A 6-year-old girl is brought to the pediatrician for the first time by her mother. Her mother states that her family just emigrated from China and her daughter has seemed to have difficulty adjusting to the American diet. Specifically, she seems to have abdominal discomfort and increased flatulence whenever she eats milk or cheese. The pediatrician orders a test to diagnose the patient. Which of the following results is most likely to be observed in this patient?
Q12
A 5-year-old boy is brought to the emergency department by a neighbor who saw him struck by a car. The man reports that the boy is intellectually disabled, and his parents frequently leave him unattended at home for most of the day. He walks around the neighborhood and sometimes has difficulty finding his way home. Today he was struck by a car that sped off. The man called the boy’s mother by phone, but she said that she was too busy to leave her job and asked the man to take the boy to the emergency department for her. A quick review of the boy's electronic medical record reveals that he has not been seen by a physician in several years and has missed several vaccines. On physical exam, the vital signs are normal. He appears dirty, thin, and small for his age with a large bruise forming on his right hip. Which of the following is the most appropriate term for this type of child abuse?
Q13
A 2-week-old infant is brought to the physician by her father because of a 1-week history of vaginal discharge. The discharge was initially clear, but now he notices that it is tinged with blood. The father is also concerned about “bruises” on his daughter's back and buttocks. Both parents work so that the infant spends most of her time in daycare or with her aunt. She was born at term following a pregnancy complicated by maternal gonococcal infection that was treated with antibiotics. She appears well. Physical examination shows mild acne across her cheeks and forehead. There are multiple large flat gray-blue patches on her back and buttocks. An image of one of the lesions is shown. Firm breast buds are present. Genitourinary examination shows erythema and swelling of the vulva and vagina with an odorless, blood-stained white discharge. Which of the following is the most appropriate next step in management?
Q14
A child with which of the following diseases would have the highest morbidity from being outside during a hot summer day?
Q15
A 3-year-old boy is brought to the pediatrician by his parents because of swelling and tenderness of his left upper arm. According to the father, the boy was running in the garden when he fell and injured his arm 2 days ago. His mother had been on a business trip the past week. The boy's father and 18-year-old brother had been taking care of the patient during that time. The mother reports that she noticed her son refusing to use his left arm when she returned from her business trip. Both parents claim there is no history of previous trauma. The boy is at the 60th percentile for height and 40th percentile for weight. The patient clings to his mother when approached by the physician. Physical examination shows swelling and bruising of the medial left upper arm and tenderness along the 8th rib on the left side. An x-ray of the arm and chest shows a nondisplaced spiral fracture of the left proximal humeral shaft and a fracture with callus formation of the left 8th rib. Which of the following is the most appropriate next step in management?
Q16
A three-year-old girl presents to general pediatrics clinic for a well-child visit. Her mother reports that she has been growing and developing normally but because of new behaviors she has noticed with her child, she is concerned of possible abuse by the child's stepfather. Vital signs are stable and the physical examination is within normal limits. The child has no visual signs of abuse. Which of the following, if reported by the mother would signify potential sexual abuse in the child?
Q17
A new mother brings in her 4-week-old son who has no significant past medical history but she complains of a new, itchy rash on his body. The patient has an older sister who developed similar symptoms when she was around the same age. The patient's blood pressure is 75/50 mm Hg, pulse is 140/min, respiratory rate is 40/min, and temperature is 37.3°C (99.1°F). Physical examination reveals confluent, erythematous patches and plaques with tiny vesicles and scaling overlying his lower back and abdomen. When questioned about possible etiologies, the mother notes that she has been bathing the patient at least twice a day. Which of the following statements is most appropriate for this patient?
Q18
A 5-year-old child whose family recently immigrated from Africa is brought in for a wellness visit. The boy appears indifferent, doesn’t seem to make eye contact, and keeps to himself. Upon examination, it is noted that his height and weight are below the 5th percentile. Furthermore, his abdomen is protuberant, and there are multiple zones of hyper- and hypopigmentation and desquamation of the skin. Upon palpation of the abdomen, he is found to have hepatomegaly, and lower extremity inspection reveals pitting edema. Which of the following is the cause of this child’s condition?
