Developmental and Behavioral Pediatrics (Detailed) MCQs

Pediatrics · 29 free questions with answers & explanations.

1. A 2-year-old child does not point at objects of interest, does not engage in pretend play, does not use two-word phrases, does not follow a two-step command, and makes minimal eye contact. What is the most likely diagnosis?
2. A 6-year-old boy with normal intelligence has persistent difficulty sustaining attention, often loses things, is easily distracted, frequently interrupts, cannot wait his turn, and has similar symptoms in both school and home settings present since age 4. DSM-5 diagnosis requires symptoms to be present in how many settings and for what minimum duration?
3. A 5-year-old child with intellectual disability (IQ 45) and characteristic facial features (upslanting palpebral fissures, epicanthal folds, single palmar crease, flattened occiput, and protruding tongue) is evaluated. Karyotype shows 47,XX +21. Which cardiac lesion is MOST commonly associated?
4. A 2.5-year-old boy has no words, no pointing, does not respond to name, has repetitive hand-flapping, and prefers spinning objects. He had 5-6 words at 18 months that he subsequently lost. The MOST important initial investigation to guide management is:
5. An 8-year-old is failing academically despite normal intelligence (IQ 95). He has significant difficulty reading (confuses b/d, reads slowly, poor phonological awareness) despite being in a stimulating environment with no sensory deficits. The MOST effective evidence-based intervention is:
6. A 5-year-old develops motor and vocal tics (eye blinking, throat clearing) for the past 12 months. Tics wax and wane. There is no academic decline and the child is not bothered. OCD symptoms are absent. His tics meet criteria for Tourette syndrome. The first-line management is:
7. A 3-year-old child lacks joint attention, does not point to share interest, has no meaningful two-word phrases, plays with toys repetitively (spinning wheels), and does not engage in pretend play. He reacts intensely to changes in routine. What is the most likely diagnosis and the key first-line evidence-based intervention?
8. A 7-year-old boy has been failing school for two years. Teachers report he is easily distracted, frequently loses his pencil and books, forgets homework daily, and struggles to follow multi-step instructions but can sit quietly. He has no hyperactivity or impulsivity. What subtype of ADHD does he most likely have, and which DSM-5 criterion helps establish chronicity?
9. A 4-year-old boy cannot use utensils properly, walks on his toes, and frequently falls. He cannot jump on one foot or climb stairs alternating feet. His speech is limited to 3-word sentences and he does not use pronouns. He can copy a circle but not a cross, and names 4 colours. Which developmental domain shows the MOST significant delay?
10. A 2-year-old child has no meaningful words, limited eye contact, does not respond to name, engages in repetitive hand-flapping, and has no pointing gesture. These features have been present since 12 months. Which developmental screening tool is the RECOMMENDED instrument for autism spectrum disorder screening at 18–24 months?
11. A 7-year-old boy is brought for evaluation of poor academic performance, difficulty sustaining attention during homework, frequently losing belongings, and making careless mistakes. He does not demonstrate hyperactivity. His symptoms have been present since age 4. Which ADHD subtype best describes this presentation?
12. An 18-month-old child is evaluated for developmental delay. He has absent speech (no words), can walk independently (achieved at 14 months), can build a tower of 2 cubes, and uses a spoon with spillage. Which developmental domain is MOST delayed relative to expected milestones at 18 months?
13. A 3-year-old boy is referred for evaluation. His parents note he does not respond to his name, avoids eye contact, lines up toys repetitively, becomes extremely distressed with routine changes, and has no meaningful words. He can stack 6 blocks and enjoys spinning objects. Which is the most appropriate first-line screening tool for this presentation?
14. A 7-year-old boy has significant difficulty sustaining attention in class, frequently loses items needed for tasks, is easily distracted by extraneous stimuli, often interrupts conversations, runs excessively in inappropriate situations, and has had symptoms since age 4. Symptoms impair academic and social functioning. Which statement best describes the diagnostic criteria for ADHD?
15. A 5-year-old child passed all developmental milestones appropriately until age 18 months, then began losing acquired speech, hand purposeful use, and social skills. She now has stereotyped hand-wringing movements, irregular breathing, and acquired microcephaly. Which gene mutation is responsible for this syndrome?
16. A 30-month-old child has no meaningful speech, does not point to share interest, avoids eye contact, and lines up toys repetitively rather than engaging in pretend play. Which developmental domain is PRIMARILY affected?
17. A 6-year-old boy frequently interrupts conversations, cannot stay seated during class, loses homework, and acts impulsively without considering consequences. His teacher reports significant academic difficulty. Symptoms have been present since age 4 across home and school settings. According to DSM-5, how many symptoms of inattention/hyperactivity are required for an ADHD diagnosis in a child younger than 17 years?
18. A child can walk independently at 18 months, build a tower of 3 cubes, use a spoon, and has a vocabulary of 10–15 meaningful words. Which single developmental milestone is MOST concerning at this age?
19. The first-line pharmacological treatment for ADHD in a 7-year-old school-age child without any comorbidities is:
20. A 2-year-old boy has no words, no pointing, and no social smiling. He does not respond to his name, engages in repetitive spinning of objects for hours, and resists change in routine. Which is the MOST appropriate first-line therapy?
21. A 7-year-old is referred for failing school performance. His teacher reports he is unable to sit still, frequently interrupts, and loses things. He has symptoms in both school and home settings, present for more than 6 months since before age 12. DSM-5 diagnosis of ADHD combined presentation is suspected. Which medication and dosing principle is CORRECT for his initial pharmacotherapy?
22. A 5-year-old boy is unable to walk on heels, falls frequently, and has calf pseudohypertrophy. His CK is 18,000 IU/L. Genetic testing shows a frameshift deletion in the DMD gene preventing production of any dystrophin protein. Which inheritance pattern and mechanism of muscle damage are CORRECT?
23. A 30-month-old child has no meaningful two-word phrases, does not make eye contact, does not respond to his name, engages in repetitive spinning behavior, and has no pretend play. These findings are most consistent with:
24. A 7-year-old boy has persistent difficulty sitting still, often interrupts others, loses things frequently, is easily distracted, and these behaviors are present at both school and home for >6 months causing academic impairment. DSM-5 diagnosis of ADHD requires symptoms to be present in at least how many settings and from what age of onset?
25. A 10-year-old boy with ADHD is started on methylphenidate. He develops significant anorexia, insomnia, and his parents note he appears slightly sad. The appropriate management of methylphenidate-associated appetite suppression is:
26. A 3-year-old child does not respond to his name, has no meaningful words, makes no eye contact, engages in repetitive hand flapping and is intensely attached to specific objects. The MOST specific screening tool validated for this condition in a toddler is:
27. A 7-year-old is referred for school difficulties. He is described as inattentive, fidgety, interrupts frequently, cannot remain seated, and loses things. These symptoms began at age 5 and occur in both home and school settings. He has no learning disability. The most appropriate first-line pharmacological treatment for ADHD in this school-age child is:
28. A 2-year-old child speaks 50 words and combines two words. He can walk up stairs holding a railing, scribble spontaneously, builds a tower of 6 cubes, and plays near but not with other children. What type of play does this child demonstrate?
29. A 4-year-old cannot speak intelligibly to strangers (though parents understand >75% of speech), shows sound substitutions and deletions, but has normal receptive language and hearing. The most appropriate referral is: