MCQS ON CHILDHOOD DEVELOPMENTAL SCREENING 2020

FPSC No : 85
MCQS ON CHILDHOOD DEVELOPMENTAL SCREENING 2020
Submission DEADLINE: 8 September 2020, 12 NOON

INSTRUCTIONS
• To submit answers to the following multiple choice questions, you are required to log on to the College
Online Portal (www.cfps2online.org)
• Attempt ALL the following multiple choice questions.
• There is only ONE correct answer for each question.
• The answers should be submitted to the College of Family Physicians Singapore via the College Online
Portal before the submission deadline stated above.
• There will be NO further extension of the submission deadline

1. The following are risk factors for developmental C. Refer Paediatrician

delay except: D. Refer Child Development Programme
A. 36 weeks’ gestation E. Perform hearing test
B. Low birth weight
C. Maternal diabetes 6. You are seeing Michael, an 18-month-old boy in
D. Maternal smoking your clinic, who has not started speaking yet. He
E. 40 weeks’ gestation can point to show what he wants. The parents
think he follows their instructions and have no
2. The following are protective factors except: concerns in his play or social interaction skills. All
other developmental milestones are age
A. Parents with stable occupation
appropriate. He is cared for by his helper as both
B. Motivated parents parents are working full time. In your clinic, he
C. Elderly parents appears to make eye contact with you, smiles
D. Grandparents and refers to his parents for praise.
E. Pre-school attendance You identify that the child’s lack of speech at 18
months is an area of concern and discuss it with
3. A three-month-old baby who has not rolled his parents. The father reports he, too, was late
over. The other examination was normal. to talk and feels there is nothing to worry.
The next appropriate step is to:
What will you do next?
A. Reassure parents
A. Agree with the father and reassure parents
B. Earlier review
B. Arrange for a review in four months with advice on
C. Refer Paediatrician
home stimulation of language and the need for referral
D. Refer Child Development Programme
if child is not meeting age appropriate milestones at the
E. Perform thyroid function test
review visit
4. A six-month-old baby who has not rolled over. C. Arrange for a review in six months
The other examination was normal. The next D. Advise parents that child would eventually catch up and
appropriate step is to: follow the ‘wait and see’ approach
A. Reassure parents E. Do nothing
B. Earlier review
C. Refer Paediatrician 7. What is/are the milestones that child should
D. Refer Child Development Programme have been met at 18 months?
E. Perform thyroid function test A. Child says the word “Papa” and “Mama” specifically
B. Child can put two or more blocks one on top of the
5. An 18-month-old toddler who does not speak other without the blocks falling
and does not have eye contact. The other C. Child can walk well with good balance, rarely falls and
examination was normal. The next appropriate does not sway from side to side
step is to:
D. When doing housework, child copies what the parent
A. Reassure parents
is doing
B. Earlier review
E. All of the above
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8. What is/are the Autism red flag(s) at 18 E. Reassure mother that this is normal developmental
months of age that may indicate a need for variation and stopping screen time will improve
further evaluation? child’s outcomes.
A. Lack of response to name
B. Lack of pointing or showing 12. A nine-month-old boy who was sleeping
C. Poor eye contact through the night now has frequent night time
D. Lack of enjoyment in carer interactions wakening. This is due to:
E. All the above A. Regression which requires further investigation
B. A prolonged afternoon nap
9. What is/are the situation(s) when hearing C. A predictable period of disorganisation as the child has
assessment should be strongly recommended? learnt to stand
A. Child has failed Newborn Hearing test or if it was D. The boy co-sleeping with parents who snore in the
not done at all. night
B. Child with recurrent or persistent ear infections for at E. The boy being overexcited during the day
least 3 months
C. Parental concerns about hearing, speech and language 13. During the 4 - 6 year well visit a mother
delay reports that she is exhausted caring for
D. Family history of permanent childhood hearing loss pre-schooler as he is constantly on the move.
E. All the above The child never stops and cannot sustain
attention for more than five minutes. On
10. Which of the following statements is TRUE history, you find that he has been watching two
A. Most late talkers will catch up by school entry but it is to three hours of TV a day since he was two
difficult to differentiate a late talker from a child with years old. He also sleeps around eight hours a
developmental language disorder at younger ages. day and goes to bed around 11pm with one
B. When there is a family history of late talking, afternoon nap in childcare. He moves a r o u n d
reassuring parents that child will eventually talk is the your clinic touching things in sight, climbing on
right thing to do. and off chairs. Which of the following is the
C. In a child who is late to talk and coming from a next most appropriate advice?
bilingual household, encouraging parents to use only A. Advise exhausting the boy with plenty of activities so
one language to hasten language development in the he will be less active by evening
child can be advised. B. Advise reducing screen time and making a referral to
D. Excessive screen time use is not associated with the developmental specialist.
language delay. C. Advise reducing screen time and review the child at
E. Early identification of hearing loss is unlikely to reduce the next well visit
impact on language development D. Advise change of screen time content to something
more calming
11. During the 18-month well child visit, a
E. Advise reducing screen time and make a referral to an
mother reports that her son is not pointing
and cannot say ‘papa’ or ‘mama’ with occupational therapist
meaning. You observe that the toddler
does not look at his mother or yourself for 14. During the 8 week visit, a mother describes
more than a few seconds. You also learn that her baby is a fussy feeder and difficult to
that he uses a smart device to watch settle and breast feed. She reports that her
YouTube clips for up to three hours ever baby is crying through the night and not
since he was walking. You counsel mother getting enough milk. When you weigh the
to stop screen time with the smart device. baby, she is making good weight gain. The
The next most appropriate step is to: baby is alert and looks at you. The mother
A. Review the child in three months as stopping screen appears tired and listless. You get a history
impairments observed that she has been feeling sad and crying most
days for the past four weeks. She has not been
B. Make a referral for further evaluation with a
getting much sleep and there is little support
developmental specialist as this may be an early at home. Your next step is to:
presentation of an autism spectrum disorder
C. Advise mother to engage in more play with ‘cause and A. Reassure mother that this is ‘post-natal blues’ and she
effect’ toys and review at the next well child visit will start feeling better in the next few days
D. Advise mother to resume screen time with the B. Make a referral for psychological support as she
television as this is more developmentally appropriate