Q19
A 5 month-old boy with no significant past medical, surgical, or family history is brought the pediatrician by his parents for a new rash. The parents state that the rash started several weeks earlier and has not changed. The boy has breastfed since birth and started experimenting with soft foods at the age of 4 months. Physical examination reveals erythematous plaques with shiny, yellow scales over the scalp and external ears. Vital signs are within normal limits. Complete blood count is as follows:
WBC 8,300 cells/ml3
Hct 46.1%
Hgb 17.1 g/dL
Mean corpuscular volume (MCV) 88 fL
Platelets 242
Which of the following is the most likely diagnosis?
Q20
An infant boy is brought to the physician for a well-child examination. He was born at term and has been healthy since. He is beginning to crawl but can not yet walk or run. He feeds himself small foods and can bang 2 cubes together. He is just beginning to successfully use a pincer grasp. He has stranger anxiety. He is at the 40th percentile for height and weight. Physical examination shows no abnormalities. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
Growth/Development US Medical PG Practice Questions and MCQs
Question 11: A 6-year-old girl is brought to the pediatrician for the first time by her mother. Her mother states that her family just emigrated from China and her daughter has seemed to have difficulty adjusting to the American diet. Specifically, she seems to have abdominal discomfort and increased flatulence whenever she eats milk or cheese. The pediatrician orders a test to diagnose the patient. Which of the following results is most likely to be observed in this patient?
A. Positive technetium 99 scan
B. Abnormal small bowel biopsy
C. Abnormal abdominal ultrasound
D. Positive hydrogen breath test (Correct Answer)
E. Negative hydrogen breath test
Explanation: ***Positive hydrogen breath test***
- The patient's symptoms of **abdominal discomfort** and **increased flatulence** after consuming milk and cheese are highly suggestive of **lactose intolerance**.
- A **hydrogen breath test** measures hydrogen in the breath after consuming lactose; in lactose intolerance, **undigested lactose** in the colon is fermented by bacteria, producing hydrogen gas that is absorbed and exhaled.
*Positive technetium 99 scan*
- A **Technetium-99m labeled red blood cell scan** is used to detect **gastrointestinal bleeding**, which is not indicated by the patient's symptoms.
- This test is typically performed when there is suspicion of active bleeding, such as in cases of **melena** or **hematochezia**.
*Abnormal small bowel biopsy*
- A small bowel biopsy is primarily used to diagnose conditions like **celiac disease** (villous atrophy) or **Crohn's disease**, which present with different symptoms, often including **malabsorption** and severe diarrhea.
- While lactose intolerance can be confirmed by measuring lactase activity in a biopsy, it is not the primary or least invasive diagnostic method.
*Abnormal abdominal ultrasound*
- An **abdominal ultrasound** is often used to visualize organs and detect issues like **gallstones**, **appendicitis**, or structural abnormalities.
- It would not directly diagnose lactose intolerance, as the condition is related to an **enzymatic deficiency**, not a structural abnormality visible on ultrasound.
*Negative hydrogen breath test*
- A **negative hydrogen breath test** would indicate that the patient is **not lactose intolerant**, as it would show a minimal increase in hydrogen levels after lactose ingestion.
- This contradicts the patient's clear history of symptoms specifically associated with dairy consumption.
Question 12: A 5-year-old boy is brought to the emergency department by a neighbor who saw him struck by a car. The man reports that the boy is intellectually disabled, and his parents frequently leave him unattended at home for most of the day. He walks around the neighborhood and sometimes has difficulty finding his way home. Today he was struck by a car that sped off. The man called the boy’s mother by phone, but she said that she was too busy to leave her job and asked the man to take the boy to the emergency department for her. A quick review of the boy's electronic medical record reveals that he has not been seen by a physician in several years and has missed several vaccines. On physical exam, the vital signs are normal. He appears dirty, thin, and small for his age with a large bruise forming on his right hip. Which of the following is the most appropriate term for this type of child abuse?
