USMLE PRACTICE QUESTION #72
TOPIC: Pediatric developmental delays and disorders
Today’s question will test your ability to identify a commonly tested cause of pediatric developmental delay.
I’m Paul Ciurysek, MD, and this is The USMLE Times: An independent, subscriber-supported newsletter designed to help you survive medical school, pass your USMLE exams, and match into your dream residency program. This question and all others are free for 48 hours; after that, it’s available to Premium subscribers only.
A 4-year-old girl is brought to the pediatric clinic by her mother due to concerns about her daughter's developmental milestones. She reports that her daughter has difficulty speaking in full sentences and often uses gestures to communicate. She was born at 37 weeks gestation and had neonatal jaundice, which resolved without intervention. His growth parameters are at the 50th percentile for height, weight, and head circumference, and his vital signs are within normal limits. During the physical examination, the child was cooperative and engaged in eye contact. She can walk, run, and climb stairs independently. She can stack blocks and use scissors to cut paper. Her social skills are age-appropriate, but she struggles with pronunciation and understanding complex instructions. The pediatrician decides to administer a hearing test, which reveals mild conductive hearing loss. Which of the following is the most likely cause of this child's developmental delay?
A. Autism spectrum disorder
B. Otitis media with effusion
C. Global developmental delay
D. Expressive language disorder
E. Receptive language disorder
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The mental model used to answer this question comes from our detailed test-taking skills masterclass (check it out if you want to elevate your test-taking skills and position yourself for exam-day success). Here’s how to think through this question:
Step 1. Read the last line to determine the actual question: “Which of the following is the most likely cause of this child's developmental delay?”
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order. 1st: Identify what’s wrong with the patient, 2nd: Determine which of the patient’s issues is the most likely underlying cause.
Step 3: Read the vignette carefully and ask yourself: “What’s the most likely cause of the patient’s developmental delay?”
Step 4. Look at the answer choices and select the option most closely resembling your final thought from “Step 3” above.
GENERAL ANALYSIS
The 4-year-old girl presents with difficulty speaking in full sentences and uses gestures to communicate, but she has age-appropriate social skills and motor development. The hearing test reveals mild conductive hearing loss.
ANSWER CHOICES:
CHOICE A: Autism spectrum disorder
Explanation: Autism spectrum disorder typically involves challenges with social interactions and communication beyond speech difficulties. The child engages in eye contact and has age-appropriate social skills, making autism less likely.
CHOICE B: Otitis media with effusion
Explanation: Otitis media with effusion (OME) can lead to temporary conductive hearing loss, affecting the child's ability to hear and process speech sounds, potentially leading to expressive language delays.
CHOICE C: Global developmental delay
Explanation: This would involve delays in multiple areas of development, not just language.
CHOICE D: Expressive language disorder
Explanation: This could be a consideration; however, the hearing loss suggests that the language issues may be secondary to hearing difficulties rather than a primary expressive language disorder.
CHOICE E: Receptive language disorder
Explanation: This involves difficulty understanding language, which is not the primary issue here.
FINAL VERDICT…
The child's mild conductive hearing loss due to otitis media with effusion is likely contributing to her expressive language delay. Addressing the hearing issue may help improve her language development.
CORRECT ANSWER: B) Otitis media with effusion
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