Growth & Development I
At which age are 90% of infants likely to demonstrate a "social smile"
A. one week
B. one month
C. Birth
D. 2 weeks
E. 2 months
E. 2 months
At what age can the majority of children regard and "rake" for a raisin without grasping it?
A. 12 months
B. 10 months
C. 8 months
D. 6 months
E. 4 months
D. 6 months
On physical examination, an 8mo boy is noted to have injected conjunctivae associated with moist erythematous lesions, some with associated bullae and crusting, located primarily around his mouth, nose, and perineum. His mother describes him as lethargic, often very irritable, with frequent loose stools and poor feeding. His weight, which has been at the 55th percentile during the first 6mo of life, is now at 30th percentile. He was breastfed for the first 6 months of life and is currently fed a cow's milk-based formula, rice cereal, fruits and vegetables.
This patient is most likely deficient in which of the following dietary elements?
A. Selenium
B. Copper
C. Manganese
D. Zinc
E. Iodine
D. Zinc
A 14yo female with cystic fibrosis presents with poor growth and complaint of increased bruising. She admits that she has been using her replacement pancreatic enzymes inconsistently.
The patient is most likely deficient in which vitamins?
A. A, B12, and K
B. A, B6, D, and K
C. A, D, E, and K
D. A, C, D, and E
E. B1, D, E, and K
C. A, D, E, and K
A 17yo girl is transported to the ED after being found sitting alone in the bathroom "drooling and talking like she was crazy". She and several of her friends "snuck into a party" and were just "hanging out drinking" when the patient's friends noticed she was missing. On exam, she is disoriented to time, place, and person; unable to recognize friends and family members; extremely anxious and frightened; and drooling excessively. Her blood pressure is 70/38, and her HR is 140. Her initial temperature is 102.2F but drops to 99.4F within minutes. On cranial nerve testing, prominent nystagmus is observed. She is noted to have very brisk deep tendon reflexes, with a 2-3 beat ankle clonus in lower extremities.
Which of the following substances is the most likely cause of her clinical findings?
A. Narcotic analgesics
B. Phencyclidine (PCP)
C. Cocaine
D. Heroin
E. MDMA aka Molly
B. Phencyclidine (PCP)
During a health maintenance visit, a male patient is able to hold a Cheerio between the fingertip of the index finger and the thumb, with the distal thumb joint flexed and the proximal thumb joint only slightly flexed.
By what age do the majority of infants accomplish this developmental milestone?
A. 2 months
B. 6 months
C. 4 months
D. 15 months
E. 12 months
E. 12 months
The parents of a 29 week of gestation, premature infant ask you about the child's growth prognosis. The child's weight is appropriate for age, and she has a fairly benign NICU course, requiring intubation for only 5 days.
At which point is the child most likely to complete catch-up growth with her term counterparts?
A. By 2 years of age
B. By the time of discharge from the NICU
C. The child is not expected to recapture normal growth
D. By the onset of adolescence
E. At 11 weeks of age - expected delivery date
A. By 2 years of age
A mother is wanting to breastfeed her newborn who was born at 33 weeks of gestation. The mother is lamotrigine for a seizure disorder and took the recommended dose of 4mg/day of folic acid prior to and during pregnancy. The baby is doing well with no signs of neural tube defect. The mother is vegan and has had breast implants.
Which of the following is correct advice for this mother?
A. Breastfeeding is contraindicated because the mother is taking lamotrigine
B. It is recommended that she formula feed her child to meet the increased protein need because he was born prematurely
C. The breast implants preclude her from breastfeeding her baby
D. The mother needs to be taking a Vitamin B12 supplement
E. If breastfeeding, she will need to add a fortifier to breast milk at 6 months of age
D. The mother needs to be taking a Vitamin B12 supplement
A 7 week old male born at 27 weeks gestation is noted to have become edematous over the last several days. Thrombocytosis and evidence of hemolytic anemia are documented during subsequent evaluation.
These clinical and laboratory findings are consistent with deficiency of which of the following?
A. Vitamin E
B. Vitamin B6 (pyridoxine)
C. Vitamin B1 (thiamine)
D. Copper
E. Zinc
A. Vitamin E
A 2mo child presents for their first well child visit. Review of the patient's newborn screen demonstrates HbFAS on hemoglobin electrophoresis.
