An 18-month-old boy presents for a well-child visit. Upon entering the room, you notice him playing with toys, touching everything in the room, and speaking to his mother in 2- word phrases. According to Piaget’s stages of cognitive development, he would best be classified in:
Correct Answer A: Sensorimotor stage is the correct answer. This stage encompasses birth to 2 years of age and consists of children learning by activity, explanation, and manipulation of the environment.
B. Preoperational stage, ages 2-7: the child engages in symbolic representation of the world.
C. Concrete operations, ages 7-11: the child is capable of limited, logical thought process.
D. Abstract operations is not a stage of Piaget’s cognitive development.
E. Formal operations, ages 12 to adult: the child can reason logically and abstractly.
A parent comes to your office for a well-child visit. You notice the patient hopping to the exam room, singing “London Bridge Is Falling Down.” Mom states the patient does a great job playing cooperatively. The age of the patient according to his observed milestones may best be described as:
Correct Answer C: 4 years old. Gross motor skills at 4 years of age include hopping, skipping, and alternating feet going downstairs. Visual motor skills at 4 years of age include buttoning clothing fully and catching a ball. Language skills at 4 years of age include knowing colors, singing songs from memory. Social skills at 4 years of age include cooperative play.
A. 2-year-old infants are able to walk up and down stairs, but not hop, may remove pants and shoes, but does not exhibit fully developed language usage or parallel play.
B. 3-year-old infants may alternate feet going up steps, dress and undress partially, use 3- word sentences, and begin group play.
D. 5-year-old infants may skip alternating feet, tie shoes, print their first name, and play competitive games.
E. 6-year-old children are in kindergarten to 1st grade and know their ABCs, may count up to ten, form friendships, and do household chores.
A mother is concerned that her 12 month old son is not developing normally. “My son doesn’t walk on his own yet and he only speaks a few words”. At this stage of development, the child should be able to:
Correct Answer A:
Developmental milestones: At 12 months, a child should be able to walk with support, pincer grasp, throw objects and speak in single words.
Developmental red flags:
PEARL: Remember the 1 year “W.O.W.” (Walk, One Word).
A 4-year-old child presents with an enlarged submandibular node that is 4 cm in diameter, nontender, and not fluctuant. The node has been enlarged for about 4 weeks and there is no history of fever or contact with any person who was ill. A complete blood count (CBC) is normal, and a Mantoux test with 5 tuberculin units of purified protein derivative shows 6 mm of induration.
Which one of the following is the most likely diagnosis?
Correct Answer E: Atypical mycobacterial infection is due to non-tuberculous mycobacteria.
In particular, Mycobacterium scrofulaceum is a common cause of lymphadenitis in children aged 1 to 3 years. Lymphadenitis usually involves a single node or a cluster of nodes in the submandibular area.
Characteristically, the nodes enlarge slowly over a period of weeks. There are very few local or systemic symptoms. Untreated, the infection will usually point to the surface, rupture, form a draining sinus and eventually calcify. Infection in other tissues occurs occasionally. A very few cases resembling progressive primary tuberculosis have been encountered in children.
A 5-week-old male infant presents with a history of vomiting and spitting up since birth. This occurs shortly after feeding and is often associated with burping. The child is exclusively breastfed. The infant was full term and the birth weight was 2.7 kg. At present, he weighs 3.7 kg and physical examination is within normal limits.
The most likely diagnosis is:
Correct Answer E: Gastroesophageal reflux (GER) occurs when stomach contents reflux, or back up, into the esophagus during or after a meal. The esophagus is the tube that connects the mouth to the stomach. A ring of muscle at the bottom of the esophagus opens and closes to allow food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES). The LES normally opens to release gas after meals. With infants, when the LES opens, stomach contents often reflux into the esophagus and out the mouth, resulting in regurgitation, or spitting up, and vomiting. GER can also occur when babies cough, cry, or strain.
GER is common in healthy infants. More than half of all babies experience reflux in the first 3 months of life, but most stop spitting up between the ages of 12 to 24 months. Only a small number of infants have severe symptoms.
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