in social interaction

Explanation: **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior. **Why Option A is the Correct Answer:** According to the **DSM-5 criteria**, symptoms of autism must be present in the **early developmental period** (typically before **3 years of age**). While symptoms may not become fully manifest until social demands exceed limited capacities, an onset after 6 years of age is inconsistent with a diagnosis of ASD. If a child develops normally until age 6 and then regresses, clinicians must investigate other neurological or degenerative conditions. **Analysis of Incorrect Options:** * **Option B (Repetitive behavior):** This is a core diagnostic criterion. It includes stereotyped motor movements (e.g., hand flapping), insistence on sameness, and highly restricted, fixated interests. * **Option C (Delayed language development):** Communication deficits are hallmark features. This includes a total lack of speech, delayed speech, or "echolalia" (meaningless repetition of words). * **Option D (Severe deficit in social interaction):** This is the "social triad" deficit, including poor eye contact, lack of social-emotional reciprocity, and inability to develop peer relationships. **High-Yield Clinical Pearls for NEET-PG:** * **M-CHAT (Modified Checklist for Autism in Toddlers):** The most commonly used screening tool (usually at 18 and 24 months). * **Male to Female Ratio:** Approximately 4:1. * **Associated Findings:** Macrocephaly is often noted in early childhood; about 30% of cases are associated with Epilepsy. * **Treatment:** Behavioral therapy (Applied Behavior Analysis - ABA) is the mainstay. Pharmacotherapy (e.g., Risperidone) is used only for associated irritability or aggression.

Question 553: All of the following may occur in Down's syndrome except?

A. Hypothyroidism
B. Undescended testis (Correct Answer)
C. Ventricular septal defect
D. Brushfield's spots

Explanation: **Explanation:** Down’s syndrome (Trisomy 21) is the most common chromosomal disorder and is associated with a wide spectrum of multisystemic anomalies. **Why "Undescended testis" is the correct answer:** While Down’s syndrome is associated with various genitourinary issues (such as an increased risk of testicular germ cell tumors), **undescended testis (cryptorchidism)** is not a classic or defining feature of the syndrome. In contrast, cryptorchidism is a hallmark feature of other trisomies, specifically **Trisomy 13 (Patau syndrome)** and **Trisomy 18 (Edwards syndrome)**. **Analysis of Incorrect Options:** * **Hypothyroidism (Option A):** Endocrine abnormalities are very common in Down’s syndrome. Both congenital and acquired (autoimmune) hypothyroidism occur with significantly higher frequency compared to the general population. * **Ventricular Septal Defect (Option C):** Congenital heart disease (CHD) occurs in approximately 40-50% of cases. While **Atrioventricular Septal Defect (AVSD/Endocardial cushion defect)** is the most characteristic, VSD and ASD are also frequently observed. * **Brushfield’s spots (Option D):** These are small, white or grayish-brown spots on the periphery of the iris. They are a classic, high-yield physical finding in Down’s syndrome, though they can occasionally be seen in normal individuals. **High-Yield Clinical Pearls for NEET-PG:** * **Most common CHD:** Endocardial Cushion Defect (AVSD). * **Most common GI anomaly:** Duodenal atresia ("Double bubble" sign). * **Hematological association:** Increased risk of ALL (Acute Lymphoblastic Leukemia) and AML (specifically M7 subtype - Megakaryocytic). * **Neurological:** Early-onset Alzheimer’s disease due to the APP gene on Chromosome 21. * **Screening:** Low AFP, Low Estriol, High hCG, and High Inhibin-A (Quadruple marker test).

Question 554: Which reflex, once present, never disappears?

