Chapter 7. Global Developmental Delay and Developmental Regression

Question 1

Question 7-1:
Which of the following are prenatal or perinatal causes of
developmental delay?
A. Hypoxic encephalopathy
B. Cytomegalovirus
c. Lissencephaly
D. Toxoplasmosis
E. All of the above

Answer 1

Answer 7-1: E.
All of these are important prenatal or perinatal
causes ‘of developmental delay. The types of infections which develop prior to birth differ
from meningitis and encephalitis which
characterize problems of postnatal
development. (p77)

Question 2

Question 7-2:
Which of the following are significant risk factors for perinatal
neurologic injury?
A. Cesarean section after a trial oflabor
B. Maternal diabetes
C. Low socioeconomic status
D. Umbilical prolapse
E. All of the above

Answer 2

Answer 7-2: E.
All of these are risk factors for perinatal
neurologic injury. There are numerous risk
factors, some modifiable and some not These
are outlined well in Table 7.3, page 77.
Among other important factors are drug
addiction, gestational age of less than 30
weeks, low APGAR and need for
resuscitation, breech presentation, placental
abruption, prior miscarriages, and vaginal
bleeding after the first trimester. Postnatal
factors of particular note include a host of
developmental markers including abnormal
sucking and crying, dysmorphic features,
hypotonia, seizures, fever, or overt signs of
bir’.h injury. (P77)

Question 3

Question 7-3:
All of the following statements about ocular findings in
developmental disorders are correct EXCEPT which?
A. Nystagmus is seen in Leigh’s disease
B. Ophthalmoplegia is typical with Refsum’s disease
C. Wilson’s disease increases the risk of cataracts
D. Homocystinuria is associated with lens dislocation

Answer 3

Answer 7-3: B.
Ophthalmoplegia is not typical with Refsum’s
disease, but is more typically seen with
mitochondrial diseases and ataxia
telangiectasia Refsum’s disease is commonly
associated with retinal degeneration. (P78)

Question 4

Question 7-4:
Which of the following statements about identification of
cause of developmental delay is true?
A. About 60-80% of developmental delay can be given an etiology
B. Fewer than 30% of patients with developmental delay can be given an etiologic diagnosis
C. Determination of an etiology usually provides a specific intervention which can be applied
D. Developmental delay identified in one child does not alter the frequency of developmental delay in subsequent children

Answer 4

Answer 7-4: A.
About 60-80”,4 of patients with developmental
delay can be given an etiologic diagnosis.
HoweveT, identification of this etiology
seldom results in a specific intervention for
the patient. Developmental delay in one child
does affect the .frequency of delay in
subsequent children, depending on diagnosis.
(P76)

Question 5

Questions 7-5 through 7-8:
The following questions pertain to
developmental milestones. For each question,
indicate at which time the milestone is
reached. Select from the following list
A. Birth to 6 months
B. 6 months to I year
C. I year to 2 years
D. 2 years to 3 years
E. After 3 years

Question 7-5
Counts 4 objects and can tell a story

Answer 5

Answer 7-5: E.
Children learn to count four objects and to tell
a story after the age of 3 years, usually by 4
years. (P76)

Question 6

Questions 7-5 through 7-8:
The following questions pertain to
developmental milestones. For each question,
indicate at which time the milestone is
reached. Select from the following list
A. Birth to 6 months
B. 6 months to I year
C. I year to 2 years
D. 2 years to 3 years
E. After 3 years

Question 7-6
Laughs

Answer 6

Answer 7~: A.
Infants under 6 months of age are able to
laugb. usually by 4 months. (P76)

Question 7

Questions 7-5 through 7-8:
The following questions pertain to
developmental milestones. For each question,
indicate at which time the milestone is
reached. Select from the following list
A. Birth to 6 months
B. 6 months to I year
C. I year to 2 years
D. 2 years to 3 years
E. After 3 years

Question 7-7
Knows full name. Pretends as part of play

Answer 7

Answer 7-7: D.
Children learn their full name between the age
of 2 and 3 years. In addition, they begin to
pretend as part ofplay. (P76)

Question 8

Questions 7-5 through 7-8:
The following questions pertain to
developmental milestones. For each question,
indicate at which time the milestone is
reached. Select from the following list
A. Birth to 6 months
B. 6 months to I year
C. I year to 2 years
D. 2 years to 3 years
E. After 3 years

Question 7-8
Feeds self. Indicates desires by pointing

Answer 8

Answer 7-8: C.
Children learn to feed themselves between I
and 2 years. At this time they also learn tQ
point for their wants. Language is still
markedly restricted, about 6 words in the
middle of this developmental time. (p76)

Question 9

Question 7-9:
Which of the fol1OV11ing statements are nue
regarding imaging in patients with
developmental delay?
I. Imaging shows a cause in about a
third of patients with global
developmental delay
2. MRI is more sensitive for cerebral
dysgenesis than CT
3. Diagnostic yield of imaging is .
greater for patients with focal
fmdings
4. Diagnostic yield of imaging is
greater for patients with cerebral
palsy
Select: A -= 1,2,3. B = I, 3. C = 2, 4. D = 4 only. E = All

Answer 9

Answer 7-9: E.
Diagnostic yield of imaging in patients with
developmental delay is greater for patientS
with focal findings, cerebral palsy, and
microcephaly. About a third of patients will
have an etiology identified with imaging. In
.general. MRI is more sensitive for
developmental abnormalities than CT. (P78)

Question 10

Which of the following statements arc nue
regarding clinical findings in disorders with
developmental delay?
1. Glycogen storage diseases are
commonly associated with
organomegaly
2. Sjogren’s syndrome is associated
with increased skin thickness and
stiffuess
3. Isovaleric acidemia is associated with
the odor of sweaty feet
4. Spinal muscular atrophy presents
with neonatal spasticity
Select: A = I, 2, 3. B = 1.3. C = 2, 4. D = 4 only. E = All

Answer 10

Answer 7-10: A.
Spinal muscular atrophy presents with
hypotonia rather than spasticity, since it is a
lower motor neuron disorder rather than an
upper motor neuron disorder. Glycogen
storage diseases, lysosomal storage diseases,
aminoacidopathies, and.several other
metabolic conditions present with
organomegaly. Sjogren’s syndrome is a
condition which is seen in youth and adults,
and has characteristic thickness and stiffness
of the skin. Isovaleric acidemia results in the
smell of sweaty feet., which usually raises
suspicion of this disorder. (P79)