Review Test

1.The parents bring a 13-month-old child to the office for a routine health maintenance visit. The child has been well since the last health maintenance visit, and the parents have no concerns today. The parents report he is sleeping through the night in his own crib and has a balanced diet and normal elimination patterns. During your physical examination, you perform a screening developmental evaluation. Which of the following findings on your developmental assessment would be most likely to merit a referral for a more thorough developmental evaluation?

A.The child cruises but is not walking independently.

B.The child’s only words are mama, dada, dog, and ball.

C.The child is afraid of strangers.

D.The child neither eats with a spoon nor drinks from a cup.

E.The child appears to be left-handed.

2.You are seeing a 1-month-old male infant in your office for a routine health maintenance visit. He was born at 32 weeks’ gestation and had Apgar scores of 3 at 1 minute and 8 at 5 minutes. His hospital course was unremarkable, and he has been feeding and growing well since going home. His mother is now concerned that he is at a higher risk for cerebral palsy because of his prematurity. It would be most appropriate to make which of the following comments?

A.It is unlikely that the child has cerebral palsy because his growth and development so far are normal.

B.If cerebral palsy does develop, it will cause loss of developmental milestones.

C.The child is at very high risk for cerebral palsy because of his prematurity.

D.Repeated examinations will be necessary to assess for cerebral palsy.

E.Laboratory testing can determine whether the child has cerebral palsy.

3.At a routine health maintenance visit, the parents of a 1-year-old child would like to learn more about toilet training. Which of the following information is most appropriate to give the parents?

A.It is important that toilet training begin now.

B.Toileting is a skill to be learned just like any other and depends on the interests and readiness of the child.

C.It is important that the parents establish control over toileting now or the pattern will be set for losing power struggles later.

D.Toilet training should be finished as soon as possible for the good of caregivers and the environment.

E.Whatever the parents and grandparents agree on is appropriate.

4.Parents in your practice are concerned about the increased incidence of autism that they have been reading about in the press. Which of the following histories would be most reassuring for parents worried that their child may be diagnosed with autism spectrum disorder?

A.The parents report that their child does not enjoy playing with other children and prefers to play alone.

B.The parents report that their child is clumsy.

C.The parents describe that their child engages in repetitive lining up of objects.

D.The parents report that their child has a fascination with letters and numbers.

E.The parents report that their child has significant language delay.

5.The parents of a 7-year-old boy bring him to see you because of secondary enuresis. He achieved daytime dryness when he was 2.5 years of age and was dry at night by 3 years of age. Recently, he has developed dribbling incontinence, which embarrasses him at school. The parents do not report any recent psychosocial stress, but they are concerned that he trips often

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when he walks quickly or runs. His physical examination is normal, except you cannot elicit an anal wink reflex. Urinalysis and urine culture are both normal. Which of the following would be the most appropriate next management step?

A.Neuroimaging studies of the brain and spine

B.Bladder stretching exercises

C.Trial of desmopressin (DDAVP)

D.Trial of imipramine

E.Psychological counseling

6.You are evaluating a toddler during a routine health maintenance visit, which includes a thorough developmental assessment. The parents report that their son is able to point to three to five body parts, uses approximately 60 words that his parents understand, and says twoword telegraphic phrases. 50% of his words are understandable. Assuming his language skills are normal for age, how old is this child?

A.13 months

B.15 months

C.18 months

D.24 months

E.30 months

7.On screening in the newborn nursery, an infant has an abnormal hearing screen. His examination is otherwise normal. Which of the following etiologic factors most likely explains the hearing loss in this infant?

A.Prenatal factors, such as maternal substance abuse

B.Perinatal factors associated with a preterm or traumatic delivery

C.Postnatal infection, such as meningitis

D.An autosomal recessive genetic defect

E.An autosomal dominant genetic defect

8.The mother of a 9-year-old boy brings him to the pediatrician because her son is exhibiting hyperactivity and inattention in school. Before this year, the boy has performed well in school and has shown no signs of hyperactivity or inattention. His teacher reports that the boy is restless in the classroom and frequently leaves his seat. His mind seems to wander during the teacher’s lectures. On questionnaires, the teacher confirms the inattention and hyperactivity. The boy shows no symptoms at home, and he does well at church school and at camp. Which of the following would be the most appropriate first step in managing this patient?

A.Explaining to the parents that he meets criteria for attention deficit/hyperactivity disorder and what that diagnosis means.

B.Looking for other causes of the hyperactivity and inattention in the differential diagnosis.

C.Beginning an empiric trial of stimulant medication to see whether his symptoms improve with pharmacologic intervention.

D.Working with the school to modify the boy’s assignments and the classroom setting.

E.Referring to a counselor for self-esteem enhancement, social skills training, and behavior modification.

9.The parents of a 3.5-year-old boy are concerned that their son has been experiencing nightmares. On further questioning, you make the diagnosis of night terrors. Which of the following factors would most support your diagnosis of night terrors and not nightmares?

A.This child’s events occur approximately 30 minutes after sleep onset.

B.This child’s events are likely to decrease in frequency after age 3 years

C.The child responds to the parent’s attempts to comfort him during the events.

D.The child becomes alert and oriented immediately after the event.

E.The child does not remember the event the next day.

10. A 2-month-old male infant is brought to your office with concerns about excessive crying.

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Based on the history, you suspect colic. Which of the following findings on your evaluation best supports this diagnosis?

A.The crying spells usually occur in the morning hours, lasting 2 hours every day, 5 days every week.

B.The infant’s weight has decreased and crossed two growth isobars since birth.

C.The parents have noticed an intermittent bulge in the infant’s right inguinal region associated with crying spells lasting anywhere from 2 to 6 hours.

D.The infant has been growing at the 10th percentile consistently since birth, with 3– 4 hours/day of crying, 4 days every week.

E.The infant appears to be thriving but cries for 2 hours every day of the week, more commonly in the early afternoon or evening hours.

11.The parents of an 18-month-old boy are very concerned because he has had several episodes in which he became frustrated and angry, held his breath, and turned blue. Which of the following is appropriate information for parents about breath-holding spells?

A.The spells are voluntary, and the boy is very likely deliberately trying to gain attention from the parents.

B.The age of onset for these spells is unusual.

C.The boy is unlikely to lose consciousness during a spell.

D.An electrocardiogram is indicated if the spells are associated with physical activity.

E.The spells may eventually cause learning disabilities and poor attention if they are allowed to continue.

12.A child is still in the sensorimotor stage of development. He is beginning to look over the high chair to see where a dropped object has gone and is starting to use a brush and comb on his hair. He has not yet started building forts with blocks. Assuming he is normal cognitively, which of the following is most likely his age?

A.6–9 months

B.10–14 months

C.15–18 months

D.18–24 months

E.24–27 months

The response options for statements 13–14 are the same. Please select one answer for each statement in the following set.

A.4 months

B.6 months

C.8 months

D.10 months

E.12 months

For each of the following infants, select the most likely age of the infant based on the infant’s developmental milestones.

1.While playing with blocks with an infant, the infant becomes upset when you hide the blocks out of view. The infant is only able to say mama and becomes upset when his mother leaves the room. He is able to hold a small object between his thumb and his index finger.

2.An infant is able to transfer objects from hand to hand and to sit alone. He is also able to mix both vowel and consonant sounds, although he is not yet saying mama and dada. You are not able to elicit a parachute reaction.

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