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MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Compared with physical changes in the earlier preschool and later adolescent years, physical
changes in middle and late childhood occur
A) in longer spurts. B) slower.
C) at the same rate. D) faster and are more significant.
Answer: B

2) The most pronounced physical change in middle and late adolescence is:
A) the height ratio. B) the muscle-to-fat ratio.
C) proportional changes. D) strength capabilities.
Answer: C

3) On average, children grow ________ centimeters per year during middle and late childhood.
A) 2.5 to 4 B) 18.5 to 25 C) 12.5 to 17.5 D) 5 to 7.5
Answer: D

4) Why are boys generally stronger than girls during middle childhood?
A) Boys have more muscle cells. B) Boys lose their baby fat more quickly.
C) Boys exercise more. D) Boys have a larger skeletal system.
Answer: A

5) Improvement in language abilities during childhood is due, in part, to ________.

A) thinning of the amygdala B) increases in serotonin levels
C) thickening of the cerebral cortex D) decreases in myelination
Answer: C

6) When areas of the brain that aren't being used lose synaptic connections and other areas that are
used show an increase in synaptic connections, this is called ________.
A) neurotransmitter restriction B) synaptic extension
C) synaptic pruning D) cortical stimulation
Answer: C

7) Seven-year-old Milaka can use scissors to cut small paper dolls out of construction paper. What best
accounts for her improving dexterity?
A) practice B) increased muscle development
C) increased bone ossification D) increased myelination
Answer: D

8) During middle and later childhood, girls usually outperform boys in ________ skills.
A) gross motor B) fine motor C) mental D) physical
Answer: B

9) Health risks of obesity in children include all of the following except ________.
A) depression B) hypotension C) hypertension D) sleep apnea
Answer: B

1
10) What is suspected to be the MAIN culprit for the increase in childhood obesity?
A) environmental influences B) insufficient sleep
C) genetic predisposition D) changes in myelination
Answer: A

11) Datafrom the UNICEF report card indicates that Canada ranked ________ from the bottom in
childhood obesity rates.
A) 3rd B) 5th C) 1st D) 2nd
Answer: D

12) Kevin is an obese child. He has tried several strategies to reduce his weight. Which of the following
strategies will his doctor be LEAST likely to recommend as a way of combating this health
problem?
A) exercise B) diet changes
C) surgery D) behaviour modification
Answer: C

13) Which of the following is a strategy that parents of an overweight child should not use?
A) Help the child develop good eating habits utilizing Canada's Food Guide.
B) Encourage the child to be physically active.
C) Limit the amount of screen time (television, computers, etc.) the child has each day.
D) Have the child follow a strict weight-loss diet.
Answer: D

14) Asan expert in childhood obesity, you've been asked to recommend to parents what they can do to
help their children achieve a healthy weight. What would you recommend?
A) surgery is the most effective solution B) eat meals together as a family
C) work with children on their literacy skills D) positive and negative punishment regime
Answer: B

15) A desire to be thin ________

A) begins around the age of ten years.
B) is evident in girls as young as five to eight years of age.
C) is limited to teenagers and young adults.
D) begins around the time of puberty.
Answer: B

16) Lacy, age 8, is obsessed about being thin. One strategy a parent can use to help Lacy is
A) inform her that she will be placed on a low-calorie diet.
B) assist her to develop a positive self-image.
C) book an appointment with a counselor.
D) prevent her from watching models on television.
Answer: B

2
17) What can parents do to help their obese children lose weight?
A) force their child to exercise regularly. B) punish their child for overeating.
C) restrict their food intake. D) model healthy eating behaviours.
Answer: D

18) Which type of cancer is most common in children?

A) lung B) colon C) pancreas D) leukemia
Answer: D

19) Piaget believed that children below the age of ________ do not have concrete operational thought.
A) 5 B) 9 C) 3 D) 7
Answer: D

20) Two identical glasses are filled to the same level with juice. A child then watches as the juice from
one glass is poured into a taller, thinner glass. A child who is capable of concrete operational
thought might say,
A) "The tall one has more juice. See how tall it is."
B) "It's still the same amount of juice. You can tell by how tall this one is."
C) "The tall one has more juice. They just look like they are the same."
D) "It's still the same amount of juice. You can tell by just pouring it back."
Answer: D

21) A child is presented with two identical balls of clay. The experimenter rolls one ball into a long, thin
shape; the other remains in its original ball. The child is then asked if there is more clay in the ball
or in the long, thin piece of clay. If the child answers the problem correctly, the child is most likely
in Piaget's ________ stage of cognitive development and is between ________ years old.
A) preoperational; 5-7 B) sensorimotor; 4-6
C) earliest; 2-3 D) concrete operational; 7-11
Answer: D

22) Which of the following is NOT a characteristic of concrete operational thought?

A) logical reasoning B) the ability to think abstractly
C) the ability to mentally reverse action D) classification skills
Answer: B

23) Tounderstand how a family tree showing relationships among relatives works, children must have
acquired the skill of
A) classification. B) seriation.
C) centration. D) mental reversibility.
Answer: A

24) Julio
understands that although he is older than his brother, he is younger than his sister. This is
because Julio understands
A) classification. B) transitivity. C) seriation. D) centration.
Answer: B

3
25) Susan'sbirthday is in February. Therefore, she knows that she is older than her classmate Cindy who
was born in March, yet she is younger than Logan, her classmate who was born in January. Susan
understands
A) classification. B) centration. C) seriation. D) transitivity.
Answer: D

26) Which one of the following ideas about cognitive development do we owe to the legacy of Jean
Piaget?
A) Children must be able to trust adults before they are willing to learn from them.
B) Children construct their own understandings about how the world works.
C) Children can store an infinite amount of information in their long-term memories.
D) Genetics plays an important role in cognitive development.
Answer: B

27) When a 3-year-old knows that a blindfolded person cannot see what the 3-year-old herself sees, the
finding
A) contradicts Piaget's ideas about the timing of concrete operational thought.
B) contradicts Piaget's beliefs about the nature of preoperational thought.
C) confirms Piaget's claims about preoperational thought.
D) indicates remarkable formal operational thought in a very young child.
Answer: A

28) Children usually understand conservation of number ________ than Piaget thought.
A) a little earlier B) much later C) much earlier D) a little later
Answer: C

29) Neo-Piagetians incorporate ideas about cognitive development from

A) the information processing approach to cognition.
B) behaviourist concepts of learning.
C) Vygotsky's ideas about the importance of culture and context.
D) the individual differences study of intelligence.
Answer: A

30) ________ develop(s) more rapidly during early childhood, and ________ develop(s) more rapidly
during middle and late childhood.
A) Short-term memory; long-term memory B) Long-term memory; short-term memory
C) Learner characteristics; control processes D) Control processes; learner characteristics
Answer: A

31) Expertise inan area is ________.

A) correlated negatively with metamemory
B) correlated negatively with learning ability in that area
C) correlated positively with fine motor skills in that area
D) correlated positively with memory for related material
Answer: D

4
32) In
a famous study, Chi (1978) found that 10-year-old children who knew a lot about chess
remembered chessboard positions better than adults who did not play much chess. Evidently, these
10-year-old chess experts could do this because they
A) had better long-term memory. B) were highly motivated to beat the adults.
C) had more expertise. D) were less intimidated by the task.
Answer: C

33) Long-term memory depends on ________.

A) heritability of memory skills B) neuroplasticity
C) heritability of intelligence D) learning strategies used
Answer: D

34) A key component of working memory is ________.