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 MCQS ON CHILDHOOD DEVELOPMENTAL SCREENING 2020

appears to be in the early stages of post-natal D. Meningococcal vaccination

depression E. Varicella vaccination
C. Suggest that she gets out more and meet with friends
and she will feel better 20. Which of the following vaccine is a live
attenuated vaccine?
D. Advise mother to stop feeling sorry for herself and
A. IPV
focus on her baby
B. Hepatitis B
E. Make a referral to the lactation consultant and the
C. PCV
baby is not getting sufficient breast milk.
D. HPV
15. A three-year-old child should be doing all of E. BCG
the following EXCEPT:
A. Telling fantasy from reality 21. Which of the following would be suggestive of
a peripheral nerve disorder in an infant?
B. Making friends
A. Dysmorphism
C. Engaging in imaginative play
B. Global developmental delay
D. Undressing themselves independently
C. Hearing impairment
E. Feeding themselves with a spoon
D. Hypotonia
16. A 12-month-old boy is brought for a well-child E. Tongue fasciculations
evaluation. The boy's mother reports that
several individuals in the family have had 22. A five-year-old boy had difficulty climbing
anaphylaxis to egg. The boy has not yet eaten stairs and was unable to keep up with PE in
eggs or foods containing egg. school. Clinical examination showed grade 4
Which of the following is the most appropriate strength in hip flexors, and grade 4+ strength
approach to administration of the measles-mumps- in shoulder abductors. There was no facial
rubella (MMR) vaccine in this child? weakness. Gower’s sign was positive. Deep
A. MMR vaccine should be administered without special tendon reflexes were present, and there were
no tongue fasciculations. The most useful
precautions
investigation to do would be:
B. Diphenhydramine should be administered at the time
A. Acid alpha-glucosidase dried blood spot
of immunization
B. Anti-acetylcholine receptor (anti-AChR) antibody
C. Blood testing for egg ovalbumin specific IgE should be
C. Creatine kinase level
performed prior to immunization
D. Lactate level
D. Skin Prick Testing for egg allergy should be done
E. SMN1 gene testing
before giving MMR vaccine
E. Administration of the MMR vaccine is contraindicated 23. What are the specific signs of exercise
intolerance in children?
17. Which of the following vaccines contain A. Frequent falls
neomycin?
B. Muscle wasting
A. PCV 13
C. Proximal muscle weakness
B. HPV vaccine
D. Rhabdomyolysis
C. MMRV vaccine
E. Tongue fasciculations
D. Hepatitis B vaccine
E. DTaP vaccine 24. Prior to investigational muscle biopsy, which
of the following drugs does the anaesthetist
18. Gelatin allergy is a contraindication for which need to avoid administering?
vaccine? A. Lignocaine
A. Hepatitis B B. Midazolam
B. Polio C. Morphine
C. MMR and Varicella D. Propofol
D. Rotavirus E. Suxamethonium
E. HPV
25. Creatine kinase levels would be high in the
19. Syncope is a known problem likely to happen following conditions:
commonly following which vaccination? A. Charcot-Marie-Tooth Disease
A. BCG vaccination B. Down syndrome
B. Rotaviral vaccination C. Duchenne muscular dystrophy
C. HPV vaccination