A. Moro's Reflex
B. Parachute reflex (Correct Answer)
C. Symmetric Tonic neck reflex
D. Asymmetric Tonic neck reflex

Explanation: The correct answer is **B. Parachute reflex**. ### **Explanation** Primitive reflexes are involuntary motor responses present at birth that are mediated by the brainstem and spinal cord. As the CNS matures and the cerebral cortex exerts inhibitory control, these reflexes typically disappear (integrate). The **Parachute reflex** is not a primitive reflex but a **protective postural reflex**. It appears at approximately **7–9 months** of age. It is elicited by tilting the infant forward as if falling; the infant responds by extending the arms to break the fall. Unlike primitive reflexes, once the parachute reflex develops, it **persists throughout life** to protect the individual from injury during falls. ### **Analysis of Incorrect Options** * **A. Moro’s Reflex:** A primitive reflex present at birth. It involves sudden extension and abduction of arms followed by flexion and adduction in response to a sudden loss of support. It typically disappears by **3–4 months**. * **C. Symmetric Tonic Neck Reflex (STNR):** This reflex involves neck extension causing arm extension and leg flexion. It appears around 6 months and disappears by **9–12 months** to allow for crawling. * **D. Asymmetric Tonic Neck Reflex (ATNR):** Also known as the "fencing posture," it occurs when the head is turned to one side. It is present at birth and disappears by **4–6 months**. Persistence beyond 6 months often indicates Cerebral Palsy. ### **High-Yield Clinical Pearls for NEET-PG** * **First reflex to appear:** Palmar grasp (in utero). * **Reflexes present at birth:** Moro, Sucking, Rooting, Palmar grasp, ATNR. * **Sequence of disappearance:** Most primitive reflexes disappear by **4–6 months**. * **Clinical Significance:** Delayed disappearance of primitive reflexes or delayed appearance of protective reflexes (like the Parachute) is a strong early indicator of **Upper Motor Neuron (UMN) lesions** or **Cerebral Palsy**.

Question 555: At what age does a child typically roll over?

A. 3 months
B. 5 months (Correct Answer)
C. 7 months
D. 8 months

Explanation: **Explanation:** The development of gross motor skills follows a **cephalocaudal (head-to-toe)** progression. Rolling over is a significant milestone that requires the integration of primitive reflexes and the development of trunk strength. * **Correct Answer (B - 5 months):** By 5 months, most infants can roll from the **supine (back) to the prone (tummy)** position. While some infants may begin rolling from prone to supine slightly earlier (around 4 months), the milestone for consistent rolling in both directions is typically achieved by 5 months. This marks the transition from static posture to active mobility. **Analysis of Incorrect Options:** * **A (3 months):** At this age, the infant achieves **neck holding** (the first major gross motor milestone). While they may turn to their side, they lack the trunk coordination to complete a full roll. * **C (7 months):** By 7 months, a child has progressed beyond rolling and is typically able to **sit with their own support** (using hands in a tripod position). * **D (8 months):** At 8 months, the child should be able to **sit without support** and may begin pivoting or creeping. **High-Yield Clinical Pearls for NEET-PG:** * **Sequence:** Neck holding (3m) → Rolling over (5m) → Sitting with support (6m) → Sitting without support (8m) → Standing with support (9m) → Standing without support (12m). * **Red Flag:** Failure to roll over by **6 months** warrants a developmental evaluation. * **Reflex Integration:** Rolling over coincides with the disappearance of the **Asymmetric Tonic Neck Reflex (ATNR)**; if ATNR persists, the child cannot roll.

Question 556: By what age does a child typically recognize their own sex?

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

Explanation: **Explanation:** The development of gender identity is a significant milestone in a child's psychosocial growth. By the age of **3 years**, most children can consistently identify themselves as a boy or a girl. This is the age where they develop a stable internal sense of their own gender, even if they do not yet understand that gender is a permanent biological trait. **Analysis of Options:** * **2 years (Option A):** At this age, children begin to become aware of physical differences between sexes and can often point to "boys" or "girls" in pictures, but they lack a firm, consistent internal recognition of their own gender identity. * **3 years (Option B - Correct):** This is the classic developmental milestone for **Gender Identity**. The child can label themselves and others correctly by sex. * **4-5 years (Options C & D):** By this stage, children move beyond simple identity to **Gender Stability** (understanding that boys grow into men) and **Gender Constancy** (understanding that gender remains the same regardless of clothing or hair length). **High-Yield Clinical Pearls for NEET-PG:** * **Gender Identity:** Established by 3 years. * **Parallel Play:** Characteristic of 2-year-olds. * **Cooperative Play:** Begins around 3–4 years. * **Sphincter Control:** Most children achieve daytime bowel and bladder control by age 3. * **Riddles and Jokes:** Children begin to understand and tell simple jokes/riddles by age 5. **Summary:** For the purpose of NEET-PG, remember the "Rule of 3": 3 years = 3-word sentences, rides a tricycle, and knows their own gender.

