MCCQE - Medical Council of Canada Qualifying Examination Pediatric Growth and Development Questions and Answers 1 — Questions and Answers
Question 1: A mother brings her 2-year-old son for a routine check-up. She is concerned about his language development. Which of the following findings would be most reassuring and considered a normal developmental milestone for his age?
- He has a vocabulary of about 10 words and gestures for his needs.
- He can combine two words to make simple phrases, such as 'more juice'. (Correct answer)
- He speaks in full, grammatically correct sentences.
- He can name four primary colours correctly.
Correct answer: He can combine two words to make simple phrases, such as 'more juice'.
At two years of age, a key language milestone is the ability to combine two words into simple phrases. A vocabulary of around 50 words is typical, and using two-word sentences (e.g., 'want cookie,' 'mama go') is expected. Speaking in full sentences is a milestone for older children (around 3-4 years), while a 10-word vocabulary is more typical for a child around 15-18 months. Naming colours is a more advanced skill, usually developing between 3 and 4 years.
Question 2: During a well-child visit for a 13-year-old male, you note the presence of coarse, dark, curly pubic hair spread over the pubis, increased penile length and width, and testicular volume of approximately 12 mL. According to the Tanner stages, which stage of pubertal development does this describe?
- Tanner Stage 2
- Tanner Stage 4
- Tanner Stage 3 (Correct answer)
- Tanner Stage 5
Correct answer: Tanner Stage 3
Tanner Stage 3 in males is characterized by the continued growth of the penis and testes, with testicular volume typically between 9-12 mL. The pubic hair becomes coarser, darker, and curlier, spreading over the pubic symphysis. Stage 2 involves the initial enlargement of the testes and sparse, straight pubic hair. Stage 4 involves further growth, darkening of the scrotal skin, and adult-quality hair that has not yet spread to the thighs. Stage 5 represents full adult genitalia and pubic hair distribution.
Question 3: A 6-month-old infant is brought in for a developmental assessment. Which of the following primitive reflexes would be considered an abnormal finding if it is still strongly present?
- Plantar grasp
- Babinski reflex
- Landau reflex
- Moro reflex (Correct answer)
Correct answer: Moro reflex
The Moro reflex, or startle reflex, typically disappears or integrates by 2 to 4 months of age. Its persistence beyond 6 months can be a red flag for neurological issues. The plantar grasp reflex disappears later, around 9-12 months. The Babinski reflex can be normal up to 2 years of age. The Landau reflex appears around 4-5 months and integrates around 12-24 months.
Question 4: You are plotting the growth of a 4-year-old girl on a WHO growth chart. Her weight has been consistently tracking along the 50th percentile, but her height has just dropped from the 25th percentile to below the 3rd percentile over the last year. What is the most appropriate next step?
- Reassure the parents that this is a normal growth variation.
- Advise a high-calorie diet to promote catch-up growth.
- Schedule a follow-up visit in one year to re-evaluate.
- Initiate an investigation for an underlying cause of growth failure. (Correct answer)
Correct answer: Initiate an investigation for an underlying cause of growth failure.
A significant drop in height percentile, especially crossing two or more major percentile lines (e.g., from the 25th to below the 3rd), is a major red flag for growth failure. This warrants a thorough investigation to rule out underlying medical conditions such as endocrine disorders, chronic illness, or malnutrition. Reassurance is inappropriate given the significant change. While nutrition is important, simply advising a high-calorie diet without investigating the cause is insufficient. Delaying follow-up for a year could be detrimental.
Question 5: Which of the following gross motor skills is typically the last to be achieved in a developing child?
- Sits without support
- Walks up stairs with alternating feet (Correct answer)
- Pulls to a stand
- Rolls from prone to supine
Correct answer: Walks up stairs with alternating feet
Walking up stairs with alternating feet is a more complex motor skill that typically develops around 3 years of age. The other milestones are achieved much earlier: rolling from prone to supine (around 4 months), sitting without support (around 9 months), and pulling to a stand (around 9-10 months).
Question 6: A new mother is concerned about her 4-month-old infant's fine motor skills. Which of the following observations would be an expected and appropriate milestone for this age?
- Demonstrates a mature pincer grasp to pick up a small object.
- Transfers an object from one hand to the other.
- Brings hands to midline and to the mouth. (Correct answer)
- Builds a tower of two blocks.
Correct answer: Brings hands to midline and to the mouth.
By 4 months, an infant should be able to bring their hands together at the midline and bring them to their mouth. Transferring objects hand-to-hand typically develops around 6 months. The pincer grasp (using thumb and index finger) matures later, around 9-12 months. Building a tower of blocks is a skill that emerges around 12-15 months.
MCCQE - Medical Council of Canada Qualifying Examination Pediatric Growth and Development Questions and Answers 1
A mother brings her 2-year-old son for a routine check-up.
She is concerned about his language development.
Which of the following findings would be most reassuring and considered a normal developmental milestone for his age?