A. Psychological abuse
B. Factitious disorder
C. Physical abuse
D. Sexual abuse
E. Neglect (Correct Answer)
Explanation: ***Neglect***
- The parents' failure to provide adequate supervision, medical care (missed vaccines, no physician visits), and basic needs (appears dirty, thin, small for age) for the intellectually disabled child despite being able to do so, constitutes **neglect**.
- Their refusal to come to the ED and leaving him unattended further supports the diagnosis of **neglect**.
*Psychological abuse*
- This involves behaviors that harm a child's **self-worth** or **emotional well-being**, such as constant criticism, threats, or terrorizing.
- While emotional harm may be present due to neglect, the primary and most comprehensive description of the actions is neglect of basic needs and care.
*Factitious disorder*
- This is a mental disorder where an individual fakes or induces illness in themselves or someone else (often a child, known as **Factitious Disorder Imposed on Another**) for attention or sympathy.
- The scenario describes a failure of care rather than a deliberate fabrication or induction of illness.
*Physical abuse*
- This involves causing **physical harm** to a child, such as hitting, burning, or shaking. The large bruise on the hip is a sign of injury, but the *cause* is being struck by a car, not direct parental physical harm.
- While a bruise is present, the overall pattern of parental behavior points to a failure to protect and care rather than direct infliction of injury by the parents on the child.
*Sexual abuse*
- This involves any sexual act or exploitation of a child by an adult.
- There are **no indicators** in the provided scenario to suggest sexual abuse.
Question 13: A 2-week-old infant is brought to the physician by her father because of a 1-week history of vaginal discharge. The discharge was initially clear, but now he notices that it is tinged with blood. The father is also concerned about “bruises” on his daughter's back and buttocks. Both parents work so that the infant spends most of her time in daycare or with her aunt. She was born at term following a pregnancy complicated by maternal gonococcal infection that was treated with antibiotics. She appears well. Physical examination shows mild acne across her cheeks and forehead. There are multiple large flat gray-blue patches on her back and buttocks. An image of one of the lesions is shown. Firm breast buds are present. Genitourinary examination shows erythema and swelling of the vulva and vagina with an odorless, blood-stained white discharge. Which of the following is the most appropriate next step in management?
A. Ceftriaxone and doxycycline therapy
B. Reassurance (Correct Answer)
C. Ceftriaxone therapy
D. Leuprolide therapy
E. Fluconazole therapy
Explanation: ***Reassurance***
- The manifestations described are **physiological newborn findings** due to maternal hormone withdrawal and hyperpigmentation, requiring no intervention.
- **Vaginal discharge and mild bleeding** are common in female infants due to declining maternal estrogen levels, while **Mongolian spots** (gray-blue patches) are benign pigmented lesions.
*Ceftriaxone and doxycycline therapy*
- This combination is used to treat **gonorrhea and chlamydia coinfection**, but the mother was already treated and the infant shows no signs of active infection.
- The vaginal discharge is physiological, and there are no other symptoms to suggest a sexually transmitted infection in the infant.
*Ceftriaxone therapy*
- Ceftriaxone is used to treat **gonococcal infections**, but the maternal infection was previously treated, and the infant's symptoms are physiologic.
- Administering antibiotics without clear signs of infection is inappropriate and can lead to **antibiotic resistance**.
*Leuprolide therapy*
- Leuprolide is a **GnRH agonist** used to treat **precocious puberty**, which is not indicated here as the breast buds and vaginal discharge are physiological.
- The infant's symptoms are a normal response to changes in maternal hormones, not an endocrine disorder.
*Fluconazole therapy*
- Fluconazole is an **antifungal medication** used to treat **candidiasis**, which is not indicated in this case as the vaginal discharge is odorless and not suggestive of a fungal infection.