Question 557: A 6-year-old child with an IQ of 50, what developmental milestones can they typically achieve?

A. Identify colours (Correct Answer)
B. Read a sentence
C. Ride a bicycle
D. Copy a triangle

Explanation: To solve this question, we must first determine the **Mental Age (MA)** of the child using the standard formula: **IQ = (Mental Age / Chronological Age) × 100** Given: IQ = 50 and Chronological Age (CA) = 6 years. 50 = (MA / 6) × 100 → **MA = 3 years.** The developmental milestones achievable by this child will correspond to those of a typical **3-year-old.** ### Why the options are correct/incorrect: * **A. Identify colours (Correct):** A child typically learns to name at least one color by age 3. Since this child’s mental age is 3, this is an achievable milestone. * **B. Read a sentence (Incorrect):** Reading a simple sentence is a milestone for a **5 to 6-year-old**. This child lacks the cognitive maturity for this task. * **C. Ride a bicycle (Incorrect):** While a 3-year-old can ride a *tricycle*, riding a **bicycle** (usually with training wheels) begins around age 4–5, and independent balancing often occurs later. * **D. Copy a triangle (Incorrect):** Copying a triangle is a fine motor milestone for a **5-year-old**. A 3-year-old can copy a circle; a 4-year-old can copy a cross or square. ### High-Yield Clinical Pearls for NEET-PG: * **Intellectual Disability (ID) Classification:** An IQ of 50 falls at the border of **Mild (IQ 50–70)** and **Moderate (IQ 35–49)** ID. Mildly impaired children are "educable" and can often reach a 6th-grade level. * **Drawing Milestones (The "Rule of Shapes"):** * 3 years: Circle * 4 years: Cross / Square * 5 years: Triangle * 6 years: Diamond * **Language Milestone:** A 3-year-old can give their full name and gender and knows about 900 words.

Question 558: What is the expected developmental milestone for a 3-year-old child?

A. Build a tower of 3 cubes (Correct Answer)
B. Copy a square
C. Identify left and right
D. Use pronouns like I, you, and me

Explanation: **Explanation:** Developmental milestones are a high-yield area for NEET-PG, categorized into gross motor, fine motor, language, and social domains. **Why Option A is Correct:** At **3 years (36 months)**, a child’s fine motor coordination allows them to stack a tower of **9–10 cubes**. However, the ability to build a tower of **3 cubes** is typically achieved much earlier, at **18 months**. In the context of this specific question (likely based on standard developmental screening patterns), building a tower of 3 cubes is a milestone already mastered by a 3-year-old. *(Note: If the question implies the maximum capacity, a 3-year-old can build a tower of 9-10 cubes; the formula is Age in years × 3).* **Analysis of Incorrect Options:** * **B. Copy a square:** This is a fine motor milestone for a **4-year-old**. A 3-year-old can copy a circle and a cross, but the diagonal lines and corners of a square require more advanced motor planning. * **C. Identify left and right:** This is a complex cognitive and spatial milestone usually achieved by age **6 years**. * **D. Use pronouns like I, you, and me:** While a 3-year-old starts using pronouns, the specific mastery of "I, you, and me" is typically a **2-year-old** milestone. By age 3, a child should be speaking in 3-4 word sentences and can state their full name and gender. **High-Yield Clinical Pearls for NEET-PG:** * **Tower of Cubes Formula:** Age (yrs) × 3. (18m = 3 cubes; 2yrs = 6 cubes; 3yrs = 9 cubes). * **Drawing Milestones:** 2yrs (Scribble), 3yrs (Circle), 4yrs (Square), 5yrs (Triangle), 6yrs (Diamond). * **Riding a Tricycle:** A classic gross motor milestone for a **3-year-old**. * **Social Play:** 3-year-olds engage in **group play/sharing**, whereas 2-year-olds engage in **parallel play**.

