Chapters 21- 40

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Which statement about rumination is false?

A. Rumination usually appears between 3-6 mo of age

B. Rumination is characterized by regurgitating and rechewing food

C. Aversive conditioning techniques may be warranted for treatment

D. Rumination may be secondary to gastroesophageal reflux disease

E. None of the above

Which scenario correctly describes pica?

A. A Canadian 6 mo old who bites plastic blocks

B. A Japanese toddler who chews on books

C. A Mexican-American 4 yr old who eats hair

D. A pregnant teen in Africa who eats earth

E. All of the above

Enuresis is defined as:

A. Wetting clothes or bedding 2 times per week for 3 consecutive months in a child at least age 5 yr

B. Wetting clothes or bedding daily for 3 consecutive months in a child at least age 3 yr

C. Wetting bed at night 3 times per month for 3 consecutive months in a child at least age 4 yr

D. Wetting clothes or bedding on 2 occasions in child at age 5 yr

All of the following characteristics describe a child as being developmentally ready for toilet training EXCEPT:

A. Cortical inhibition of reflex bladder contractions

B. Awareness of when bladder is full

C. Voluntary control of external sphincters

D. Motivation by the child to stay dry

E. Ability to use toilet paper appropriately

Enuresis in the all of the following clinical scenarios warrants urologic referral and treatment EXCEPT:

A. Monosymptomatic enuresis

B. Enuresis and poor urine stream

C. Enuresis and history of multiple urinary tract infections

D. Daytime wetting

E. Nocturnal enuresis and genital abnormalities

Treatment of enuresis should include all of the following EXCEPT:

A. Enlisting the cooperation of the child

B. Having the child void before retiring

C. Using alarms

D. Having the child launder the soiled sheets

E. Limiting fluids at bedtime

An 8 yr old with nighttime enuresis is invited to a sleepover next weekend. What treatment is most likely to keep him dry for the party?

A. Desmopressin acetate

B. Limiting fluid intake at the part

C. Maintaining a star chart

D. Bell-and-pad apparatus

E. Punishment

Head banging, hair twirling, rocking, thumb sucking, teeth grinding, and nail biting all are:

A. Habit disorders that probably relieve tension

B. Behavior problems that are easy to cure in children

C. Usually related to insecurity and poor parenting

D. Tics

All of the following are considered habit disorders EXCEPT:

A. Breath holding

B. Teeth grinding

C. Nail biting

D. Stuttering

E. Thumb sucking

Which of the following statements about Gilles de la Tourette syndrome is true?

A. Coprolalia occurs in the most patients

B. It is characterized by motor tics and stuttering

C. It is often comorbid with OCD and ADHD

D. It usually resolved by adolescence

E. It affects girls more often than boys

15. Which of the following statements about pediatric anxiety is false?

A. Over one third of children suffering from social phobia will not graduate high school

B. The best treatment strategy for severe separation anxiety is SSRI combined with cognitive behavioral therapy

C. Children with separation anxiety disorder have a 3 times higher risk of developing panic disorder than children without SAD

D. School refusal in young children is most likely due to social phobia

E. Panic disorder may present as acute respiratory distress without wheezing, stridor, or fever

17. A 12 yr old girl presents with a history of repetitive handwashing related to contamination obsessions. After performing an interview you diagnose OCD and begin treatment with sertraline. After an initial response, you increase the dose to the recommended maximum dose. She tolerates the medication without side effects but continues to be impaired by the obsessions and washing rituals. The next step in treatment involves:

A. Increasing the sertraline

B. Adding fluvoxamine to the sertraline

C. Referring the girl for cognitive-behavioral therapy (CBT)

D. Adding risperidone to the sertraline

E. Obtaining an ASO titer

19. Compared with adolescents, young children with depression have an increased frequency of:

A. Somatic complaints

B. Hallucinations

C. Melancholic symptoms

D. Suicidal thoughts

21. The treatment of choice for childhood-onset depression with only mild functional impairment is:

A. Monoamine oxidase inhibitors

B. Tricyclic antidepressants

C. Serotonin reuptake inhibitors

D. Benzodiazepines

E. None of the above

26. Any patient with an atypical presentation of an eating disorder (ED), based on age, sex, or other factors not typical for anorexia nervosa (AN) or bulimia nervosa (BN) deserves a scrupulous search for an alternative explanation. Disorders that should be included in the differential diagnosis include:

A. Craniopharyngioma and celiac disease

B. Diabetes mellitus and hyperthyroidism

C. Inflammatory bowel disease and hepatocarcinoma

D. Adrenal insufficiency and parasitic infection

E. All of the above

27. Severe eating disorders may be lethal. Which of the following poses a significant risk of mortality?

A. Cardiac arrhythmia

B. Introducing a normal diet

C. Amenorrhea

D. A and B

E. All of the above

31. A 6 yr old is seen hitting his sister. When asked what he has done, he lies. His lying is most likely to represent:

A. Pathologic behavior, which needs formal counseling

B. Playing with language

C. Reaction formation

D. Avoidance of an unpleasant punishment

E. None of the above

33. Which of the following statements about autistic disorder (AD) is false?

A. Rates of autism have increased in the past decade due to increased immunization rates

B. Ritualistic behavior is common with autism

C. Genetic factors play a significant role in autism

D. Early, intensive behavioral therapy, targeted toward speech and language development, is successful in improving language and social function of autistic children

35. Which of the following neurodevelopmental terms is NOT matched with an appropriate example?

A. Dyspraxia—A 6 yr old who cannot tie shoelaces or assemble a model

B. Graphomotor dysfunction due to finger agnosia—A student who labors over writing, pressing the pencil excessively hard into the page