Which of the following complications is most commonly associated with this patient's diagnosis?
A. Renal papillary necrosis
B. Renal medullary carcinoma
C. Aplastic crisis (red cell aplasia)
D. Acute chest syndrome
E. Pain (vaso-occlusive) crisis
A. Renal papillary necrosis
During a routine health maintenace examination for a 3 yo girl, you complete a developmental assessment.
Which of the following findings is most concerning for a delayed milestone?
A. Speaks with 75% intelligibility to non-family members
B. Interacts well with other children while playing by sharing and taking turns
C. Walks upstairs with support, placing both feet on each step
D. Dresses self without assistance, but has difficulty with buttons
E. Includes 4 body parts when drawing a person
C. Walks upstairs with support, placing both feet on each step
A child can run well, build a tower of 5 blocks, and walk up and down stairs, placing 2 feet on each step. They have a vocabulary of 50-100 words, use 2 word phrases, and can identify 6 body parts.
What of the following is likely to be their age?
A. 24 months
B. 18 months
C. 36 months
D. 12 months
E. 9 months
A. 24 months
A 4yo girl presents for a well child visit. She can throw a ball overhand, copy a square, button her shirt, count to 4, knows 500 words, and her speech is 100% understandable. She has no food allergies. Her height is at 70th percentile, and her weight and BMI are at the 98th percentile. Her vital signs and exam are normal.
Which of the following limitations regarding beverage consumption is the most appropriate in this patient?
A. < 45mg of caffeine per day
B. </= 40oz of non-fluoridated water per day
C. < 16oz of 100% fruit juice per day
D. </= 24oz of unflavored skim milk per day
E. < 8oz of sugar sweetened beverages per day
D. </= 24oz of unflavored skim milk per day
The parents of a 10mo boy present with the concern that their son has "yellow jaundice". They report that he is otherwise well with the exception that his stools are a little more frequent. On physical exam, his skin has a yellowish hue, most prominent on the palms, soles, cheeks, and tip of nose. His conjunctivae are clear.
Which of the following is likely to provide the explanation for this patient's clinical findings?
A. Hepatitis panel
B. Abdominal ultrasound
C. Dietary history
D. Liver Biopsy
E. Sending stool for fat and reducing substances
C. Dietary history
Accumulation of carotene (carotenemia) due to a diet with yellow-orange vegetables. Will see yellowish discoloration on certain parts of skin excluding sclera.
In hyperbilirubinemia - will see scleral icterus before skin discoloration
Given this history, which of the following is the most likely congenital heart lesion?
A. A small muscular ventricular septal defect
B. Tetralogy of Fallot
C. Coarctation of the aorta
D. A bicuspid aortic valve with aortic valve stenosis
E. A closing patent ductus arteriosus
A. A small muscular ventricular septal defect
On a neurologic development level, children are able to copy different shapes in a regular order.
Which of the following is the correct sequence in which children can copy these forms?
A. Square, Cross, Circle
B. Circle, Square, Cross
C. Circle, Cross, Square
D. Cross, Square, Circle
E. Diamond, Square, cross
C. Circle, Cross, Square
Which of the following is the correct method to calculate midparental height for a girl?
A. (Mother's height + [Father's height + 5 inches])/2
B. (Mother's height + [Father's height - 5 inches])/2
C. (Mother's height - 5 inches) + [Father's height)/2
D. (Mother's height + Father's height)/2
E. (Mother's height + Father's height) - (5 inches/2)
B. (Mother's height + [Father's height - 5 inches])/2
Which of the following clinical manifestations is most likely associated with these radiographic findings?
A. Bitot Spots
B. Austin Flint murmur
C. Argyll Robertson pupils
D. Hutchinson Teeth
E. Scoliosis
E. Scoliosis
A 5yo boy presents for a well child exam. He is healthy and active, but spends most of his time indoors playing quietly. He will begin kindergarten next year. His exam is normal. His growth has been excellent. His father describes him as a "picky eater". He does not drink milk but eats some cheese. He eats a wide variety of other foods. His father is concerned that he will become vitamin D deficient if he does not drink milk. You explain the various sources and actions of vitamin D in the body.
What is the primary role of 1,25-(OH)2-D?