Question 559: All are components of Laurence Moon Biedl syndrome, EXCEPT?

A. Digital anomaly
B. Asthenic built (Correct Answer)
C. Mental retardation
D. Hypogonadism

Explanation: **Explanation:** Laurence-Moon-Bardet-Biedl Syndrome (LMBBS) is a rare autosomal recessive ciliopathy characterized by multi-system involvement. The hallmark feature regarding body habitus is **central obesity**, not an asthenic (thin/slender) build. Therefore, Option B is the correct "except" answer. **Analysis of Options:** * **Asthenic built (Correct Answer):** Patients with this syndrome typically develop early-onset truncal obesity. An asthenic build is contradictory to the clinical presentation of LMBBS. * **Digital anomaly (Incorrect):** Post-axial polydactyly (extra digits) is a classic diagnostic feature of the syndrome. * **Mental retardation (Incorrect):** Cognitive impairment or developmental delay is a core component of the clinical pentad. * **Hypogonadism (Incorrect):** Hypogonadotropic hypogonadism, manifesting as delayed puberty or small genitalia, is frequently present. **Clinical Pearls for NEET-PG:** To remember the features of Laurence-Moon-Bardet-Biedl Syndrome, use the mnemonic **"PRoblem"**: 1. **P**olydactyly (Post-axial) 2. **R**etinitis pigmentosa (leading to night blindness; most common feature) 3. **O**besity (Truncal) 4. **B**rains (Mental retardation) 5. **L**ittle gonads (Hypogonadism) 6. **E**xtra: **M**edullary cystic disease/Renal anomalies (often the cause of mortality). *Note:* Historically, Laurence-Moon and Bardet-Biedl were considered separate, with "Laurence-Moon" emphasizing spastic paraplegia and "Bardet-Biedl" emphasizing polydactyly and obesity, but they are now often grouped together in clinical exams.

Question 560: What is true about head circumference measurement?

A. It is measured from the supra-orbital ridge.
B. It is used to diagnose hydrocephalus or microcephaly.
C. Serial measurement is useful.
D. All of the above. (Correct Answer)

Explanation: Head circumference (Occipitofrontal Circumference - OFC) is a critical anthropometric parameter in pediatrics, reflecting brain growth and intracranial volume. **Explanation of the Correct Answer:** The correct answer is **D (All of the above)** because: * **Option A:** The standard technique involves placing a non-stretchable tape over the most prominent part of the occiput posteriorly and the **supra-orbital ridges** (just above the eyebrows) anteriorly. This ensures the maximum circumference is captured. * **Option B:** It is the primary screening tool for disorders of brain volume. Values >2 Standard Deviations (SD) above the mean suggest **hydrocephalus** or macrocephaly, while values <3 SD (or <2 SD in some classifications) below the mean indicate **microcephaly**. * **Option C:** A single reading is less informative than **serial measurements** plotted on a growth chart. Crossing percentiles or a rapid increase in velocity is often the first sign of pathology (e.g., increasing intracranial pressure) before clinical symptoms appear. **High-Yield Clinical Pearls for NEET-PG:** * **Average OFC at birth:** 33–35 cm. * **Growth Pattern:** It increases by ~2 cm/month (0–3 months), 1 cm/month (3–6 months), and 0.5 cm/month (6–12 months). * **Milestone:** At 1 year, the average OFC is **45 cm**. * **Chest Circumference (CC) vs. OFC:** At birth, OFC > CC (by ~2–3 cm). They become equal at **1 year** of age. If CC > OFC before 6 months, suspect microcephaly; if OFC > CC after 2 years, suspect malnutrition or hydrocephalus.

Practice by Chapter

Normal Growth Parameters

Practice Questions

Developmental Milestones

Practice Questions

Puberty and Adolescent Development

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Growth Disorders

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Failure to Thrive

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Developmental Screening and Assessment

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Developmental Delays

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Growth Charts and Monitoring

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Short Stature

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Tall Stature

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Precocious and Delayed Puberty

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Psychosocial Development

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