A) emotional intelligence B) the analytical executive
C) experiential intelligence D) the central executive
Answer: D

35) Arecent research review concluded that children with learning difficulties in reading and math have
________.
A) semantic memory deficits B) working memory deficits
C) short-term memory deficits D) long-term memory deficits
Answer: B

36) Fuzzy trace theory holds that older children have better memory and reasoning because ________.
A) children's divergent thinking enhances long-term memory
B) children use and remember gist more, which is more enduring
C) children's convergent thinking improves short-term memory
D) children use and remember verbatim traces more, which are more enduring
Answer: B

37) A teacher asks his students to consider what it would be like to live in a submarine underwater.
Considering all the requirements for life in this setting as well as all the implications would require
students to engage in ________.
A) metacognitive processes B) critical thinking
C) fuzzy trace analysis D) convergent thinking
Answer: B

38) What colour is a sapphire? Answering this question elicits ________.

A) critical
thinking B) creative thinking
C) divergent thinking D) convergent thinking
Answer: D

5
39) The principal of a school engages the students in a discussion of where a new playground should be
built and what it should include. A creative solution would be enhanced by ________.
A) engaging in brainstorming B) eliciting convergent thinking
C) inducing long-term memory processes D) invoking metacognitive processes
Answer: A

40) Ms. Bond, a science teacher, often uses ________, which emphasizes that children need to build
their own scientific knowledge and understanding.
A) scientific analogy B) curriculum development
C) constructivist teaching D) pedagogical teaching
Answer: C

41) The ability to think about something in novel and unusual ways and to come up with unique
solutions to problems is called
A) creativity. B) spontaneity. C) elasticity. D) congruency.
Answer: A

42) Standardized testing in schools typically measures ________ thinking.

A) creative B) convergent C) divergent D) novel
Answer: B

43) The type of thinking that produces many answers to the same question is called ________ thinking.
A) expressive B) convergent C) divergent D) expanded
Answer: C

44) Which one of the following questions would be most likely generate a brainstorming session?
A) How many pieces of fruit would you have if you were given two apples, three pears, and a
banana?
B) How can a person get to Labrador from Manitoba?
C) What is the largest mammal living on the North American continent?
D) What is the capital of Alberta?
Answer: B

45) Knowing about knowing is called ________.

A) cognition B) metacognition C) memory D) intelligence
Answer: B

46) "It's
hard for me to remember the time-tables, Mom!" says Jonah. He is demonstrating his
________.
A) appreciation for short-term memory B) intelligence quotient
C) knowledge of fuzzy trace theory D) metacognitive ability
Answer: D

6
47) Jenny ismore outgoing than Christopher is; and he is more creative than Albert. They vary on
________.
A) individual differences B) metamemory abilities
C) personal distributions D) metacognitive skills
Answer: A

48) The stable, consistent ways in which people are different from each other are called ________.
A) personal distributions B) individual differences
C) metamemory abilities D) metacognitive skills
Answer: B

49) Who developed the first intelligence test?

A) Binet B) Piaget C) Wechsler D) Stanford
Answer: A

50) According to William Stern, how is IQ calculated?

A) CA divided by 100 plus SD B)CA divided by SD times 100
C) MA divided by 100 plus CA D) MA divided by CA times 100
Answer: D

51) The concept of intelligence has not been easy to define because it is
A) difficult to identify consistent differences in intelligence between individuals.
B) difficult to identify examples of intelligence.
C) such a concrete concept.
D) a complex concept that includes many different aspects.
Answer: D

52) Incontrast to the study of information processing, the study of intelligence is more likely to involve
the concept of
A) problem-solving skills. B) individual differences.
C) language. D) cognitive processes.
Answer: B

53) Sally's mental age is 12; but her chronological age is 9. Sally's intelligence quotient is
A) 133. B) 100. C) 75. D) 108.
Answer: A

54) Amber isgiven a Stanford-Binet intelligence test. Her mental age is determined to be 12.8 and her
chronological age is 11.0. Amber's IQ score is
A) about average. B) above the majority of the population.
C) below the majority of the population. D) 86.
Answer: B

7
55) Intelligenceis assumed to be normally distributed, which of the following would you expect to find
in the overall population?
A) more people of high intelligence than of low intelligence
B) more people of high intelligence than of moderate or low intelligence
C) more people of moderate intelligence than of high or low intelligence
D) more people of low intelligence than of moderate or high intelligence
Answer: C

56) Which of the following is NOT a test used by school psychologists to assess intelligence levels?
A) Gardner's Skills B) Wechsler scales C) Stanford-Binet D) Apgar Scale
Answer: D

57) The Wechsler scales provide

A) both verbal and performance IQs. B) an overall IQ only.
C) a verbal IQ based on two verbal subscales. D) a performance IQ only.
Answer: A

58) A verbal subscale item on the Wechsler scales might include an item such as ________.
A) How old are you? B) 3 + 3 = ?
C) What is your mother's name? D) Why should we wear shoes?
Answer: D

59) According to Howard Gardner's theory of multiple intelligence, a child who could distinguish the
patterns of leaf growth on several different types of trees would possess a ________ type of
intelligence?
A) linguistic B) spatial C) naturalist D) interpersonal
Answer: C

60) According to Howard Gardner's theory of multiple intelligence, the ability to be sensitive to the
behaviour, moods, and needs of others is an example of the ________ type of intelligence?
A) bodily-kinesthetic B) interpersonal
C) naturalist D) intrapersonal
Answer: B

61) Whose triarchic theory of intelligence states that intelligence comes in three forms?
A) Sternberg B) Spearman C) Gardner D) Stern
Answer: A

62) Sternberg's triarchic theory and Gardner's theory of multiple intelligence are examples of theories
which maintain that
A) intelligence is a general ability.
B) intelligence consists of a number of specific abilities.
C) there are separate information-processing components of intelligence.
D) there are three types of intelligence.
Answer: B

8
63) Gardner's theory of intelligence argues that there are ________ types of intelligence.
A) 8 B) 7 C) 5 D) 4
Answer: A

64) According to Gardner, all of the following are types of intelligence EXCEPT
A) naturalist skills. B) verbal skills. C) artistic skills. D) musical skills.
Answer: C

65) Colin
does not earn high grades on standardized tests; but he has a black belt in martial arts.
According to Gardner, Colin has ________ skills.
A) interpersonal B) intrapersonal
C) bodily-kinesthetic D) spatial
Answer: C

66) Which one of the following is a form of intelligence identified by Robert J. Sternberg?
A) creative intelligence B) spatial intelligence
C) social intelligence D) intrapersonal intelligence
Answer: A

67) Sternberg and Gardner's theories of intelligence are ALIKE in that both
A) hypothesize several different types of intelligence.
B) stress the ability to quickly identify and remember patterns.
C) hypothesize a single-factor theory of intelligence.
D) stress the ability to adapt to novel situations.
Answer: A

68) The correlation between taking music and IQ performance is ________.

A) positive B) neutral C) unknown D) negative
Answer: A

69) Parentalcommunication with their children ________.

A) correlates positively with children's IQ B) is surprisingly unrelated to IQ
C) correlates negatively with children's IQ D) decrease slightly as IQ stabilizes
Answer: A

70) Mayer-Salovey-Caruso propose that emotional intelligence represents an ability to ________.

A) validate critical thinking B) think in a convergent way
C) think in a divergent way D) validate reason with emotion
Answer: D

9
71) Raven's Progressive Matrices are an example of ________.
A) an intelligence test that aims to be culture-fair
B) researchers acknowledging the role of improved teaching practices on IQ scores
C) an intelligence test designed to measure creativity as well
D) an intelligence test developed due to the Flynn effect
Answer: A

72) It is difficult to create a culture-free intelligence test because ________.

