Growth/Development — MCQs

A 3-year-old boy presents to the clinic for evaluation of leg pain. This has been persistent for the past 3 days and accompanied by difficulty walking. He has also had some erythema and ecchymoses in the periorbital region over the same time period. The vital signs are unremarkable. The physical exam notes the above findings, as well as some swelling of the upper part of the abdomen. The laboratory results are as follows: Erythrocyte count 3.3 million/mm3 Leukocyte count 3,000/mm3 Neutrophils 54% Eosinophils 1% Basophils 1% Lymphocytes 43% Monocytes 3% Platelet count 80,000/mm3 A magnetic resonance image (MRI) scan of the abdomen shows a mass of adrenal origin. Which of the following is the most likely cause of this patient's symptoms?

A 6-month-old girl is brought to the physician for a well-child examination. She was born at 37 weeks' gestation. Pregnancy and the neonatal period were uncomplicated. The infant was exclusively breastfed and received vitamin D supplementation. She can sit unsupported and can transfer objects from one hand to the other. She babbles and is uncomfortable around strangers. She is at 40th percentile for length and at 35th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. In addition to continuing breastfeeding, which of the following is the most appropriate recommendation at this time?

A six-month-old male presents to the pediatrician for a well-child visit. The patient’s mother is concerned about the patient’s vision because he often turns his head to the right. She has begun trying to correct the head turn and places him on his back with his head turned in the opposite direction to sleep, but she has not noticed any improvement. She is not certain about when the head turning began and denies any recent fever. She reports that the patient fell off the bed yesterday but was easily soothed afterwards. The patient is otherwise doing well and is beginning to try a variety of solid foods. The patient is sleeping well at night. He is beginning to babble and can sit with support. The patient was born at 37 weeks gestation via cesarean delivery for breech positioning. On physical exam, the patient’s head is turned to the right and tilted to the left. There is some minor bruising on the posterior aspect of the head and over the sternocleidomastoid. He has no ocular abnormalities and is able to focus on his mother from across the room. Which of the following is the best next step in management?

A 12-year-old boy is brought to the physician for a well-child examination. He feels well. He has no history of serious illness. He has received all age-appropriate screenings and immunizations. His 7-year-old brother was treated for nephrotic syndrome 1 year ago. He is at 50th percentile for height and 60th percentile for weight. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 96/54 mm Hg. Physical examination shows no abnormalities. Urine dipstick shows 1+ protein. A subsequent urinalysis of an early morning sample shows: Blood negative Glucose negative Protein trace Leukocyte esterase negative Nitrite negative RBC none WBC 0–1/hpf Protein/creatinine ratio 0.2 (N ≤ 0.2) Which of the following is the most appropriate next step in management?

A 5-day-old male presents to the pediatrician for a well visit. The patient has been exclusively breastfed since birth. His mother reports that he feeds for 30 minutes every two hours. She also reports that she often feels that her breasts are not completely empty after each feeding, and she has started using a breast pump to extract the residual milk. She has been storing the extra breastmilk in the freezer for use later on. The patient urinates 6-8 times per day and stools 3-4 times per day. His mother describes his stools as dark yellow and loose. The patient was born at 41 weeks gestation via cesarean section for cervical incompetence. His birth weight was 3527 g (7 lb 12 oz, 64th percentile), and his current weight is 3315 (7 lb 5 oz, 40th percentile). His temperature is 97.3°F (36.3°C), blood pressure is 62/45 mmHg, pulse is 133/min, and respirations are 36/min. His eyes are anicteric, and his abdomen is soft and non-distended. Which of the following is the best next step in management?

A 15-year-old boy is brought to the physician with excessive daytime sleepiness over the past year. His parents are concerned with his below-average school performance over the last 3 months. He goes to bed around midnight and wakes up at 7 am on school days, but sleeps in late on weekends. He exercises regularly after school. He usually has a light snack an hour before bed. He does not snore or have awakenings during sleep. He has no history of a serious illness and takes no medications. 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. He does not smoke or drink alcohol. There is no history of a similar problem in the family. His vital signs are within normal limits. His BMI is 22 kg/m2. Physical examination shows no abnormal findings. Which of the following is the most appropriate recommendation at this time?

A 4-year-old girl presents to the office with her parents who are concerned about their daughter and slow, progressive changes in her behavior. The girl was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and was meeting all developmental milestones until about 2 years ago. At one point she had a vocabulary of several words and now she verbalizes in grunts. She also flaps her hands in a repeated motion and has difficulty walking. Her parents have tried several home therapies to improve their daughter's symptoms including restricted diets, hydrotherapy, and a variety of nutritional supplements. The vital signs include: heart rate 90/min, respiratory rate 22/min, blood pressure 110/65 mm Hg, and temperature 36.9°C (98.4°F). On physical exam, she is well nourished and stares absently out the window. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. She has mild scoliosis. Which of the following is the most likely diagnosis?

A concerned mother presents to clinic stating that her 14-year-old son has not gone through his growth spurt. She states that, although shorter, he had been growing at the same rate as his peers until the past year. There is no evidence of delayed puberty in the mother, but the father's history is unknown. The patient has no complaints. On physical exam, the patient is a healthy-appearing 14-year-old boy whose height is below the third percentile and whose weight is at the 50th percentile. His bone age is determined to be 11 years. A laboratory workup, including thyroid stimulating hormone (TSH), is unremarkable. What is the most likely diagnosis?

An 8-year-old boy is brought to the hospital because of blurred vision and headache for 3 months. During this period, the father has noticed that the child has been tilting his head back to look straight ahead. The patient has also had difficulty falling asleep for 2 months. He has had a 3.5 kg (7.7 lb) weight loss over the past 6 months. His temperature is 37.7°C (99.8°F), pulse is 105/min, and blood pressure is 104/62 mm Hg. Examination shows equal pupils that are not reactive to light. The pupils constrict when an object is brought near the eye. His upward gaze is impaired; there is nystagmus and eyelid retraction while attempting to look upwards. Neurologic examination shows no other focal findings. Which of the following is the most likely sequela of this patient's condition?

An 18-month-old boy is brought to the physician by his mother because of concern that he has not yet begun to walk. He was born at term and exclusively breastfed until 15 months of age. His mother says he has been well, apart from an episode of high fever and seizure 4 months ago for which she did not seek medical attention. He has an older brother who is currently receiving medical treatment for failure to thrive. His parents have no history of serious illness; they are of normal height. His last vaccine was at the age of 4 months. He is at the 20th percentile for length, 10th percentile for weight, and 50th percentile for head circumference. Physical examination shows dry mucous membranes and erosion of the enamel on the lingual surface of the incisors and carious molars. He has frontal bossing. His wrists are widened, his legs seem bent, and there is beading of the ribs. Which of the following is the most likely underlying cause of this patient's delay in walking?