Pediatric Medicine Early Childhood Development: Review Questions Frank J. Genuardi, MD, MPH Dr. Genuardi is Chief, Division of Adolescent Medicine, Department of Pediatrics, University of Florida Health Science Center, Jacksonville, FL; and a member of the Hospital Physician Editorial Board. Choose the single best answer for each question.
	1. A 2-week-old baby girl is brought to her pediatrician for a well-child examination. She was born at term following an uncomplicated pregnancy, labor, and delivery, with a birth weight of 3400 g (7.6 lb). Her mother states that the infant is exclusively breast fed, nurses every 2 to 3 hours, and has 6 to 8 wet diapers and 2 to 4 seedy stools daily. At the time of her examination, she weighs 3450 g (7.7 lb). Results of the physical examination are normal. Which of the following is the most appropriate next step in the care of this patient? Continue breast feeding only Continue breast feeding with supplemental cow’s milk formula Continue breast feeding with supplemental soy formula Continue breast feeding and add rice cereal to her diet Discontinue breast feeding and start her on soy formula Click here to compare your answer. 2. An 18-month-old boy is brought to his pediatrician for a well-child examination. He has been healthy since birth, and his immunizations are up to date. Length, weight, and head circumference are all at the 50th percentile. During the examination, the patient walks and runs, and his mother states that he can climb stairs. However, he has not been observed to jump or throw a ball overhand. He is able to grasp objects with his finger and thumb and bang cubes together, but he cannot put a block in a cup or build a tower of two cubes and does not scribble. Which of the following assessments of his motor development is correct? Normal gross motor skills, normal fine motor skills Normal gross motor skills, delayed fine motor skills Delayed gross motor skills, normal fine motor skills Delayed gross motor skills, delayed fine motor skills Click here to compare your answer. 3. A 24-month-old girl is brought to her pediatrician because her parents are concerned that she is not talking as well as her older sister did at the same age. She is able to point to 4 pictures and combines 2 words together, but only about half of her speech is intelligible. Which of the following is the most likely diagnosis for this patient? Attention deficit disorder Autistic disorder Hearing loss Mental retardation Normal language development Click here to compare your answer.		4. A 4-year-old boy is brought to his pediatrician because of bedwetting. He was toilet trained without difficulty at age 26 months, but he has continued to have nighttime wetting 3 to 4 times per week. He has been otherwise healthy since birth, with normal growth and development. There have been no particular family changes or other stresses. Results of urinalysis and urine culture are negative. Which of the following is the most appropriate next step in this patient’s management? Begin therapy with desmopressin acetate Obtain a voiding cystourethrogram Provide reassurance Refer to a child psychiatrist Reward the child for dry nights and punish him for wet nights Click here to compare your answer. 5. A 6-year-old boy is brought to his pediatrician because of sleep disturbances. He is noted to have recurrent episodes of awakening in the middle of the night and screaming, with a frightened appearance, tachycardia, and hyperventilation. He is unaware of his parents or his surroundings during these episodes, he cannot be consoled, and he falls asleep again after a few minutes. He has no memory of these episodes the following morning. Which of the following is the most likely diagnosis for this patient? Childhood schizophrenia Nightmares Night terrors Seizure disorder Sleep apnea Click here to compare your answer.
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