A) definitions of intelligence are culture-bound
B) children's needs are so different
C) they're expensive to develop
D) they don't consider the role of physical disabilities on IQ scores
Answer: A

73) Eastern cultures see intelligence as a way for members of a community to

A) engage successfully in social roles.
B) grow in exposure to computers and social media.
C) predict weather from the waves of the ocean.
D) increase their ability to provide food for the family.
Answer: A

74) What is the BEST explanation for why minorities earn lower scores on IQ tests?
A) environment B) racism C) heredity D) unfair scoring
Answer: A

75) Which of the following would be considered a culture-fair intelligence test?

A) a test of language skills
B) a test that reflects the knowledge of children from lower SES families
C) a non-verbal test
D) a test that reflects the dominant culture
Answer: C

76) A culture-fair intelligence test is one in which all of those who take it
A) value the same skills. B) have the same opportunity to do well.
C) have had the same life experiences. D) score about the same.
Answer: B

77) Many intelligence tests are biased in that they

A) use only standardized test items familiar to all test takers.
B) reflect the common values of all test takers.
C) reflect the cultures of some test takers more than others.
D) test predominantly non-verbal skills.
Answer: C

10
78) Which of the following would be the BEST example of a test item from a culture-fair test?
A) "What do farmers use tractors for?"
B) "What should you do if you find a 3-year-old child in the street?"
C) "Trace a path through the maze."
D) "Why do individuals buy automobile insurance?"
Answer: C

79) "Hannah has an IQ of 135. She is very bright, and I'm sure she will have no difficulties at all in any
of her school subjects. With that level of intelligence, I'm sure she'll be quite successful whether she
chooses to go into medicine or law as a career." This speaker is
A) viewing the IQ score as an indicator of interpersonal intelligence.
B) giving an appropriate interpretation of an intelligence test.
C) assuming that intelligence is composed of several different factors.
D) misusing the results of an intelligence test.
Answer: D

80) Mr. French wants to know which of the children who have applied for admission to his special
science school really have the potential to become successful scientists. He gives them all an
intelligence test and admits only those who score in the top 10 percent. What would Binet say about
Mr. French's use of an intelligence test?
A) Mr. French has chosen a group of individuals who will excel in science.
B) Mr. French is a wise man to have used an intelligence test to predict career success.
C) Mr. French is misusing the intelligence test, because such tests were not developed to predict
career success.
D) Mr. French is using the intelligence test inappropriately, because the test must be given at least
twice to better predict career success.
Answer: C

81) Which of the following is the MOST appropriate use of intelligence test results?
A) They should be eliminated as an assessment tool because of their cultural bias and frequent
misinterpretation.
B) They should be used primarily to direct students to appropriate career choices.
C) They should be considered one aspect of a person's whole range of talents.
D) They should be the major tool for determining school placement, but nothing more.
Answer: C

82) What problem may result from using a single number as a measure of intelligence?
A) People may focus on increasing their intelligence to the exclusion of other pursuits.
B) Stereotypes may form on the basis of IQ scores.
C) Teachers may not teach children with high IQs as well as they teach children with low IQs.
D) People are confused by the measure and unsure of its meaning.
Answer: B

11
83) Paul has an IQ of 78. He lives in his own apartment, has a job, and supports himself. He has many
friends, goes bowling, eats out frequently and does his own budget. He has no difficulty adapting to
everyday life. According to the definition of learning disability Paul is ________.
A) having cognitive difficulties B) organically disabled
C) not intellectually disabled D) is mildly disabled
Answer: C

84) Cultural-familial intellectual disability is a mental condition in which there is no evidence of

________.
A) inorganic brain damage B) environmental influences in family
C) intellectual stimulation in family D) organic brain damage
Answer: D

85) Intellectual disability is best regarded as ________.

A) a way of life B) mental process C) cultural attribute D) disease process
Answer: A

86) Intellectual delay affects

________.
A) more girls than boys B) boys and girls in a profound manner
C) boys and girls equally D) more boys than girls
Answer: D

87) Developmental delay happens more often to ________.

A) boys; no girls are affected B) girls; no boys are affected
C) boys than girls D) girls than boys
Answer: C

88) Cultural-familial
intellectual disability normally results in
A) mildto moderate disability. B) severe to profound disability.
C) moderate damage to brain tissues. D) moderate to severe disability.
Answer: A

89) Gifted children tend to

A) be less mature. B) desire a great deal of explicit instruction.
C) be emotionally distressed. D) be socially well-adjusted.
Answer: D

90) Leila has an IQ of 143 and is an accomplished cellist. She would probably be considered ________.
A) to have adjustment challenges
B) to have an IQ score that falls within a normal range
C) to be gifted
D) to need interpersonal skills coaching
Answer: C

12
91) Studieshave shown that most people who are academically gifted, or who have a superior talent in
some area tend to
A) also have some type of mild-to-moderate mental disorder like depression or psychosis.
B) also have some type of emotional disturbance like moodiness or an antisocial tendency.
C) be more mature and have fewer emotional problems than the average person.
D) be more mature than average people, but they have more emotional problems.
Answer: C

92) Researchby Dr. Joan Freeman (2009) identified four criteria that characterize gifted children.
Which of the following is NOT one of those criteria?
A) Gifted children have a keen sense of awareness
B) Gifted children are outgoing.
C) Gifted children have an ability to learn.
D) Gifted children are independent.
Answer: B

93) During middle-late childhood, children's vocabulary ________.

A) stabilizes B) increases dramatically
C) decreases slightly D) remains unchanged
Answer: B

94) Knowledge about language is called ________.

A) lexical knowledge B) auditory awareness
C) metalinguistic awareness D) phonological learning
Answer: C

95) "Joey,
throw me the ball!" and "Mrs. Sanchez, may I please use the washroom?" show how Betsy
understands the ________ of language.
A) phonologics B) metalinguistics C) semantics D) pragmatics
Answer: D

96) The ________ approach stresses that reading instruction should parallel a child's natural language
learning.
A) phonics B) complex-language
C) basic skills D) whole-language
Answer: D

97) Carmela is teaching her son to read by sounding out the words in storybooks. Carmela is using the
________ approach.
A) whole-language B) complex-language
C) balanced-instruction D) basic-skills-and-phonetics
Answer: D

13
 98) Robert begins teaching children to read by having them learn to make sounds that go with each
letter of the alphabet. Robert appears to be taking a(n) ________ approach.
A) analytic B) whole-language
C) information-processing D) basic-skills-and-phonetics
Answer: D

99) Research, comparing the whole-language and basic-skills-and-phonetics approaches to learning to

read, has shown that
A) the basic-skills-and-phonetics approach helps children to sound out words better.
B) the approaches are equally successful if teachers follow one or the other.
C) neither approach is truly superior to the other but phonics needs to be emphasized.
D) the whole-language approach produces superior word recognition.
Answer: C

100) Research on the effects and consequences of French immersion has shown that
A) bilingualism is associated with some minor cognitive deficits.
B) learning one's native language interferes with learning a second language.
C) bilingualism does not impair a child's ability to speak their first language.
D) bilingualism leads to poorer social adjustment.
Answer: C

101) Children enrolled in bilingual programs are ________.

A) less likely to be bilingual as adults
B) dependent on the teaching method used to become bilingual
C) more likely to be bilingual as adults
D) bilingual if motivated by parents
Answer: C

102) Josie is considering enrolling her child in a French immersion program at school. She's not sure if
there are any real benefits for her child (other than acquiring a second language). Which piece of
information would be best to give to Josie to help her make this decision?
A) bilingual children score higher in math and spatial ability tests than monolingual children do
B) bilingual children tend to be more anxious than monolingual children
C) bilingual children display superior interpersonal skills than monolingual children
D) bilingual children tend to do better in language and cognitive tasks than monolingual children
do
Answer: D

103) Which of the following is a learner-centred approach to student learning?

