PREP 2005 Self Assessment Questions in Developmental-Behavioral Pediatrics
Disorders of cognition, language, learning and attention
no intervention at this time
Question 81
referral for neurologic evaluation
You are seeing a 5-year-old boy for a
health supervision visit. Physical
examination findings are normal, but you
notice that his speech pattern includes
several utterances such as “thi-thi-this” and
“b-ut.” He seems anxious when you ask
him a direct question, and his mother
completes several sentences for him.
referral for psychological evaluation
referral for speech and language
evaluation
Of the following, the MOST appropriate
next step for this child is
treatment with clonidine
are at increased risk of substance abuse
Question 94
have a paradoxic response to stimulant
medications
A 14-year-old boy was diagnosed with
attention-deficit/hyperactivity disorder
(ADHD) at age 7. Although he continues to
have some difficulty with inattention in
class, he has responded well to stimulant
medications. His mother would like to know
what to expect as her son enters
adulthood.
have educational outcomes similar to
adults who do not have a history of
childhood ADHD
have motor signs (hyperactivity) that
remain prominent in adulthood
Of the following, your BEST response is
that most adults who have a history of
ADHD in childhood
have similar symptoms symptoms in
adulthood as they did in childhood
breech presentation at birth
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Question 114
You diagnose attention-deficit/hyperactivity
disorder (ADHD) in a 7-year-old boy. His
mother asks you about the cause of this
condition.
excessive dietary intake of sugar
Of the following, your BEST response is that
ADHD has been shown to be associated with
food allergy
family history of similar symptoms
maternal age at conception
advise her mother to place her in the
prone position to sleep
Question 117
You see a 4-month-old breastfed girl for a
health supervision visit. Her length and head
circumference are at the 25th percentile, and
her weight is at the 75th percentile. On
physical examination, you note posterior
occipital flattening. She briefly focuses on your
face, but does not track. She also does not roll
over.
counsel her mother regarding diet and
overfeeding
refer her for ophthalmologic examination
refer her for physical therapy evaluation
Of the following, the MOST appropriate next
step is to
tell her mother that she should begin
tracking objects in the next 2 months
ask further questions regarding the girl’s
anxious behavior
Question 119
During the health supervision visit of a 9month-old girl, her mother expresses
concern that her daughter begins to cry
when strangers pick her up. On physical
examination, the girl sits alone and pulls to
stand, but she does not cruise. She transfers
objects between her hands and picks up
cereal with a scissoring motion of her thumb
and forefinger. She laughs and plays pat-acake with her mother, but does not babble.
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refer the girl for audiology evaluation
refer the girl for occupational therapy
evaluation
refer the girl for physical therapy
evaluation
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Of the following, the MOST appropriate next
step is to
tell the mother that the girl’s
development is normal
administer the Childhood Depression
Inventory survey
Question 167
A 12-year-old girl is having difficulty in
school, although both her parents and her
teachers feel that she is very intelligent and
diligent in completing assignments. Recent
intelligence testing documented a full-scale
intelligence quotient of 125 using the
Wechsler Intelligence Scale for Children.
There are no new family stresses. The girl
has friends and is active in extracurricular
activities. Physical examination results are
normal. Her mother would like to know why
she is having difficulty in school.
advise them to request alternative
educational placement
request a subtest profile of scores
request behavioral testing
suggest that they restrict her
extracurricular activities
Of the following, the MOST appropriate next
step to assist this family is to
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she should request a school evaluation
to consider alternative educational
placement
Question 177
The mother of a 6-year-old girl tells you that
she and the girl’s teacher both note that the
girl is easily distracted. The child has
difficulty paying attention to the rules of
games when interacting with her family. On
physical examination, she appears well and
has no difficulty responding to your
questions. You ask her to draw a picture of
her family, and she completes the task
easily. She sits quietly while you speak with
her mother. The mother is surprised at how
well the girl behaves in the office.