C. Expressive language dysfunction—Child who has difficulty following instructions

D. Visual processing deficit—7 yr old with difficulty discerning left from right

E. Difficulty with working memory—11 yr old who has particular difficulty with word problems in math class

36. Which statement regarding language development and dysfunction is NOT true?

A. Students with mathematics difficulty may use a strong language ability to compensate

B. Up to 80% of children with academic disabilities have problems that are language based

C. Expressive language dysfunction is a risk factor for delinquency

D. Language difficulty in a native tongue usually does not impact learning a second language

E. Language disorders may affect learning in multiple subject areas

41. Which of the following statements about dyslexia is NOT true?

A. Dyslexia is familial and heritable

B. Dyslexia is a transient developmental lag that will correct with appropriate therapy

C. Diagnosis must be made differently in young children vs older children

D. Although a dyslexic child may enjoy being read to, he/she may avoid reading aloud

43. Which of the following statements is NOT true?

A. Hearing evaluation should be considered in any child with concern for speech/language delay

B. A child with sudden regression in language skills should undergo EEG testing

C. A child with language and cognitive delays should be referred for genetic evaluation

D. A key difference between children with speech and language impairment alone and children with autism is interest in social interaction

E. Children with normal receptive language and social skills who talk late (" late talkers" ) remain at risk for academic difficulty

44. Which child merits referral for speech and language evaluation?

A. A 15 mo old with one word

B. A 18 mo old who does not follow simple commands

C. A 30 mo old who is not using two-word combinations.

D. A 24 mo old who does not point to body parts when named

E. All of the above

46. Which of the following statements is NOT true about the language development of bilingual children?

A. Language development is comparable to monolingual peers by age 3

B. As toddlers, they may mix words of both languages

C. Exposure to two languages may cause clinically significant language delay

D. They may experience a mild delay in talking

47. Which statement about stuttering is NOT true?

A. Onset of stuttering typically occurs between age 2 and 4

B. Boys are more likely than girls to stutter

C. Girls have a worse prognosis than boys for spontaneous recovery

D. Therapy is most effective is started during the preschool period

E. Key differences between stuttering and developmental dysfluency include the absence of tension and frustration with developmental dysfluency

50. Medical diagnostic testing in children with intellectual disability is not always indicated. Which of the following clinical scenarios does not clearly warrant the indicated testing?

A. Mild intellectual disability—Blood lactate level

B. Progressive neurologic disorder—Urine organic acids, plasma amino acids

C. Child with intellectual disability and seizures—EEG

D. Child with microcephaly and severe intellectual disability—MRI of brain

E. Child with cardiac anomaly, midface hypoplasia intellectual disability—DNA microarray

51. In male patients with intellectual disability and positive family history, the next step in evaluation should be:

A. Plasma ammonia assay

B. Blood lead level determination

C. EEG

D. Molecular genetic testing for fragile X syndrome

E. Cranial CT

52. The parents of a 10 yr old girl with intellectual disability are seeking information on what to expect for her future. The youngster is in a mainstreamed educational program, is just beginning to master simple reading skills, and has one close friend. The difficulty of long-term prognostication aside, possible life goals for this child include:

A. Holding a regular job

B. Getting married

C. Having children

D. All of the above

57. Which of the following statements regarding foster care is true?

A. A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care

B. A minority of children in foster care have a history of abuse or neglect

C. The mission of foster care is to safely care for children while providing services to families to promote reunification

D. Most (> 70%) of children in foster care are reunited with their families

E. A and C

61. Which of the following statements about bullying is NOT true?

A. Victims may become bullies and vice versa

B. Boys are more likely to be bullies; girls are more likely to be victims

C. Victims of chronic bullying may develop psychotic symptoms as adolescents

D. Bullies typically experience high social standing and thus infrequently have adjustment disorder

E. Management of bullying and school violence involves systemic interventions with parents, victims, bullies, and the school

62. Which presentation at a well child visit is most indicative of possible abuse?

A. Toddler with bruise and laceration on forehead, plus older bruise over shin; mother says he ran into a chair

B. 3 month old infant with bruise on right forearm and left buttock; parent states infant rolled off changing table

C. Mild scald burn with splash marks on trunk of 6 mo old infant; parent states she accidentally spilled coffee

D. Bite mark on shoulder of 9 mo old with distance between canines about 2 cm; father believes 2 yr old brother has been biting recently

E. B and D

70. Which of the following findings are considered diagnostic of sexual abuse in a prepubescent female?

A. Clue cells on wet prep

B. Culture positive for gonorrhea

C. A notch in the anterior hymen with generalized erythema

D. A complete transection of the posterior hymen

E. B and D

74. A child with severe malnutrition is admitted to the hospital. Which of following diet programs is most appropriate?

A. Allow the child to eat whatever is appealing, in whatever quantities he/she chooses

B. Restrict diet initially and incrementally increase calories each day.

C. Monitor serum electrolytes closely

D. Give additional vitamin supplement

E. B, C, and D

76. Snoring and mouth breathing as a cause of failure to thrive suggest:

A. Streptococcal pharyngitis

B. Mononucleosis

C. Obstructive sleep apnea

D. Anterior meningocele

E. Cerebral palsy

77. A primary care provider provides several important services for children with chronic disease, including preventive services. Of the following, which is the greatest unmet care need for such patients?

A. Refilling chronic medications

B. Dental care

C. Coordination of multiple specialists

D. Dietary screening

84. Perpetuating the myth of " everything is going to be all right" with a dying child will:

A. Help reassure the child

B. Hide " bad things" from the child

C. Enhance an awareness of eventual death

D. Alleviate fears

E. Prevent exploration of fears

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