A) direct instruction approach B) mastery approach
C) constructivist approach D) teacher-directed approach
Answer: C

14
104) Mrs. McCarthy is highly intent that her students spend maximum time on academic tasks. She most
likely ascribes to the ________ approach.
A) exploratory B) direct instruction
C) cognitive focus instruction D) constructivist
Answer: B

105) In terms of behavioural adjustment, family SES was found to be strongly related to
A) schizophrenia. B) hyperactivity.
C) emotional problems. D) depression.
Answer: B

106) In general, children of recent immigrants ________.

A) score higher on math and reading tests than non-immigrant children
B) fare better than other children in psychological well-being
C) report experiencing hostile teachers and a tense school environment
D) tend to experience considerable anxiety in school
Answer: B

107) Which of the following advice would you give a teacher who is trying to encourage creativity in
their students?
A) "encourage them to get assistance from their parents"
B) "provide them with items from standardized IQ tests and assist them to work through each
item"
C) "encourage them to explore possibilities and not worry about getting the correct answer"
D) "emphasize rote memorization"
Answer: C

108) Canadian parents tend to take advantage of private schools and home schooling for their children
because
A) they are wealthy enough to afford it.
B) their children have shown too little academic progress in public schools.
C) their children need specialized services.
D) they find home schooling to be better for their kids.
Answer: D

109) Autistic disorder has its onset ________.

A) in the first 6 years of life
B) in the first 3 years of life
C) after a traumatic injury to the brain
D) during the pruning process of neurons during infancy
Answer: B

15
110) In terms of adjusting to mainstream schools, aboriginal children tend to ________.
A) feel integrated and a part of the school's community
B) prefer home-schooling
C) require additional math support
D) feel alienated and misunderstood
Answer: D

111) Which one of the following statements about disabilities is NOT correct?
A) More than half (59%) of children with a physical disability also have a learning disability.
B) Diagnosing whether or not a child has a learning disability is difficult.
C) Children with learning disabilities have below average intelligence.
D) A physical disability is a risk factor for academic problems.
Answer: C

112) Among children with learning disabilities, the most common problem involves
A) reading. B) handwriting. C) mathematics. D) spelling.
Answer: A

113) Children with learning disabilities are

A) at or above average in intelligence. B)significantly above average in intelligence.
C) not able to be tested for intelligence. D) below average in intelligence.
Answer: A

114) A severe impairment in reading and spelling ability is known as ________.

A) attention deficit hyperactivity disorder B) dyslexia
C) phonological deficit disorder D) speech impediment
Answer: B

115) It seems that learning disabilities ________.

A) place these children in high risk for suicide
B) are entirely due to environmental factors
C) appear to have no other problems or disorders such as mental retardation
D) are caused by abnormal hormone levels during pregnancy
Answer: C

116) Loren tends to have a great deal of trouble spelling and reading. The letters in the words appear to
"swap places" for him, making it very difficult to read and write. He seems to have ________.
A) phonological anxiety disorder B) dysmorphic vocabulary disorder
C) attention deficit disorder D) dyslexia
Answer: D

16
117) Attention deficit hyperactivity is most effectively treated
A) with stimulants.
B) by using behavioural management techniques and medication.
C) with antidepressants.
D) by implementing special diets.
Answer: B

118) Most children with attention deficit hyperactivity disorder are initially diagnosed in the first three
grades of elementary school. This is probably because
A) the disorder does not emerge until middle childhood.
B) the disorder is caused by the pressures of schooling.
C) diagnoses are not available until middle childhood.
D) this is the first time children are really required to sit still and concentrate seriously.
Answer: D

119) Many children aged 10- to 15-year-olds with ADHD reported feeling ________ at school.
A) out of control B) "left out" C) anxious D) depressed
Answer: B

120) What teratogen has been linked to the occurrence of ADHD?

A) anti-nausea medication B) alcohol
C) cocaine D) marijuana
Answer: B

121) The area of the brain linked to ADHD is ________.

A) amygdala B) cerebral cortex C) hippocampus D) pons
Answer: B

122) Research shows that ________ are effective at improving the attention of children with ADHD.
A) depressants B) anti-hallucinogens
C) anti-anxiety medications D) stimulants
Answer: D

123) Which one of the following plays the most important role in proposing the course of ADHD?
A) heredity B) developmental delays
C) lack of motivation D) inconsistent parenting
Answer: A

124) Kang has been diagnosed with attention deficit hyperactivity disorder and recently started a common
form of drug therapy. Kang is probably receiving a ________ known to ________ the nervous
system of children with ADHD.
A) hormone; speed up B) antidepressant; slow down
C) barbiturate; speed up D) stimulant; slow down
Answer: D

17
 125) Alexa has serious problems while interacting with others, with verbal and non-verbal
communication, and often engages in repetitive behaviours. She seems to be exhibiting signs of
________.
A) ADHD B) autism spectrum disorder
C) dyslexia D) Asperger syndrome
Answer: B

126) Caring for a child with a chronic condition is associated with ________.
A) paternal depression B) lower SES
C) higher SES D) maternal depression
Answer: D

127) Eight-year-old Jill is mildly intellectually disabled and has just learned that she is about to be
"mainstreamed." What is going to happen to Jill?
A) She will be placed in a regular classroom, with normal children, in her local public school.
B) She will be moved from the child ward of her mental institution and placed in the ward with
adolescents and adults.
C) She will be placed in a special education class in her local public school.
D) Her job skills training will now occur in a real-world setting rather than in the classroom.
Answer: A

128) What is the primary criticism of mainstreaming children with disabilities?

A) Their situation is unique.
B) More individualized instruction might be required.
C) They do not have the same IQ as regular classroom students.
D) They are not able to comprehend the content of a mainstream classroom.
Answer: B

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

129) Discuss height and weight changes that take place during middle and late childhood.
Answer: The average rate of growth for children during this period of time is about 5 to 7.5 centimeters
per year, with a weight gain of about 2.3 to 3.2 kilograms per year.

130) You've been invited to advise a local school board on how they can get children to exercise more.
What advice will you provide?
Answer: Offer more physical activities run by volunteers, improve physical fitness activities at school,
work with children to plan school & community activities that interest them, encourage
families to focus more on physical activities & exercise more.

131) What are the health risks associated with obesity?

Answer: The health risks associated with obesity include high blood pressure or heart disease, type 2
diabetes, sleep apnea, and mental health concerns such as low self-esteem, depression, or
feeling judged, teased, or bullied (Government of Canada, 2015).

18
132) What are the most highly recommended course of health promotion strategies for children who are
obese?
Answer: Experts recommend a treatment that involves a combination of diet, exercise, and cultivating
healthy lifestyles for children.

133) You've been asked to deliver a workshop to parents whose children have eating disorders. One
parent asks what parents can do to promote a positive body image in their children. How will you
answer this question?
Answer: 1) Promote a sense of competence in children, 2) listen to their concerns about not being as
good as their peers, and 3) explain the unrealistic and unhealthy aspects of the media's
portrayal of thinness.

134) List three mental abilities that the child in concrete operations can successfully complete.
Answer: (1) Seriation; (2) conservation; (3) reversibility; (4) classification; and, (5) transitivity.

135) List three effective strategies for adults to use when attempting to improve children's memory skills.
Answer: (1) Motivate children to remember material by understanding it rather than by memorizing it;
(2) Repeat with variation on the instructional information and link early and often; (3) Embed
memory-relevant language when instructing children.