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MCQS ON CHILDHOOD DEVELOPMENTAL SCREENING 2020

D. Myasthenia Gravis 29. This 14-year-old boy’s chest pain is likely to be

E. Spina Bifida BENIGN if
A. The pain is intense, localized to the third left
26. A three-month-old infant is found to have a costochondral junction, lasts a few seconds and
cardiac murmur. An urgent referral should be occurs randomly at least three times every week.
made to a paediatric cardiologist if B. It occurs consistently 20-30 minutes into every
A. Weight and height have been tracking along the 25th basketball training session.
centile since birth. C. He has cold sweats, light-headedness and palpitations
B. There is difficulty appreciating the splitting of the when he does higher intensity physical activity.
second heart sound. D. His father is well but his paternal uncle collapsed and
C. There is difficulty palpating the femoral pulses. died suddenly at 35 years of age.
D. There is a soft liver felt 1 cm below the right subcostal E. The ECG shows a heart rate of 76/min and a
margin. corrected QT interval of 467ms.
E. The heart rate is 135/min and the respiratory rate is
40/min. 30. A 12-year-old child was incidentally found to
have a cardiac murmur during an episode of
27. A two-year-old boy presents with seven days mild upper respiratory tract infection. This is
of fever with red eyes, red lips and few left likely to be an innocent murmur if
sided cervical lymph nodes (the largest A. It is a soft ejection systolic murmur grade 2/6 over the
measuring 2cm). No rashes are seen. He also upper left sternal edge that disappears from the lying
has a wet cough and pharyngitis. The
to the sitting position.
mycoplasma IgM is reactive. After 48 hours of
treatment with clarithromycin, the fever is still B. It is a soft ejection systolic murmur grade 2/6 over the
unremitting. The left-sided cervical lymph upper left sternal edge associated with fixed splitting
nodes have increased in size and there is of the second heart sound.
severe pain in the neck. The next step(s) of C. It is a soft ejection systolic murmur grade 2/6 over the
management would be best for this child. upper left sternal edge associated with a soft diastolic
A. Treat with levofloxacin for macrolide resistant rumble in the lower left sternal edge.
mycoplasma infection and monitor for another two to D. It is a soft continuous murmur grade 2/6 over the left
three days for response. upper sternal edge.
B. Start treatment with amoxicillin-clavulanic acid for E. It is a soft short systolic murmur grade 2/6 over apex
cervical lymphadenitis with evolving abscess formation associated with a mid-systolic click.
and refer to an otolaryngologist.
C. Await spontaneous resolution of the fever in the next
two to five days, as there may be a concomitant
adenovirus infection.
D. Perform some baseline blood investigations and
consider referral to a paediatric cardiologist in the
next two to three days to exclude incomplete
Kawasaki Disease.
E. Urgent referral to a paediatrician or paediatric
cardiologist to exclude incomplete Kawasaki Disease.

28. Which of the following is NOT a risk factor for

the development of metabolic syndrome for a
nine-year-old?
A. History of maternal gestational diabetes
B. Birth weight 3.78 kg
C. Family history of coronary artery disease
D. Presence of acanthosis nigricans
E. Watches You-tube and plays computer games for
three to four hours almost every day

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FPSC No. 78
“Chronic Disease Management Rerun”
Answers to 30 MCQ Assessment
1. D 11. C 21. D
2. B 12. B 22. A
3. C 13. E 23. E
4. A 14. D 24. A
5. E 15. E 25. C
6. B 16. C 26. B
7. D 17. D 27. A
8. B 18. E 28. E
9. B 19. E 29. D
10. D 20. B 30. C

FPSC No. 79
“Geriatric Care Rerun”
Answers to 30 MCQ Assessment
1. E 11. D 21. A
2. B 12. E 22. E
3. A 13. A 23. D
4. E 14. C 24. D
5. B 15. B 25. C
6. E 16. E 26. D
7. C 17. E 27. B
8. D 18. E 28. D
9. E 19. D 29. D
10. E 20. D 30. D

FPSC No. 81
“Mental Health Update Rerun”
Answers to 30 MCQ Assessment
1. B 11. E 21. E
2. D 12. D 22. E
3. E 13. E 23. A
4. E 14. D 24. D
5. C 15. E 25. D
6. B 16. A 26. D
7. E 17. D 27. C
8. C 18. E 28. A
9. E 19. D 29. B
10. D 20. C 30. E

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