- The infant's symptoms are physiological and not indicative of an infectious process requiring antifungal treatment.
Question 14: A child with which of the following diseases would have the highest morbidity from being outside during a hot summer day?
A. Cerebral palsy
B. Cystic fibrosis (Correct Answer)
C. Asthma
D. Tay-Sachs disease
E. Down syndrome
Explanation: ***Cystic fibrosis***
- Patients with **cystic fibrosis** have a defect in the **CFTR channel**, which leads to abnormal chloride and water transport, resulting in highly concentrated sweat.
- This excessive loss of **sodium chloride** can rapidly lead to **dehydration** and electrolyte imbalances (hyponatremia, hypochloremia) in hot weather, increasing morbidity.
*Cerebral palsy*
- While children with **cerebral palsy** may have difficulty with mobility and thermal regulation, their primary challenge in hot weather is generally not unique physiological vulnerability to heat.
- Their morbidity would be related to other **comorbidities**, not a direct physiological challenge with heat.
*Asthma*
- **Asthma** can be exacerbated by hot, humid air or air pollution, but it does not directly lead to unique electrolyte imbalances or rapid dehydration from heat exposure itself.
- The morbidity relates to **respiratory distress** rather than a primary issue with fluid and electrolyte balance in heat.
*Tay-Sachs disease*
- **Tay-Sachs disease** is a progressive neurodegenerative disorder with no direct physiological vulnerability to hot weather different from other children.
- Morbidity is related to progressive neurological deterioration, not heat intolerance or **electrolyte disturbances**.
*Down syndrome*
- Children with **Down syndrome** may have cardiac or respiratory issues, and some may have decreased sweating capacity, but they do not typically undergo extreme **electrolyte loss** through sweat like those with cystic fibrosis.
- While heat exposure should be managed carefully, their risk of heat-related morbidity is secondary to their general health challenges rather than a specific defect in sweat composition.
Question 15: A 3-year-old boy is brought to the pediatrician by his parents because of swelling and tenderness of his left upper arm. According to the father, the boy was running in the garden when he fell and injured his arm 2 days ago. His mother had been on a business trip the past week. The boy's father and 18-year-old brother had been taking care of the patient during that time. The mother reports that she noticed her son refusing to use his left arm when she returned from her business trip. Both parents claim there is no history of previous trauma. The boy is at the 60th percentile for height and 40th percentile for weight. The patient clings to his mother when approached by the physician. Physical examination shows swelling and bruising of the medial left upper arm and tenderness along the 8th rib on the left side. An x-ray of the arm and chest shows a nondisplaced spiral fracture of the left proximal humeral shaft and a fracture with callus formation of the left 8th rib. Which of the following is the most appropriate next step in management?
A. Notify Child Protective Services (Correct Answer)
B. Contact brother for clarification
C. Hospitalize the boy for further evaluation
D. Arrange for surgical treatment
E. Screen for defective type I collagen
Explanation: ***Notify Child Protective Services***
- The combination of a **spiral fracture** in a young child and a **healing rib fracture** is highly suggestive of **non-accidental trauma/child abuse**, especially given the inconsistent history provided by the parents.
- Physicians have a legal and ethical obligation to report suspected child abuse to **Child Protective Services (CPS)** for investigation and protection of the child.
*Contact brother for clarification*
- While gathering more information is generally helpful, relying solely on the brother's clarification is insufficient, as he may also be involved or unwilling to disclose the truth.
- The immediate priority in suspected child abuse is ensuring the child's safety and initiating a formal investigation through the proper channels.
*Hospitalize the boy for further evaluation*
- Hospitalization for further evaluation might be considered after reporting to CPS, especially if there are concerns about the child's immediate safety or medical stability, but it is not the *most appropriate first step* in addressing the suspicion of abuse.
- The primary concern is protecting the child from potential ongoing harm, which requires the involvement of CPS.
*Arrange for surgical treatment*
- While the fractures may eventually require treatment, prioritizing surgical intervention over addressing the potential abuse would be inappropriate.
