Developmental Milestones MCQs

According to OP Ghai 10 th Ed, at 6 months, as the ability to chew develops, the child can take a biscuit to his mouth and chew. At this age, he tends to mouth all objects offered to him. This is called mouthing of objects and can be a reason for inadvertent foreign body ingestion or aspiration. This tendency abates by around 1 year of age in most children. According to other texts and sources, mouthing reduces between 12-18 months. Reference: OP Ghai 10 th Edition, Page 31

Age of attaining milestones normally Riding a tricycle comes normally at 3 years of age Saying full name and gender also comes at 3 years of age Copying a circle comes at 3 years of age Narrating a story comes at 4 years of age. Now, in this question, the child is able to perform the milestones corresponding to 3 years, but unable to do milestones related to 4 years. Hence, the developmental age of the child should be 3 years. Reference: OP Ghai 10 th Edition, Tables 3.1, 3.2 and 3.4

Let us evaluate the information given in the question. A normal infant can sit with own support from 6 months onwards, also called as Tripod position. Reaching for and grasping a cube with one hand, also called as Unidextrous grasp comes at 6 months of age Transferring objects hands to hands develops between 6 to 7 months of age. Waving bye-bye develops at 9 months Immature Pincer grasp comes by 9 months and mature one by 12 months. So, the child is able to do milestones of at or before 7 months of age, but not attained milestones related to 9 months and beyond. Hence the probable age of the child is 7 months. References: OP Ghai 10 th Edition, Tables 3.1, 3.2, 3.3, 3.4; Nelson textbook of pediatrics, 20 th edition, pg-69

Let us evaluate the information given step-wise. Feeding self with spoon with spillage is achieved by 15 months & without spillage by 18 months of age. Can undress self with assistance or supervision by 2 years of age. Can dress self with assistance or supervision by 3 years of age. Knowing gender comes by 3 years. Hence best possible answer here is 2 to 3 years. Reference: OP Ghai 10 th Edition, Table 3.3; Nelson textbook of pediatrics, 20 th edition, pg-76

Let us understand the information given here. The child is able to sit with own support, laughs loudly & has stranger anxiety. All of this is pointing towards a likely developmental age of 6 to 7 months. Thus the best answer is option D, i.e., 28 weeks. Reference: OP Ghai 10 th Edition, Pages 28-35.

The child in the question has West Syndrome. West syndrome starts between the ages of 2 and 12 months and consists of a triad of infantile epileptic spasms that usually occur in clusters (particularly in drowsiness or upon arousal), developmental regression, and a typical EEG picture called hypsarrhythmia. West syndrome is best treated with ACTH. However, if West Syndrome occurs as a part of Tuberous Sclerosis, then Vigabatrin is the preferred agent. Reference: Nelson textbook of Pediatrics, 20 th ed., pg. 2836

Recurrent jerky movements + Delayed milestones + Hypsarrhythmia on EEG indicates a likely diagnosis of West Syndrome. West syndrome is best treated with ACTH. High-dose ACTH is preferred over low-dose ACTH Vigabatrin is considered by some as a drug of second choice for infantile spasms and by some even as an alternative to ACTH as a drug of first choice in Tuberous Sclerosis patients. Reference: OP Ghai 10 th Edition, Page 582, AOCN 2021 Guidelines On West Syndrome

Hepatosplenomegaly with PAS positive histiocytes suggests diagnosis of Langerhans cell histiocytosis (LCH). The hallmark of LCH is clonal proliferation of monocyte lineage. The presence of birbeck granules in the cytoplasm of tumor cells is characteristic of LCH. Birbeck granules are tennis racket shaped bilaminar granules. They are not seen in all tumor cells by electron microscopy, hence detection of S-100 and CD1a by immunohistochemistry are needed for confirmation of diagnosis. Reference: Nelson textbook of Pediatrics, 1 st SA edition, pg. 2487