USMLE STEP 1 PRACTICE QUESTION #45
TOPIC: Childhood development
Today’s question is based on a topic most people dislike, but it will likely appear on each of your USMLE exams: childhood development. The key to correctly answering this type of question is asking yourself which milestone will likely happen next for each category. After each milestone is identified, answering the question becomes relatively straightforward.
A 16-month-old girl presents to the pediatric clinic for her routine well-child visit. Her mother is concerned about the child's development, as she is not yet walking independently. The girl was born at 38 weeks of gestation and has had no significant health issues. Her growth parameters are appropriate for her age. Her vital signs are within normal limits. The child was alert, interactive, and happy during the physical examination. She can sit without support, crawl, and pull herself to a standing position. She can hold a scribble with a crayon and pick up small objects with her thumb and index finger. The child can say "mama" and "dada" meaningfully and follow simple one-step commands. Which of the following developmental milestones is she most likely to achieve next?
A. Jumping in place with both feet
B. Walking up and down stairs with assistance
C. Walking independently
D. Speaking in two-word sentences
E. Throwing a ball overhand
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The mental model for this specific type of question comes from our detailed test-taking skills masterclass. Here’s how to think through this question:
Step 1. Determine what the question is asking: Which developmental milestone will be achieved next?
Step 2. Read the vignette and identify how far the child has developed.
Step 3. Based on her most recently achieved milestone, ask yourself which milestones (gross motor, fine motor, language, social) should come next.
Step 4. Look at the answer choices and select based on the milestones considered in step 3.
GENERAL ANALYSIS
This question involves assessing the developmental milestones of a 16-month-old girl who is not yet walking independently. Based on her current abilities, it asks which developmental milestone she is most likely to achieve next.
ANSWER CHOICES:
ANSWER CHOICE A: Jumping in place with both feet
Jumping in place with both feet is a milestone typically achieved around 24-30 months.
ANSWER CHOICE B: Walking up and down stairs with assistance
Walking up and down stairs with assistance usually occurs around 18-24 months.
ANSWER CHOICE C: Walking independently
Walking independently is a milestone typically achieved between 12-15 months of age, though some children may achieve it slightly later.
ANSWER CHOICE D: Speaking in two-word sentences
Speaking in two-word sentences is a language milestone typically achieved around 18-24 months of age.
ANSWER CHOICE E: Throwing a ball overhand
Throwing a ball overhand is a milestone typically achieved around 18-24 months of age.
FINAL VERDICT…
The child in this scenario is 16 months old and demonstrates several developmental skills, such as sitting without support, crawling, pulling to stand, and using a pincer grasp. These skills indicate that she is developing appropriately, albeit slightly delayed in walking independently. Walking independently is a milestone typically achieved between 12-15 months, but some children may achieve it slightly later. Given her current abilities, the next milestone is most likely the ability to walk independently. It is important to remember that developmental milestones can vary, and some children may reach particular milestones earlier or later than others.
CORRECT ANSWER: C) Walking independently
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