136) Describe fuzzy trace theory.

Answer: Memory is best understood by considering both verbatim memory trace & gist.

137) Critical thinking is an important skill. Define it and provide an example.

Answer: Thinking reflectively and productively, evaluating evidence. It involves the creation of new
ideas & the rethinking of earlier used procedures as well as the conclusions arrived at earlier.

138) Explain the differences between convergent and divergent thinking and provide examples.
Answer: Convergent thinking produces 1 right answer. Divergent thinking produces many answers to
the same question and characterizes creativity. For example: What uses can you make of a
shoe? Convergent answer = protect feet. Divergent answer = could use as a receptacle, to dig
in dirt/sand, as a flower pot, etc.

139) What is metacognition? How does it develop?

Answer: Metacognition is what a person knows about knowing. During first-order cognitive skills
children know about the world, and during second-order cognitive skills children know
something about their own knowledge.

140) Briefly discuss the three components of Sternberg's triarchic theory of intelligence.
Answer: (1) Analytical intelligence: ability to analyze, judge, evaluate, compare and contrast; (2)
creative intelligence: ability to create, design, invent, originate, and imagine; and, (3) practical
intelligence: ability to use, apply, implement, and put into practice.

19
141) List four of Gardner's eight types of intelligence.
Answer: (1) Verbal; (2) mathematical; (3) spatial; (4) bodily-kinesthetic; (5) interpersonal; (6)
intrapersonal; (7) musical skills; and, (8) naturalist.

142) What is the Flynn effect? Identify some of the reasons that the Flynn effect has been observed in
Third World countries.
Answer: The Flynn effect is a change in IQ over a period of time. Possible reasons for the Flynn effect
that has been observed in Third World countries are: a healthier diet which improves memory
and attention, growing exposure to media which stimulates cognitive skills, and smaller
families with higher incomes can lead to an increase in resources.

143) What is a culture-fair test and what does it look like? Is it possible to devise such a test of
intelligence?
Answer: Culture-fair test of intelligence is intended to be free of cultural bias so items would be
familiar to children from diverse backgrounds. Another approach uses no verbal questions
(e.g., Raven's Progressive Matrices test). It's very difficult to devise valid & reliable measures
of intelligence that are culture-free because people vary in their exposure to different
experiences and things. Sternberg argues that a more realistic goal is culture-reduced test.

144) List 4 characteristics of gifted children according to Dr. Joan Freeman.

Answer: Dr. Freeman identified 4 characteristics of gifted children: a lively mind, a keen sense of
awareness, the ability to learn, and independence.

145) Discuss two approaches to teaching children how to read.

Answer: Whole-language approach: reading instruction parallels children's natural language learning, reading
materials are whole and meaningful.
Basic-skills-and-phonetics approach: reading instruction stresses phonetics and rules for translating
written symbols into sounds, involves simplified materials.

146) Describe the effects of second language learning on children.

Answer: According to a survey of research on second language in Canada, children involved in second
language learning enjoy significant linguistic, academic, and cognitive benefits, and are also
able to develop high levels of proficiency in both languages. Further, heightened mental
flexibility, creative thinking skills, enhanced metalinguistic awareness, and greater
communicative sensitivity are cognitive benefits to second language learning.

147) Is it better to learn a second language as a child or as an adult?

Answer: There appears to be no definitive answer to this question. Learning a second language can
happen at any age (Canadian Paediatric Society, 2016).

148) Contrast the constructivist approach and the direct instruction approach to student learning.
Answer: Constructivist approach: learner-centred, individuals are encouraged to actively construct their
knowledge and understanding. Direct instruction approach: teacher direction and control,
maximum time spent on academic tasks.

20
Another random document with
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mouths of the absorbents which may have been opened by the
scraping. Treatment for two or three days with brewers’ yeast will
usually suffice to put the surface in a healthy condition, after which it
may be skin-grafted or treated by any of the ordinary plastic
methods.
Rhinoscleroma.—The bacillus of rhinoscleroma was described in
the chapter on Inflammation, under the heading
Pyogenic Organisms. It is a specific infection, primarily of the skin,
which appears invariably upon the nose. It begins either in the skin
or mucous membrane, or both, and having once thoroughly invaded
the tissues grows in all directions. It shows no tendency to heal, but
gives to the tissues a distinctive brawny induration. From the nose it
extends to the palate, pharynx, and antrum, making steady
encroachment upon the parts which it affects, distorting the features,
obstructing respiration, and often causing pain by pressure on the
sensory nerves. Its first appearance is characterized by nodules,
frequently covered with dilated bloodvessels. Unless it can be seen
and recognized early it is a wellnigh hopeless condition with which to
contend. Extirpation of the affected tissue is the only satisfactory
method of dealing with it. It is a different disease from rhinophyma
described elsewhere. (See Figs. 7 and 8, p. 55.)
Mycosis Fungoides.—This form of skin infection, of somewhat
uncertain origin, is met in shape of fungoid
nodules, and likely to involve the upper part of the body; they tend to
increase in number and size, to infiltrate, often to ulcerate,
sometimes to disappear by spontaneous absorption, but in severe
cases cause death, either by malnutrition or sepsis. Tumors are thus
formed which attain the size of a child’s head. As soon as surface
infection or ulceration begins the breaking-down process is rapid;
there is early involvement of the lymph nodes, and the general
health begins to suffer. The tendency in almost every case is to fatal
termination. Cases may run from a few months to fifteen years,
however, before this stage is reached. By some authors the disease
is considered as a peculiar form of sarcoma. It is, however, generally
regarded as a granuloma, whose specific organism has not been
ascertained.
 Fig. 104

Ulcerating gumma of skin, cicatrizing in certain areas. (Lexer.)

Actinomycosis, Syphilis, Leprosy, and Glanders should be

included
among the chronic infections of the skin, and have been described.
Radesyge.—Radesyge is a granulomatous involvement of the
skin, peculiar to certain parts of Europe, particularly
Norway, which has been by some considered to be an expression of
leprosy, by others to be a disease by itself. It is generally held that
the lesions which have passed under this name are really
expressions of cutaneous syphilis.
Framboesia; Yaws.—This is an endemic tropical disease, of
which we see our nearest specimens in the
West Indies, and involves especially the negro and Oriental races. It
begins with an eruption, papules maturing in fungoid form, being met
with most often at mucocutaneous borders, but appearing anywhere
upon the surface. It is specific and inoculable, having a period of
incubation of about two weeks, and becoming generalized in from
fifteen to twenty weeks. The papules increase in size, become
covered with yellow crusts, which fall off and expose a rough surface
which discharges an offensive puruloid material. After remaining in
this condition for an indefinite time the lesions spontaneously
improve and may disappear, leaving only pigmented spots to mark
their previous sites. Beyond local cleanliness and antiseptic
applications the lesions require but little treatment. If anything more
is attempted it should be thorough and effected with the cautery or
the sharp spoon.
Mycetoma.—Mycetoma is more commonly known as Madura
foot, or sometimes the fungus foot of India. It prevails
especially in Southern India and about Madras, and is apparently
confined to that part of the globe. Nevertheless it has been reported
from Algiers and from South America. It is a specific infection of the
foot, beginning in the skin; it rarely occurs on the hands, the scrotum,
etc. It leads to the formation of an infectious granuloma, which
gradually destroys the texture and identity of the tissues, and finally
demands amputation or ablation of the part.
Russian bacteriologists have discovered parasites resembling the
protozoa which they have found in the granulations and ulcerations
of the Delhi boil. They were also occasionally seen in the leukocytes.
By these observers these parasites have been regarded as active
agents and have been given the name ovoplasma orientale.
Oriental Boil.-This also is a slow infection of the skin, met with
especially in Southern India, where it is known as the Biskra button
and the Aleppo or Delhi boil.[19] It appears mainly on the unprotected
parts of the body at first as a papule and then a nodule, which
enlarges, ulcerates, usually tends to heal spontaneously, and leaves
an ineffaceable scar. It is practically a granuloma of the skin, is auto-
inoculable, and is best treated by complete excision.
[19] Delhi boil is now known to be another of the local infections of
exposed surfaces, occurring especially about the lower extremities and the
genitals, due to the invasion of one of the trypanosomas, its actual
pathology having been only recently demonstrated.
 Guinea Worm, or Filaria Medinensis.—This worm is about one
line in diameter and two or
three feet long, and is found generally throughout the tropics. The
embryo is taken into the intestines with drinking water and migrates
to the skin, beneath which it develops. The male worm has never
been discovered. What is known of the evidence of its presence
pertains only to the female. When fully developed it can be felt in a
coil beneath the skin. It produces local inflammation, a vesicle forms,
and the head of the worm then protrudes. When it is exposed it can
be frequently extracted by gentle traction, removing as much each
day as protrudes. Christie has suggested to destroy the worm by
electrolysis, and others inject into the vesicle some antiseptic, by
which the worm is killed, it being afterward absorbed without difficulty
(Fig. 105).