A. Stimulate absorption of phosphorus from the stomach and resorption of calcium from the kidney.
B. It has no function except to be a prohormone for vitamin D.
C. Stimulate absorption of calcium and phosphorus from the small intestine and maintenance of calcium levels in bone.
D. It stimulates the excretion of parathyroid hormone
E. It gives bones structural support.
C. Stimulate absorption of calcium and phosphorus from the small intestine and maintenance of calcium levels in bone.
A 17 yo male with no significant PMHx is new to your office for screening for sexually transmitted infections. When interviewed alone, he admits to using IV drugs for the past two years and having >10 sexual partners over that time. Testing for syphilis, gonorrhea, chlamydia, and HIV are negative. You order a hepatitis panel, which shows a positive hepatitis C virus antibody.
What is the best next step in management of this patient?
A. Order HCV viral load to determine the amount of active virus.
B. Confirm the antibody test with recombinant immunoblot assay
C. Screen for cirrhosis with an ultrasound of the liver
D. No further testing is needed because he is immune to HCV
E. Begin treatment with direct-acting antiviral medications
B. Confirm the antibody test with recombinant immunoblot assay
During a well-child examination, a 4yo child is asked to draw a person. The drawing has 2 eyes, a nose, a mouth, hair, and 2 legs.
Which of the following is the calculated age equivalent (age level) of this child based on the components of his drawing?
A. 3.75 years of age
B. 4.25 years of age
C. 6 years of age
D. 5 years of age
E. 3.50 years of age
B. 4.25 years of age
Each point converts to a value of 1/4 added to base of 3
One point each is given to: 2 eyes, 2 ears, a nose, a mouth, hair, 2 arms, 2 legs, 2 hands, 2 feet, a neck, and a trunk.
A 16mo new patient presents to your office for her well child exam. A review of her records reveals that her head circumference was normal at birth but increased with the onset of a seizure disorder at 6 months of age. Since then, her head circumference has been above 98th percentile. She has recently taken her first steps and babbles but has no recognizable words. Anterior fontanelle is still open and flat. Generalized hypotonia is noted on exam, but the rest of the exam is unremarkable.
What is the most likely cause for this child's macrocephaly?
A. Space-occupying lesion
B. Benign familial megalencephaly
C. Metabolic megalencephaly
D. Hydrocephalus
E. Benign enlargement of subarachnoid space
C. Metabolic megalencephaly
You are caring for a 12mo girl who emigrated from Bolivia about 1 month ago. Her parents have brought her in today for persistent diarrhea and a rash on her lower extremities that has lasted approximately 3 months now. She began solid foods at 4 months of age. Her mother stopped breastfeeding at 6 months of age due to poor supply and poor nutrition herself. The patients' growth has been static for the past 3 months. After taking a careful dietary history, you learn that her diet has mostly consisted of corn mash, some cows milk and goats milk, and a few vegetables. You suspect she has pellagra (Niacin Deficiency).
Which of the following features of the dietary history are most consistent with your suspicion of pellagra?
A. Slow growth
B. Goat's milk consumption
C. Lack of breast milk
D. Cow's milk consumption
E. Corn mash consumption
E. Corn mash consumption
An 18 month boy is transported to the ED following removal from his home due to medical neglect. On physical exam, he appears cyanotic and severely malnourished. Skin exam reveals no petechiae or purpura. His respiratory rate is 38 BPM, HR 140. A gallop rhythm is noted on auscultation. CXR reveals cardiomegaly, especially on the right side of the heart.
Which of the following vitamin deficiencies is the most likely cause of his symptoms?
A. Vitamin B1 (thiamine)
B. Vitamin B2 (riboflavin)
C. Vitamin A
D. Vitamin B6 (pyridoxine)
E. Vitamin C
A. Vitamin B1 (thiamine)
A 3yo boy presents for this first health maintenance visit after arriving to the US from an orphanage in the DR. His adoptive parents know little about his past medical history, except that the patient was abandoned by his birth mother soon after birth. On physical exam, his neck appears shortened and broad, and he has low occipital hairline. A plain radiograph shows evidence of fusion and hypoplasia of the C3-C7 vertebrae.
Which of the following is most likely to be identified during additional evaluation of this patient?
A. Hypoplastic scapula
B. Hemihypertrophy
C. Pseudoarthrosis of the clavicle
D. Varicose veins
E. Absent radii
A. Hypoplastic scapula