MCCQE Pediatric Growth and Development 2 — Questions and Answers
Question 1: A 9-month-old infant cannot sit without support and does not transfer objects between hands. Which developmental domain is most delayed?
- Fine motor
- Gross motor (Correct answer)
- Language
- Social-emotional
Correct answer: Gross motor
Sitting without support is a gross motor milestone expected by 6–7 months; failure to achieve this by 9 months indicates gross motor delay.
Question 2: A 3-year-old boy is at the 5th percentile for height. His growth velocity over the past year was 5 cm. Which finding would most suggest constitutional growth delay over growth hormone deficiency?
- Bone age equal to chronological age
- Bone age delayed by 2 years with normal growth velocity (Correct answer)
- Low IGF-1 level
- Height below the third percentile for mid-parental height
Correct answer: Bone age delayed by 2 years with normal growth velocity
Constitutional growth delay is characterized by delayed bone age with a normal growth velocity and a family history of late puberty.
Question 3: Which Tanner stage describes the onset of breast development (thelarche) in females?
- Tanner stage 1
- Tanner stage 2 (Correct answer)
- Tanner stage 3
- Tanner stage 4
Correct answer: Tanner stage 2
Tanner stage 2 marks the beginning of breast development with a small breast bud, signaling the start of puberty in girls.
Question 4: A 2-year-old uses 2-word phrases and has a vocabulary of 50 words. Which assessment is most appropriate?
- Reassure parents; development is normal (Correct answer)
- Refer for speech therapy immediately
- Order brain MRI
- Test for hearing loss
Correct answer: Reassure parents; development is normal
By age 2, children are expected to have at least 50 words and use 2-word combinations, so this child's language development is within normal limits.
Question 5: At what age does a child typically develop the pincer grasp (thumb-forefinger apposition)?
- 4 months
- 6 months
- 9 months (Correct answer)
- 12 months
Correct answer: 9 months
The mature pincer grasp develops around 9–10 months, allowing precise grasping of small objects between thumb and index finger.
Question 6: A 15-year-old girl has not yet had her first menstrual period but has Tanner stage 4 breast development and pubic hair. What is the most appropriate next step?
- Reassure; primary amenorrhea is defined as no menses by age 16 with secondary sexual characteristics (Correct answer)
- Order pelvic ultrasound and hormone panel now
- Start oral contraceptive pills
- Refer to genetics for Turner syndrome workup
Correct answer: Reassure; primary amenorrhea is defined as no menses by age 16 with secondary sexual characteristics
Primary amenorrhea is defined as no menses by age 15 in the presence of secondary sexual characteristics, so this 15-year-old does not yet meet diagnostic criteria.
Question 7: Which reflex is abnormal if still present at 6 months of age?
- Parachute reflex
- Moro reflex (Correct answer)
- Babinski reflex
- Plantar grasp reflex
Correct answer: Moro reflex
The Moro (startle) reflex normally disappears by 4–6 months; persistence beyond 6 months suggests central nervous system pathology.
MCCQE Pediatric Growth and Development 2
A 9-month-old infant cannot sit without support and does not transfer objects between hands.
Which developmental domain is most delayed?