Fig. 105

Guinea-worm bleb just cut off. (Bryant.)

Blastomycetic Dermatitis.—This is a true protozoan infection of

the skin, first described by Wernicke in
1892, which has now become quite generally recognized and
described. The parasite is a very small, spheroid protozoan, and is
found in the skin elements, as well as in the pus and debris
discharged from the lesions. It has been successfully cultivated and
inoculated. It is classed among the yeast fungi. It produces lesions
very much like some of those met with in syphilis, tuberculosis, and
mycosis fungoides. Indeed it may be necessary to use the
microscope in order to complete the diagnosis, which is best
accomplished by teasing a small portion of tissue on the slide in
liquor potassæ (Hardaway).
The lesions begin usually as small papules, which may later
coalesce and become covered with a fine scab. Around these there
develop thickened borders, with fungus-like projections. Between the
little elevations pus may form, or an exudate occur in sufficient
quantity to dry into a large-sized crust. Here, as in lupus, cicatrization
may be going on at interior points while the lesion is encroaching
around the margin. The affection is slow, and the ulcer may attain a
size of several inches in diameter.
The treatment consists in radical measures, i. e., strong caustics,
curetting or complete extirpation with the knife, which may be
followed by more or less plastic work, as required.
Coccidioidal Granuloma.—Under this name is described a rare
form of granulomatous lesion of the
skin, whose exciting cause is not one of the ordinary bacteria, but a
form of mold—one of the varieties of oidium. The clinical
manifestations of this lesion resemble those of blastomycetic
dermatitis, save that in the latter the primary focus of infection is
always found in the skin and remains there localized, whereas
coccidioidal granulomas may occur as well in the deeper tissues or
viscera as upon the skin; in fact, the skin lesions of the latter may be
described as oidiomycosis in distinction from blastomycosis. It
produces miliary skin nodules which closely resemble tuberculous
lesions, and may even caseate or assume an acute type and break
down rapidly. The lesions are progressive, with a tendency to
dissemination, both by the lymph and the blood currents. The lymph
nodes are usually early affected and often suppurate.
Cysticercus, or Tænia Solium, may be found in the
subcutaneous tissue in the shape
of small nodules, covered by unaffected skin. When young these
tumors are tense and elastic, but are subject to calcareous changes.
They occur frequently on the back.
Echinococcus Cysts are also found in the skin, where they may
attain a size which will make them fluctuate.
The treatment for all such lesions is complete eradication.
Trophoneuroses. Perforating Ulcer of the Foot.—This has already
been alluded to in the chapter on Ulcers and
Ulceration. The lesion apparently begins as a thickening or callosity,
usually beneath the head of the first metatarsal bone, at a point
where much pressure is made, owing to the natural position of the
foot. Beneath the thickened skin there develops an adventitious
bursa, in which, or in the skin itself, the first degeneration may take
place. The result is a deep ulcer, with overhanging borders, and a
thin, often foul discharge. The lesion is not painful, and patients are
less likely to spare the foot. It is usually associated with some central
spinal disease, or with a peripheral neuritis. It is more common in
those patients who have had disease leading to loss of sensation in
the foot.
The treatment consists in excision of the ulcer down to healthy
tissues, with careful protection. Skin grafting is often found
successful.
Ainhum.—Ainhum is essentially a disease of the negro and of
tropical climates. It usually begins in the little toe or little finger, and
goes on to spontaneous amputation, the result of an anemia caused
by the formation of a sclerotic ring, which encircles the digit and
shuts off the blood supply. It is an annular scleroderma, or keloid,
which produces the disturbance.

CYSTS OF THE SKIN.

The most common cysts of the skin are the sebaceous, known
also as steatomas, which result from obstruction of the ducts of
sebaceous follicles, and accumulation therein of sebaceous
secretion. They are found where these glands abound, and may
attain the size of a hen’s egg or larger. They are frequently infected
and suppurate, or their contents may undergo slow change and lose
their original characteristics by the time they are evacuated. Peculiar
changes occur in rare instances, since they may calcify, or their
bases serve even for the development of cutaneous horns, while in
the other direction they not infrequently undergo malignant
degeneration. In some of these cysts a small opening can be found,
through which, on pressure, fatty or butter-like contents can be
exposed. When their contents begin to putrefy the odor becomes
offensive.
Another variety of the skin cyst is the so-called atheromatous,
which is more allied to the cutaneous dermoid, and whose contents
are often nearly pure cholesterin. Sometimes they contain hair or
other epithelial products. They occur usually in the scalp. These are
essentially inclusion cysts and purely epiblastic products. When
infected their contents putrefy and smell badly. (See Fig. 88, p. 285.)
Treatment.—The treatment for any cysts of the skin consists in
extirpation of the sac. It is sufficient to split them
thoroughly with a sharp, curved bistoury, and then, on either side, to
seize the edge of the divided sac with forceps and enucleate it. All
this can be done under local anesthesia. The cavity should be
thoroughly disinfected and not too tightly closed.
Under the name Cock’s peculiar tumor some English writers have
alluded to the offensive ulcerated surface, with raised edges, which
is left after the contents of these cysts have undergone putrefaction
and escaped by breaking down of the surface. Such a lesion is on
the border-land between mere ulceration and malignancy.

HYPERTROPHIES AND BENIGN TUMORS OF THE SKIN.