- The immediate and most critical step is to investigate the cause of the injuries through official channels to prevent future harm.
*Screen for defective type I collagen*
- Conditions like **osteogenesis imperfecta**, which involve defective type I collagen, can cause recurrent fractures, but the specific pattern of injuries (spiral fracture, healing rib fracture) and the inconsistent history are far more indicative of abuse than a genetic disorder in this context.
- Screening for a genetic condition would be considered after ruling out abuse, or if there were other signs suggestive of a genetic bone disorder (e.g., blue sclera, dentinogenesis imperfecta).
Question 16: A three-year-old girl presents to general pediatrics clinic for a well-child visit. Her mother reports that she has been growing and developing normally but because of new behaviors she has noticed with her child, she is concerned of possible abuse by the child's stepfather. Vital signs are stable and the physical examination is within normal limits. The child has no visual signs of abuse. Which of the following, if reported by the mother would signify potential sexual abuse in the child?
A. Asking questions about reproduction
B. Looking at another child's body parts while playing "doctor"
C. Cross-dressing
D. Simulating intercourse (Correct Answer)
E. Masturbation
Explanation: ***Simulating intercourse***
- **Simulating intercourse** is an **age-inappropriate sexually aggressive behavior** that is highly suggestive of sexual abuse in a three-year-old.
- This behavior indicates the child has witnessed or experienced sexual acts beyond normal curiosity.
*Asking questions about reproduction*
- Children naturally develop **curiosity about the human body** and reproduction as they grow.
- While it can be a sign of increased awareness, by itself, it does not suggest sexual abuse.
*Looking at another child's body parts while playing "doctor"*
- **Childhood play**, including "doctor," often involves exploring body parts in a natural, curious way.
- This is a common and typical developmental behavior and does not automatically signify abuse without other concerning signs.
*Cross-dressing*
- **Cross-dressing** is often related to a child's **exploration of identity** and gender roles, which is a normal developmental process.
- It is not indicative of sexual abuse as it's separate from sexual acts.
*Masturbation*
- **Masturbation** is a common and **normal self-exploratory behavior** in children from a very young age.
- It is part of typical development and does not, in itself, suggest sexual abuse.
Question 17: A new mother brings in her 4-week-old son who has no significant past medical history but she complains of a new, itchy rash on his body. The patient has an older sister who developed similar symptoms when she was around the same age. The patient's blood pressure is 75/50 mm Hg, pulse is 140/min, respiratory rate is 40/min, and temperature is 37.3°C (99.1°F). Physical examination reveals confluent, erythematous patches and plaques with tiny vesicles and scaling overlying his lower back and abdomen. When questioned about possible etiologies, the mother notes that she has been bathing the patient at least twice a day. Which of the following statements is most appropriate for this patient?
A. Usually, scabs with a distinctive yellow, gold, or brown crust are seen.
B. This condition is usually seen on the scalp, face, ears, and neck.
C. Hot baths that are too long, or too frequent, can dry out the skin. (Correct Answer)
D. You can expect blisters, fever and large areas of skin that peel or fall away.
E. This condition is caused by the herpes simplex virus.
Explanation: ***Hot baths that are too long, or too frequent, can dry out the skin.***
- The rash described (confluent, erythematous patches and plaques with tiny vesicles and scaling) on a 4-week-old, along with a history of an older sibling with similar symptoms, is highly suggestive of **atopic dermatitis** (eczema).
- Frequent, prolonged hot baths **strip the skin of its natural oils**, exacerbating skin dryness and disrupting the skin barrier, a known trigger for atopic dermatitis flares in infants.
- Given the mother's history of bathing twice daily, counseling about appropriate bathing frequency is the most relevant management advice.
*Usually, scabs with a distinctive yellow, gold, or brown crust are seen.*
- **Yellow, gold, or brown crusts** are characteristic of **impetigo**, a bacterial skin infection, not typically seen as the primary presentation of atopic dermatitis.
