USMLE Step 1 Boot Camp Problem Drill 03: Development and Aging

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1 USMLE Step 1 Boot Camp Problem Drill 03: Development and Aging Question No. 1 of In the delivery room, a newborn baby receives an Apgar score of 7 at one minute. Which of the following describes an evaluation that would have resulted in that score? Question #01 (A) Appearance shows pink trunk and limbs, Pulse is 110 bpm, Grimace response to stimulation is positive with pulling away, Activity is vigorous, and Respiration is strong and regular. (B) Appearance shows pink trunk and limbs, Pulse is 110 bpm, Grimace response to stimulation is positive but without pulling away, Activity is vigorous, and Respiration is strong and regular. (C) Appearance shows pink trunk and limbs, Pulse is 110 bpm, Grimace response to stimulation is positive but without pulling away, Activity is mild, and Respiration is strong and regular. (D) Appearance shows pink trunk and limbs, Pulse is 90 bpm, Grimace response to stimulation is positive but without pulling away, Activity is mild, and Respiration is strong and regular. (E) None of the above Appearance shows pink trunk and limbs, Pulse is 110 bpm, Grimace response to stimulation is positive with pulling away, Activity is vigorous, and Respiration is strong and regular adds up to an Apgar score of 10. Appearance shows pink trunk and limbs, Pulse is 110 bpm, Grimace response to stimulation is positive but without pulling away, Activity is vigorous, and Respiration is strong and regular adds up to an Apgar score of 9. C. Incorrect Appearance shows pink trunk and limbs, Pulse is 110 bpm, Grimace response to stimulation is positive but without pulling away, Activity is mild, and Respiration is strong and regular adds up to an Apgar score of 8. D. Correct! Appearance shows pink trunk and limbs, Pulse is 90 bpm, Grimace response to stimulation is positive but without pulling away, Activity is mild, and Respiration is strong and regular adds up to an Apgar score of 7. One of the answers is correct. Apgar scores are point scores given to every newborn infant at 1 minute and 5 minutes after birth. The newborns are evaluated in 5 different categories, and given 0-2 points per category. A score of 10 points total is a perfect score. The categories and point scores given for each are: Appearance: blue 0, pink trunk 1, pink trunk and limbs. Pulse: none 0, < 100/min 1, > 100/min 2. Grimace, or response to stimulation: none 0, positive 1, positive with pulling away. Activity: none 0, mild 1, active 2. Respiration: none 0, weak & irregular 1, strong & regular 2. (D)Appearance shows pink trunk and limbs, Pulse is 90 bpm, Grimace response to stimulation is positive but without pulling away, Activity is mild, and Respiration is strong and regular. RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

2 Question No. 2 of A toddler undergoes a psychiatric evaluation, in which there is evidence of gender-specific role play. What is the likely age of this toddler? Question #02 (A) 0 12 mos (B) mos (C) mos (D) mos (E) > 48 mos 0 12 mos would be much too early to realize core gender identity mos would be too early to realize core gender identity. C. Correct! At mos, the toddler should realize his or her own core gender identity. D. Incorrect! mos would be considered a delay in realization of core gender identity. > 48 mos would be considered a significant delay in realization of core gender identity. There are a number of milestones that are evaluated in toddlers to assess for normal development: At mos, the toddler should be able to go up stairs, stack 3 blocks, and speak 2 word sentences by the age of 2. At mos, the toddler should be able to stack 6 blocks and realize rapproachement relationship with others. At mos, the toddler should realize his or her own core gender identity. At mos, the toddler should demonstrate parallel play with other children. (C)24 36 mos RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

3 Question No. 3 of Developmentally, a normal 3 year old preschooler would be expected to be able to do all of the following except for: Question #03 (A) Be toilet trained. (B) Stack 9 blocks. (C) Ride a tricycle. (D) Draw a stick figure drawing. (E) Speak in complete sentences. A normal 3 year old should be toilet trained, (pee at 3). A normal 3 year old should be able to stack 9 blocks. A normal 3 year old should be able to ride a tricycle, (3-wheeler at 3). D. Correct! A normal preschooler would not be expected to draw a stick figure until 4 years of age. A normal 3 year old should be able to speak in complete sentences. There are a number of milestones that are evaluated in preschoolers to assess for normal development: At mos, the preschooler should be able to stack 9 blocks and be toilet trained. Mnemonic: pee at 3. At 3 yrs, the preschooler should be able to ride a tricycle (mnemonic: 3 wheeler at 3 yrs), copy line or circle drawings, and speak in complete sentences. At 4 yrs, the preschooler should be able to hop on 1 foot, draw simple stickfigure drawings, participate in cooperative play, and brush their own teeth. (D)Draw a stick figure drawing. RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