the girl’s behavior in your office may not
reflect usual home and school behavior
the mother and teacher have unrealistic
behavioral expectations
you would like to refer the girl for
behavioral counseling
Of the following, your BEST response to the
mother is that
you would like to refer the girl for
psychological evaluation
Growth and development
finger-feed himself
Question 134
You are seeing a 6-month-old boy for a
health supervision visit. He is breastfed and
has had no recent illnesses. His growth
parameters are at the 25th percentile. On
physical examination, he babbles, reaches
for the otoscope, and pulls to a sitting
position with no head lag.
imitate sounds
pull to stand
transfer objects from one hand to the
other
Of the following, he MOST likely also can
use a scissors grasp to obtain a piece of
cereal
build a tower of two cubes
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Question 161
follow a command with a gesture
You see a 9-month-old girl for a health
supervision examination. She has been
healthy, and growth parameters are at the
50th percentile. She can cruise, feed herself
with her fingers, and recognize her own
name.
independently place her arms in a shirt
when she is being dressed
release a cube into a cup
Of the following, she MOST likely also can
say “mama” and “dada” as sounds
copy a straight line
Question 216
feed herself with a spoon
You see an 18-month-old girl for a health
supervision examination. She has been
healthy, and her growth parameters are at
the 50th percentile. On physical examination,
she stacks a tower of two cubes, runs, and
walks up stairs with her hand held.
identify pictures in a book
jump off the floor with both feet
Of the following, she MOST likely also can
wash her own hands
Psychosocial issues and problems
discuss his behavior with his teacher
Question 91
A 7-year-old boy who has cerebral palsy
and mild mental retardation is brought to
you for evaluation of his behavior. He has a
recent history of school avoidance and
becomes agitated most mornings when he
is waiting for the school bus. He is in a
mainstreamed regular classroom for most
of the day and is in a resource classroom
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initiate a hematologic evaluation
question the mother about his bruises
refer him for a genetics evaluation
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for math and language instruction. His
regular classroom teacher has complained
about his oppositional behavior. His mother
notes that he has been more withdrawn at
home in the past several months. On
physical examination, his growth
parameters are at the 25th percentile. He
has mildly dysmorphic features, and you
note several areas of bruising on his neck
and upper arms.
refer him for behavioral counseling
Of the following, the MOST appropriate
next step is to
obtain electromyography testing
Question 98
You are evaluating a 14-year-old girl who
lost the use of her right arm 1 week after a
tetanus immunization. She has not been
attending school, and her parents have
been assisting her to bathe and dress. The
parents have been discussing divorce for
the past several months. On physical
examination, her growth parameters are at
the 75th percentile. While in your office,
she jokes with her mother and does not
appear concerned about her impairment.
On neurologic examination, tone and
reflexes are normal and symmetric in her
arms. She has good strength in her left arm
and hand, but is unable to lift her forearm
or hand against gravity on the right. She
has 4/5 strength in her right hand (finger
flexors).
obtain a serum creatine kinase level
order magnetic resonance imaging of the
brain
refer to a child psychiatrist
refer to an orthopedic surgeon
Of the following, your BEST course of
action is to
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abdominal radiography
Question 30
A 5-year-old girl was toilet trained at 4
years of age. She is brought to you with a
1-month history of nighttime wetting. Her
mother does not relate any new family
stresses.
measurement of serum electrolytes
referral for psychological evaluation
Of the following, the MOST appropriate
next step in the evaluation of this child is
referral for urologic evaluation
urinalysis
he may benefit from academic promotion
in math classes only
Question 140
Recently, a 7-year-old boy has been
complaining of boredom in class. He has
an older brother who has above-average
intelligence, and the younger boy can do
most of his brother’s homework. His
teacher describes the boy as very active,
with impulsive and inattentive behavior in
the classroom. Intelligence testing reveals
a full-scale intelligence quotient (IQ) of 135.
He excels in math class and has average
performance in language-based classes.
He likes to talk about math problems and
has a few friends who have similar
interests. His parents ask your opinion
about his behavior and his academic
performance.
he should receive academic assistance
to improve his language skills
it is very unusual for gifted children to
have attention-deficit/hyperactivity
disorder
most gifted children excel in all areas of
academics
they should encourage friendships and
activities with older children
Of the following, your BEST response is
that
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