Growth/Development — MCQs

An 8-year-old boy presents to his pediatrician for a well visit. His parents state that he has been doing well in school and has many friends. The patient is a member of the chess club and enjoys playing video games. He has a past medical history of asthma which is treated with albuterol. The patient is in the 99th percentile for weight and 30th percentile for height. His temperature is 99.5°F (37.5°C), blood pressure is 122/88 mmHg, pulse is 90/min, respirations are 11/min, and oxygen saturation is 98% on room air. The patient's body mass index is 39.1 kg/m^2 at this visit. On physical exam, you note a young boy who maintains eye contact and is excited to be at the doctor's office. Cardiopulmonary exam is within normal limits. Abdominal exam reveals normal bowel sounds and is non-tender in all 4 quadrants. Neurological and musculoskeletal exams are within normal limits. Which of the following is the most likely outcome in this patient?

A 4-year-old boy is brought to the physician because of non-fluent speech. His mother worries that his vocabulary is limited for his age and because he cannot use simple sentences to communicate. She says he enjoys playing with his peers and parents, but he has always lagged behind in his speaking and communication. His speech is frequently not understood by strangers. He physically appears normal. His height and weight are within the normal range for his age. He responds to his name, makes eye contact, and enjoys the company of his mother. Which of the following is the most appropriate next step in management?

A previously healthy 6-month-old girl is brought to the physician by her mother for occasional “eye crossing.” Her mother says that the symptoms have become worse, especially before bedtime. The patient was born via cesarean delivery at 37-weeks' gestation and has met all developmental milestones. The patient's immunizations are up-to-date. She is at the 50th percentile for both length and weight. Her temperature is 36.7°C (98°F), pulse is 130/min, respirations are 40/min, and blood pressure is 90/60 mm Hg. Visual acuity is 20/20 in both eyes. There is an asymmetric corneal light reflection. When the left eye is covered, the right eye moves laterally. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in the management of this patient?

A 2-month-old boy presents to the clinic with his mother for evaluation of crusty, greasy patches on the skin of the scalp that appeared 1 week ago. The mother states that the patient has been acting normally and is feeding well. She had a vaginal birth with no complications. On examination, the patient is smiling and playful in his mother’s arms. He can hold his head up and focus on faces and is happily gurgling. Vital signs are stable and weight, length, and head circumference measurements are all within normal limits. The skin on the scalp appears greasy, with yellow, scaly patches and evidence of inflammation. What is the most likely diagnosis?

A 5-week-old male infant is brought to the Emergency Department with the complaint of vomiting. His parents state he has been unable to keep normal feedings down for the past week and now has projectile non-bilious vomiting after each meal. He was given a short course of oral erythromycin at 4 days of life for suspected bacterial conjunctivitis. Physical examination is significant for sunken fontanelles and dry mucous membranes. A palpable, ball shaped mass is noted just to the right of the epigastrium. Which of the following conditions is most likely in this patient?

A 6-year-old girl is brought to the emergency department because of abdominal pain, vomiting, and fatigue for the past 4 hours. Over the past month, she has had a 4-kg (8.8-lb) weight loss, increased thirst, and increased urinary frequency. Examination shows dry mucous membranes, decreased skin turgor, and hyperventilation with a fruity odor. Laboratory studies show a blood glucose level of 420 mg/dL and acetoacetate in the urine. Which of the following is the most likely inheritance pattern of this patient's underlying condition?

A 1-year-old boy is brought to the physician because of irritability and poor feeding that began 2 days ago. His mother reports that he has been crying more than usual during this period. He refused to eat his breakfast that morning and has not taken in any food or water since that time. He has not vomited. When changing the boy's diapers this morning, the mother noticed his urine had a strong smell and pink color. He has not passed urine since then. He was born at term and has been healthy. He appears ill. His temperature is 36.8°C (98.2°F), pulse is 116/min, and blood pressure is 98/54 mm Hg. The boy cries when the lower abdomen is palpated. Which of the following is the most appropriate next step in management?

A 7-year-old boy is brought to the clinic by his mother due to a sudden onset of puffiness of the eyes. His mother is also concerned about his abdominal distention which she first noticed 5 days ago. There is no history of a recent upper respiratory tract infection, decreased urination, or gross hematuria. His vaccinations are up to date. His vitals include: heart rate 86/min, respiratory rate 16/min, temperature 37.6°C (99.7°F), and blood pressure 100/70 mm Hg. Physical examination findings include periorbital edema and abdominal distention with a fluid thrill. Laboratory evaluation reveals the following findings: Urinalysis Protein 4+ Urinary protein 4 g/L Creatinine ratio 2.6 Red blood cells Nil White blood cells Nil Urinary casts Fatty casts Serum creatinine 0.4 mg/dL > Serum albumin 1.9 g/dL Serum cholesterol 350 mg/dL Ultrasonogram of the abdomen reveals kidneys with normal morphology and gross ascites. Which of the following statements best describes the complications that this boy may develop?

A 16-year-old teenager presents to the pediatrician with his mother. After she leaves the room he tells the physician that he is worried about puberty. All of his friends have had growth spurts, started building muscle mass, and their voices have changed while he still feels underdeveloped. The physician takes a complete history and performs a thorough physical examination. He goes through the patient’s past medical records and growth charts and notes physical findings documented over the last five years, concluding that the patient has delayed puberty. Which of the following findings supports his conclusion?

A 2-year-old boy is brought to the emergency department by his parents because of facial swelling that has now progressed to total body swelling. He also complains of nausea and abdominal pain. The child was in his usual state of health a week ago when they first notice swelling around his eyes. A few days later his legs started to swell. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today, his blood pressure is 104/60 mm Hg, the heart rate is 90/min, the respiratory rate is 25/min, and the temperature is 37.1°C (98.8°F). On examination, he has facial edema, abdominal shifting dullness, and bilateral leg edema up to the knees. Urine dipstick shows 4+ protein and urinalysis shows fatty casts. Serum albumin is 2.2 g/dL. Which of the following is the most likely etiology of this patient condition?