- While eczema can become secondarily infected with bacteria (impetiginization), these crusts are not the defining feature of uncomplicated eczema.
*This condition is usually seen on the scalp, face, ears, and neck.*
- While this describes the typical distribution of **seborrheic dermatitis** (cradle cap) in infants, atopic dermatitis in young infants commonly affects the **face (especially cheeks) and extensor surfaces**.
- In this case, the presentation on the lower back and abdomen, while somewhat atypical, is consistent with atopic dermatitis, especially given the family history and identified trigger factor.
*You can expect blisters, fever and large areas of skin that peel or fall away.*
- The description of **blisters, fever, and large areas of peeling skin** is characteristic of severe conditions like **Stevens-Johnson syndrome (SJS)** or **Toxic Epidermal Necrolysis (TEN)**, which are much more severe and life-threatening.
- The rash described in this patient does not indicate such a severe systemic reaction and is consistent with uncomplicated infantile atopic dermatitis.
*This condition is caused by the herpes simplex virus.*
- The herpes simplex virus causes **herpes simplex** infections, which manifest as clustered vesicles on an erythematous base (e.g., eczema herpeticum when it complicates atopic dermatitis).
- **Atopic dermatitis** is a chronic inflammatory skin condition with genetic predisposition and environmental triggers, not a primary viral infection.
Question 18: A 5-year-old child whose family recently immigrated from Africa is brought in for a wellness visit. The boy appears indifferent, doesn’t seem to make eye contact, and keeps to himself. Upon examination, it is noted that his height and weight are below the 5th percentile. Furthermore, his abdomen is protuberant, and there are multiple zones of hyper- and hypopigmentation and desquamation of the skin. Upon palpation of the abdomen, he is found to have hepatomegaly, and lower extremity inspection reveals pitting edema. Which of the following is the cause of this child’s condition?
A. Vitamin A deficiency
B. Total caloric deprivation
C. Severe protein malnutrition (Correct Answer)
D. Secondary protein-energy malnutrition
E. Hypothyroidism
Explanation: ***Severe protein malnutrition***
- The constellation of **pitting edema**, **protuberant abdomen** (due to ascites), **hypopigmentation** and **desquamation** of skin, and general indifference in a child from Africa strongly points to **kwashiorkor**, a form of severe protein malnutrition.
- **Hepatomegaly** can occur due to fatty liver changes caused by impaired triglyceride transport from the liver, which is dependent on adequate protein synthesis.
*Vitamin A deficiency*
- Primarily causes **ocular symptoms** like night blindness (**nyctalopia**) and conjunctival xerosis.
- While it can impair immune function and contribute to growth failure, it does not typically cause the prominent edema, skin changes, or hepatomegaly seen in this case.
*Total caloric deprivation*
- This typically leads to **marasmus**, characterized by severe wasting and a "skin and bones" appearance due to depletion of both fat and muscle stores.
- **Edema** is generally absent in marasmus, which distinguishes it from kwashiorkor.
*Secondary protein-energy malnutrition*
- This type of malnutrition results from **underlying diseases** (e.g., chronic infections, malabsorption) rather than primary dietary insufficiency.
- While the symptoms could overlap, given the child's origin from Africa, **primary dietary deficiency** is a more direct and common cause for these specific signs.
*Hypothyroidism*
- Characterized by **growth retardation**, **constipation**, **lethargy**, and **cold intolerance**.
- While some features like indifference and growth stunting might overlap, hypothyroidism does not typically cause **pitting edema**, severe skin abnormalities, or the specific type of hepatomegaly observed here.
Question 19: A 5 month-old boy with no significant past medical, surgical, or family history is brought the pediatrician by his parents for a new rash. The parents state that the rash started several weeks earlier and has not changed. The boy has breastfed since birth and started experimenting with soft foods at the age of 4 months. Physical examination reveals erythematous plaques with shiny, yellow scales over the scalp and external ears. Vital signs are within normal limits. Complete blood count is as follows:
WBC 8,300 cells/ml3
Hct 46.1%
Hgb 17.1 g/dL
Mean corpuscular volume (MCV) 88 fL
Platelets 242
Which of the following is the most likely diagnosis?