Corns.—Clavi, or corns, vary in density. A soft corn differs from a
hard one only in that it is located where it is softened by
moisture of the parts. A hard corn is a reduplication or callosity,
conical in shape, representing great hypertrophy, with condensation
of surface epithelium. Beneath old lesions of this kind will frequently
be found small cysts, while nerve fibers become entangled, and
these little lesions are sometimes exceedingly sensitive. They
frequently become inflamed, the process proceeding to suppuration
or ulceration.
Bunions.
—When beneath such an indurated area of skin there forms an
adventitious bursa, or a natural one becomes involved, the lesion is
called a bunion. These are more frequent over the joints of the toes,
where they sometimes cause intense discomfort. The bursæ
sometimes connect with the joint cavity, and should one suppurate
the other necessarily becomes involved. An infection of either of
these lesions causes local and possibly fatal disturbance. I have
seen death from pyemia follow infection of a bursa beneath a soft
corn (Fig. 106).
These lesions are not met with among the savage races or those
who go barefooted. They are essentially products of the footwear
affected in modern society. Were shoes made to fit the natural foot
and not to constrain it in abnormal positions, corns and bunions
would be practically unknown.
—Preventive treatment is the most important and pertains to
properly adapted footwear. Unfortunately the treatment of these
minor lesions is too frequently left to charlatans and so-called
chiropodists, who may give temporary relief in many instances, but
have no knowledge of either the nature of the difficulty or its proper
surgical treatment.
Soft corns will usually disappear if the parts can be kept clean and
dry. Hard corns are essentially callosities, which should be pared
down or trimmed off until the surface is almost ready to bleed. It may
then be painted with a collodion containing 20 per cent. of salicylic
acid and a little alcohol. If this mixture be applied to the surface of a
clean and dry corn it can often be peeled away with the corn after a
few days. When it is desirable to soften any callosity of this kind,
previous to paring or trimming it, it can be done by applying for a few
hours a mixture of equal parts of glycerin and liquor potassæ; this
will so soften a callosity as, when applied over night, to make it
endurable through the following day.
Bunions are so often associated with hypertrophy of the underlying
bone as to entitle them to consideration under deformities of the feet.
The most pronounced expressions are usually seen in connection
with hallux valgus (q. v.), and their treatment comprises excision of
the bunion and its underlying bursal sac, along with exsection of the
joint. By this radical local measure complete relief is usually afforded.
 Treatment. Fig. 106
Cutaneous Horns.
—These have the
consistence of an
ordinary nail, are
epiblastic products,
varying in size,
length, color, and
shape. They have
been alluded to in the
chapter on Tumors.
Sutton has divided
them into sebaceous,
which occur most
often upon the head
and spring from an
old sebaceous cyst
(see above); warty
horns, which much
resemble them;
cicatricial and nail
horns, which are
instances of
exaggerated growth
of the finger-nails.
Treatment.—A
simple excision of the
growth with its base is
all that is needed in
these cases.
Warts; Verrucæ.—
T Distorted foot, from pressure and bunion. (Erichsen.)
hese constitute one
variety of papillomas,
the overgrowth having its original site in the prickle-cell layer of the
rete. The most common form occurs upon young subjects on the
exposed parts, as the face, hands, and feet. These are usually
multiple; they frequently occur upon the surface, and retain dirt in
such a manner as to be nearly always recognizable on the
surrounding skin. They frequently disappear with as little known
reason as that which caused their appearance.
Dilated papillary growths, like a fringe, are sometimes seen about
the face and neck of elderly people. These have been known as
filiform warts, while Unna gave them the name fibrokeratomas.
A form described as the seborrheic wart occurs upon the face and
elsewhere in elderly people. It is frequently pigmented, may itch
intolerably, and is perhaps the form which most often undergoes
malignant degeneration. To the acuminate form of wart, which is
usually soft, and most often met with as a venereal wart about the
genital region, has been given the name condyloma. These appear
in either sex, grow rapidly, are covered with a puruloid secretion,
bleed easily, and assume often such shape and resemblance as to
give rise to expressions “strawberry growth,” “raspberry growth,” etc.
They are always produced by irritation, usually in connection with
one of the venereal diseases, and are generally due to lack of
cleanliness. They may grow luxuriantly and over a considerable
area, and, when appearing on the surface of the vulva, conceal
completely the parts underneath. They also occur in connection with
the mucous patches of tertiary or hereditary syphilis, but have
essentially the same structure, no matter how produced.
Treatment.—In the treatment of ordinary warts nothing is better than
absolute cleanliness. A dry wart touched daily with formalin solution,
or covered with collodion containing 1 to 2 per cent. of corrosive
sublimate, will usually shrink and become detached in a few days.
Thorough excision of any true wart is sufficient to finally dispose of it.
If the wart be cut through it is likely to bleed profusely, since its
vessels are larger than those of the surrounding skin. Any growth of
this kind can also be destroyed by the actual cautery, or by one of
the strong caustic agents, which, however, should be used with great
care.
Venereal warts, condylomas, are best treated radically, either with
the actual cautery or with scissors and sharp spoon. Local
anesthesia is always advisable in order that this may be thoroughly
done. In instances of extensive growths of this kind a general
anesthetic may be profitably given.
Molluscum Contagiosum.—Molluscum contagiosum, sometimes
known as epithelial molluscum, is a
name applied to small warty growths more or less embedded in the
skin, from which, by pressure, some epithelial debris can be forced
out. The lesions are rarely single and yet rarely numerous. They may
be met upon any part of the body, especially upon exposed portions.
They are doubtless results of skin infections by various organisms.
The best treatment is excision, although they may be split and
cauterized and thus made to shrivel, or the same effect may be
produced by electrolysis.
 Fig. 107

Keloid occurring in a laparotomy scar. (Lexer.)

Keloid.—This has already been mentioned under the heading

Fibroma, in the chapter on Cysts and Tumors. It deserves
further mention here, however, because of the disfigurement
produced by keloid scars, and because the spontaneous
expressions of the disease may occasionally demand surgical
intervention. In cicatricial tissue it often follows the scars left by burns
or excision of tuberculous lesions. Since subcutaneous sutures have
been introduced there is less keloid than there was years ago (Fig.
107).
PLATE XXIX
 Keloid. (Hardaway.)