4 Question No. 4 of A 13 year old boy who is developing sexually sees his doctor for a camp physical. The doctor notes on examination of the boy s genitalia that he has slight, fine pubic hair and that his testicles are starting to enlarge. What Tanner stage does the pediatrician assign to the boy in the medical record? Question #04 (A) Tanner stage 1. (B) Tanner stage 2. (C) Tanner stage 3. (D) Tanner stage 4. (E) Tanner stage 5. Tanner stage 1 shows no pubic hair or change in size of genitalia. B. Correct! Tanner stage 2 shows soft pubic hair beginning to develop and enlargement of the testes. Tanner stage 3 shows pubic hair filling in and becoming curly associated with enlargement of the penis. D. Incorrect! Tanner stage 4 shows continuation of thickening of the penis with enlargement and darkening of the scrotum. Tanner stage 5 shows adult characteristics of the genitalia. The Tanner stages of sexual development are measured with a numbered scale that evaluates pubic hair, male genitalia and female breasts in the developing adolescent and young adult: Stage 1 no pubic hair or changes in genitalia and breasts. Stage 2 soft pubic hair begins to develop, testes enlarge in boys, and breasts tissue elevation begins in girls. Stage 3 pubic hair fills in and becomes coarse and curly, penis grows in size and length in boys, and breast tissue begins to extend beyond the areola in girls. Stage 4 the penis widens as the scrotum enlarges and darkens in boys, and breast tissue continues to develop with a raised areola in girls. Stage 5 male and female adult sexual characteristics are present. (B)Tanner stage 2. RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

5 Question No. 5 of An infant is born prematurely and only weighs 2100 grams. Which of the following conditions would this infant be at risk for? Question #05 (A) Respiratory distress syndrome (RDS). (B) Persistent fetal circulation (PFC). (C) Necrotizing enterocolitis (NEC). (D) Intraventricular hemorrhage (IVH). (E) All of the above Low birth weight infants are at risk for respiratory distress syndrome (RDS) as well as the other conditions listed. Low birth weight infants are at risk for persistent fetal circulation (PFC) as well as the other conditions listed. Low birth weight infants are at risk for necrotizing enterocolitis (NEC) as well as the other conditions listed. D. Incorrect! Low birth weight infants are at risk for intraventricular hemorrhage (IVH) as well as the other conditions listed. E. Correct! A D are correct answers. Low birth weight is defined as that less than 2500 g and may be caused by prematurity or intrauterine growth retardation. Low birth weight infants are at risk for: Respiratory distress syndrome (RDS) Infections Necrotizing enterocolitis (NEC) Intraventricular hemorrhage (IVH) Persistent fetal circulation (PFC) (E)All of the above RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

6 Question No. 6 of A 6 year old boy who has normal intelligence and verbal skills demonstrates abnormal repetitive motions and has difficulty interacting with other children and cannot seem to make friends. The most likely diagnosis in this child is: Question #06 (A) ADHD (B) Oppositional defiant disorder (C) Asperger s disorder (D) Autism (E) Childhood disintegrative disorder Attention deficit hyperactivity disorder or ADHD is a disorder of children who demonstrate a shortened attention span and hyperactive behavior. Such children are of normal intelligence, but are impulsive, emotionally labile, and accident prone. Oppositional defiant disorder in children refers to ongoing patterns of defiant, uncooperative and hostile behavior against authority figures that interferes with the child s day to day function. Criminality is absent. C. Correct! Asperger s disorder is considered to be a milder form or autism in which the child has normal intelligence and verbal skills, but still suffers from impaired social interaction, poor relationship formation, and the presence of repetitive behaviors. This diagnosis is most commonly made between the ages of 4 and 11 yrs. D. Incorrect! Autism is a disorder of childhood that is manifested by impaired communication, poor social interaction, lack of formation of relationships, and the presence of repetitive behaviors. Autistic children usually have below normal levels of intelligence, but may possess unusual savant-like abilities. Onset is usually by 3 yrs of age. Childhood disintegrative disorder refers to a condition in which children develop normally until 2 3 yrs of age, but then demonstrate a significant loss in motor skills, play skills, expressive and receptive language skills, social skills, and bladder and bowel control. Onset is between the ages of 2 and 10 yrs. Asperger s disorder is considered to be a milder form or autism in which the child has normal intelligence and verbal skills, but still suffers from impaired social interaction, poor relationship formation, and the presence of repetitive behaviors. This diagnosis is most commonly made between the ages of 4 and 11 yrs. (C)Asperger s disorder RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