A. Infantile seborrheic dermatitis (Correct Answer)
B. Tinea capitis
C. Pityriasis amiantacea
D. Atopic dermatitis
E. Langerhans cell histiocytosis
Explanation: ***Infantile seborrheic dermatitis***
- This condition commonly presents in infants with **erythematous plaques and greasy, yellowish scales** on the scalp (**cradle cap**) and sometimes extending to the ears, face, and diaper area.
- The onset usually occurs in the first few months of life, and it is typically **self-limiting** and resolves spontaneously.
*Tinea capitis*
- This is a **fungal infection** of the scalp, presenting with **scaly patches, alopecia, and sometimes pustules**; it is less likely to present with shiny, greasy scales.
- It often causes **pruritus** and can lead to lymphadenopathy, which are not described in this case.
*Pityriasis amiantacea*
- Characterized by **thick, silvery or yellowish scales** that tightly adhere to the hair shafts, binding them together.
- While it involves scales on the scalp, the scales in this condition are typically **dry and tightly adherent**, differentiating it from the greasy scales seen in seborrheic dermatitis.
*Atopic dermatitis*
- Typically presents with **erythematous, itchy, and dry skin lesions** (eczema), often with excoriations due to scratching.
- While it can affect the scalp, the characteristic **greasy, yellowish scales** described are not typical of atopic dermatitis.
*Langerhans cell histiocytosis*
- This is a rare disorder that can present with **seborrheic dermatitis-like rash** but is often accompanied by other systemic symptoms like **fever, lymphadenopathy, hepatosplenomegaly**, or bone lesions.
- The patient's otherwise healthy state and normal blood counts make this diagnosis less likely.
Question 20: An infant boy is brought to the physician for a well-child examination. He was born at term and has been healthy since. He is beginning to crawl but can not yet walk or run. He feeds himself small foods and can bang 2 cubes together. He is just beginning to successfully use a pincer grasp. He has stranger anxiety. He is at the 40th percentile for height and weight. Physical examination shows no abnormalities. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
A. Follows one-step commands
B. Says mama or dada (Correct Answer)
C. Enjoys peek-a-boo
D. Gives objects to others
E. Knows 3–6 words
Explanation: ***Says mama or dada***
- The infant is at roughly **9–10 months** based on developmental milestones like crawling, banging cubes, developing pincer grasp, and stranger anxiety.
- At this age, saying **"mama" or "dada" specifically** (not just babbling) is a common and expected **emerging language milestone**.
- This represents a NEW skill being acquired at this developmental stage.
*Follows one-step commands*
- Following one-step commands, especially without gestures, is typically a milestone achieved later, around **12–15 months** of age.
- The infant's current stage of development, particularly concerning language acquisition, indicates they are not yet at this level of comprehension.
*Enjoys peek-a-boo*
- While infants at **9–10 months** do enjoy peek-a-boo, this is not a NEW or emerging skill at this age.
- Peek-a-boo is typically enjoyed starting around **6–9 months** and represents an **already established** skill by this developmental stage.
- The question asks for "additional skills expected" at this age, and "mama/dada" is the emerging milestone, whereas peek-a-boo enjoyment is already well-developed.
*Gives objects to others*
- **Giving objects to others** as a communicative gesture or to share is a more complex social milestone, typically emerging around **12–15 months** of age.
- This action requires a greater understanding of social interaction and reciprocity than what's expected for this infant's current stage.
*Knows 3–6 words*
- Knowing and using **multiple specific words** (3-6 words) is a language milestone typically reached closer to **12–15 months**.
- At 9–10 months, the infant is just beginning to say specific words like "mama" or "dada", indicating an earlier stage of vocabulary development.