7 Question No. 7 of Which of the following symptoms is unlikely to indicate a child experiencing abuse? Question #07 (A) The child may have genital abrasions. (B) The child may be depressed. (C) The child may have an anal fissure. (D) The child s mother is the likely abuser. (E) The child may have a past history of multiple urinary tract infections. The sexually abused child may have genital abrasions. The sexually abused child may be depressed. The sexually abused child may have an anal fissure as a manifestation of anal trauma. D. Correct! A male figure known to the child would be the most likely candidate to be the sexual abuser, not the child s mother. The sexually abused female child may have a past history of multiple urinary tract infections. Child abuse refers to behaviors by anyone in contact with children that result in the mistreatment of or harm to a child. There are 4 main categories of child abuse as follows: Physical abuse of children is responsible for approximately 3,000 deaths/yr in the United States. The abuser is most commonly the primary caregiver, and often female. A physically abused child may present with multiple bruises, cigarette burns, multiple fractures of varying ages on X-ray, subdural hematomas and retinal hemorrhages or detachments. Sexual abuse of children is usually caused by a male figure known to the child. Signs of sexual abuse of children include genital and/or anal trauma, UTIs, STDs and depression. Psychological abuse such as belittling, name-calling, bullying, and rejection all have deleterious effects on children. Neglect refers to the failure to provide for a child s basic needs such as food, clothing, shelter and supervision. (D)The child s mother is the likely abuser. RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

8 Question No. 8 of You are a geriatrician (specialization in treatment of the elderly), which of the following medical conditions would you be least likely see in your practice? Question #08 (A) Arthritis (B) Diabetes (C) Heart disease (D) Hypotension (E) Osteoporosis Arthritis is commonly seen in a geriatric practice. Diabetes is commonly seen in a geriatric practice. Heart disease is commonly seen in a geriatric practice. D. Correct! Hypertension would be much more likely to be seen in a geriatric practice, not hypotension. Osteoporosis is commonly seen in a geriatric practice. Common medical conditions seen in the elderly include: hypertension heart disease diabetes arthritis osteoporosis dementia (D)Hypotension RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

9 Question No. 9 of A 67 year old couple is experiencing sexual difficulty. Which of the following is most likely to be a contributing factor? Question #09 (A) There is loss of sexual desire. (B) Elderly men are impotent. (C) Elderly men take longer to ejaculate. (D) Elderly women have thickened vaginal walls. (E) Elderly women have longer, stretched vaginas. There is not necessarily a loss of sexual desire in the elderly. Most elderly men are capable of getting erections and having sex. C. Correct! Elderly men do take longer to ejaculate. D. Incorrect! Elderly women have thin vaginal walls. Elderly women have shortened vaginas. Sexual changes occur in the elderly, but it is important to note that there is not necessarily a loss of sexual desire in this age group. Normal sexual changes that do occur in the elderly are as follows: Males become slower to get an erection, take longer to ejaculate, and have a longer refractory period. Females demonstrate vaginal dryness, vaginal wall thinning, and vaginal shortening. (C)Elderly men take longer to ejaculate. RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

10 Question No. 10 of An 80 year old woman complains of difficulty sleeping at night. Which of the following is unlikely to be the root cause? Question #10 (A) It takes longer to fall asleep. (B) There are more awakenings during the night. (C) There is a decrease in REM sleep. (D) There is an increase in slow-wave sleep. (E) None of the above In the elderly, it normally takes longer to fall asleep. In the elderly, there are more awakenings during the night. In the elderly, there is a decrease in REM sleep. D. Correct! In the elderly, there is actually a decrease in slow-wave sleep. One of the answers is correct. Sleep patterns normally change in the elderly with: an increase in the time it takes to fall asleep (sleep latency), an increase in the number of awakenings during the night, a decrease in REM sleep, and a decrease in slow-wave sleep. (D)There is an increase in slow-wave sleep. RapidLearningCenter.com Rapid Learning Inc. All Rights Reserved

Transitional Phases in childhood Dr Jeané Cloete

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