Treatment.—The surface indication is always for excision or

eradication, but one cannot give the slightest guarantee against
recurrence in even worse form in the same scar. Electrolysis may
have a beneficial effect on some of the lesions, but will only
occasionally prove satisfactory. A number of years ago thiosinamin
was introduced, and has perhaps given a larger measure of success
than any other remedy. It is used in 5 or 10 per cent. solution, which
is injected into and around the growth, and may lead to gradual
absorption of the hypertrophied tissue. The pain which the injection
produces does not last long and I have seen many excellent results
follow its use.
The same injections may be resorted to in general keloidal
disease, which is seen most often in the colored race. In negroes it
may follow traumatism of the skin surface, and attain the size of a
saucer or plate. (See Plate XXIX.)
Neurofibroma.—Fibroma of the skin may happen at any time and
is likely to develop in the finer branches of the
cutaneous nerves, where it will constitute a small tumor, known as
painful subcutaneous tubercle. These little tumors attain the size of a
pea and appear between the skin and superficial fascia. Sometimes
they are painful and are always tender. Unless thoroughly removed
they tend to recur. Nevertheless complete removal is the only
remedy.
Fibroma Molluscum.—A much larger, softer, and more complex
tumor is that known by Virchow as fibroma
molluscum. These tumors may attain large size, and may be single
or multiple. Over four thousand of these lesions have been counted
on one subject. They develop from the connective tissue of the
cutaneous nerves, and involve later the globular and follicular
structures of the skin, softening and undergoing such changes as to
deserve the adjective molluscum. Changes analogous to these lead
to what has been described as dermatolysis, i. e., hypertrophy of the
skin, with loosening of the subcutaneous tissue, by which it is thrown
more or less into folds. Another clinical expression of the same
condition has been known as pachydermatocele, in which pendulous
masses of skin hang from various parts of the body, especially the
face and neck, and undergo pigmentation and other changes.
Treatment.—These lesions can be excised, always with temporary
cosmetic improvement, but not always with a guarantee against
recurrence of the trouble.
Scleroderma.—This name is given to a leathery induration of the
skin occurring in circumscribed areas, which have
been called “morphea,” or in diffuse patches, which shade off into
surrounding normal skin. The first indication is a stiffening
accompanied by some thickening and hardness. Sometimes the
affection is painful, and the brawny hardening which it produces
makes it irksome and uncomfortable. The skin thus affected can not
be picked up between the fingers, and is more or less adherent to
the tissues beneath. When the difficulty is pronounced the sweat and
sebaceous glands cease to functionate. If it occur about a joint the
movement of the latter may be interfered with, even to the extent of
producing ankylosis. Wherever it appears there is impediment to
motion and flexibility of the parts beneath. The tendency usually is to
spontaneous disappearance with atrophy. While subsiding at one
locality it may recur in another. Upon the hands it may effect such
great disturbance of function as to produce what has been described
as “sclerodactylia.” The skin over bony prominences, when irritated,
may break down; ordinarily it does not go on to ulceration.
Pathology.—The pathology of scleroderma is very obscure.
Whether it depend upon primary disturbances of circulation, both of
blood and lymph, or whether it is produced by cellular hypertrophies
has not been determined.
The characteristic induration of this disease is not imitated in other
affections except scleroma neonatorum, but it may, nevertheless, be
confused with the infiltration of tuberculosis, of syphilis, or of
malignant disease. While the disease persists, in most cases it is not
often fatal.
Treatment.—It is to be treated mainly by tension, the general and
constitutional conditions by massage, and inunction with soothing
oils or with the ichthyol-mercurial ointment. It has been successfully
treated, as is keloid, by the subcutaneous use of a 10 per cent.
alcoholic solution of thiosinamin. The ultraviolet rays and even the x-
rays, used judiciously and carefully, may also be of service.
Rhinophyma.—This form of tumor is to be differentiated from
rhinoscleroma, the latter being due to a peculiar
specific bacillus, while rhinophyma is a filth disease, due to
hypertrophy of the sebaceous structures of the nose from obstruction
of the sebaceous ducts. It is often seen among alcoholics, perhaps
less frequently at home than abroad. Pathologically it consists of
enormous and irregular hypertrophy of the sebaceous gland
elements and connective tissue of the skin of the nose. Each
hypertrophied gland secretes in proportion to its increase in size, and
even the vessels of the part become engorged. In consequence
there results a lobulated, distorted, most disagreeable appearance,
which often becomes exceedingly offensive. The tumors thus formed
sometimes increase to a size sufficient to interfere with breathing
and with feeding. The resulting nasal enlargement is usually trilobed.
The first impetus to the overgrowth comes sometimes from such
cutaneous irritation as frostbite, or local irritation of some kind.
Treatment.—The treatment of rhinophyma consists in the
unrestricted use of scissors and the sharp spoon, with the
preservation of so much of the integumentary structure as may serve
to cover the reduced dimension of the nose. These lesions will bleed
freely at first, but bleeding is usually easily checked. When a plastic
covering of the defect is impossible, the surface may be left to
granulate, with a certain feeling of security that the cicatricial
contraction following will reduce the enlargement to normal
proportions.
Xanthoma.—This name is applied to a macular lesion, papillary or
tuberculous, marked by the appearance of yellowish
spots, occurring singly or in groups, often about the eyelids, but seen
anywhere upon the skin. When occurring in papules it is called
xanthoma planum; when in nodules, xanthoma tuberosum. There is
a variety met with in diabetes which is temporary and usually
disappears spontaneously.
Treatment.—The treatment for xanthomatous patches is either
electrolysis or complete excision, under local anesthesia.
Keratosis.
—Keratosis is a term applied to thickening of the normal epidermis,
occurring in limited areas, the skin being transformed into tense or
almost horny tissue. The form which occurs in elderly individuals is
called keratosis senilis. It occurs upon the face, the hands, and
forearms, but may be seen on any part of the body. The involved
areas become discolored, sometimes by true pigmentation, more
often by a deposit of dirt. As long as epithelial reproduction occurs
away from the basement membrane the lesions are simple and
innocent, but in elderly people it requires but little irritation to provoke
a down-growth of epithelium, and then the development of
epithelioma is rapid.
Treatment.—These reduplicated epithelial elements can be kept soft
by an application of equal parts of glycerin and liquor potassæ. After
being softened they may be easily scraped down to a normal level,
but will later reform. If they begin to ulcerate they should be excised.
Should excision be declined the area may be treated with the
thermocautery or with one of the caustic pastes.
Vascular Growths.—These have already been mentioned in the
chapter on Tumors, under the head of
Angioma. So far as the skin is concerned they usually occur in the
shape of nevi (called strawberry growths) or the more disseminated
form, sometimes involving considerable areas, commonly known as
“port-wine marks,” which are essentially cutaneous telangiectases,
are almost always of congenital origin, and frequently appear in
complete form even at birth. They may occur rapidly or slowly. An
isolated nevus should be treated by complete excision. Large
vascular areas, or port-wine marks, are best treated by repeated
electrolysis. If treated early they are sometimes eradicated by the
local use of sodium ethylate.
The so-called nevus pigmentosus, or pigmented mole, is generally
of congenital origin, and may or may not be accompanied by
vascular changes. It is not infrequently covered with hair, and
sometimes forms a patch of considerable size, often upon the face.
These lesions occasionally occur in such form as to entitle them to
be styled nevus verrucosus or nevus pilosus. Occurring upon the
back or trunk they are usually disregarded. When upon the face they
should receive surgical treatment.
 Treatment.—Excision is, of course, the best method of treatment
unless a disfiguring scar be feared. This can usually be prevented by
proper plastic methods. When excision seems inadvisable
electrolysis is the next best method of attack. No matter how
vascular may be the lesion itself, the vessels a short distance from
the margin of these growths are rarely dilated, and hemorrhage is
not a feature which need deter one from radical treatment.
Lymphangioma.—This has also been described in the chapter on
Tumors. A circumscribed form is occasionally
found in or beneath the skin. It occurs early in life, constitutes a more
or less sessile tumor, which collapses on pressure, fills slowly, its
surface being often irregular, warty, or horny. Should the surface be
injured lymph will escape rather than blood. An extended form of it
constitutes one kind of elephantiasis. (See chapter on Lymphatics.)
Any septic infection of a growth of this character is likely to result
seriously and at once.
Treatment.—The best treatment is excision under thorough aseptic
precautions; next to this is destruction with the cautery, which will
lead to resulting sloughing and cicatrization.
Malignant Disease.—All forms of cancer may appear, primarily, in
or upon the skin. From the ordinary surface
epithelium springs epithelioma; from the glandular elements possibly
round-cell carcinoma; and from the mesodermic elements any of the
radical varieties of sarcoma, while endothelioma is less common.
Epithelioma.—This is a frequent infection of the skin, which may
arise primarily as an original lesion, usually following surface
irritation, or secondarily, either as the extension of similar disease
from other parts or of degeneration of previously innocent epithelial
tumors. Epithelial outgrowth, so long as it be an outgrowth, and do
not transgress the limits of the basement membrane, is essentially
innocent in character; but so soon as growth in the downward
direction begins we have the beginning of a skin cancer, which may
proceed to fatal extent if not promptly recognized and properly
treated. These growths vary very much in rapidity and malignancy.
Occurring upon surfaces which are kept constantly moist and warm
they develop more rapidly, as upon the tongue, within the vulva,
rectum, etc. The slowest form of growth of this kind is the so-called
rodent ulcer. Epithelioma which begins in or upon the skin or mucous
membrane tends to spread to and involve everything in its
neighborhood; even bone and cartilage succumb to its ravages, and,
becoming involved, lose all their characteristics and melt away in the
surrounding ulcer. This produces in the course of time hideous and
serious developments. No tissue is exempt from its ravages, and yet
life may be prolonged for many years, even when the face is almost
entirely eaten away. Epithelioma and rodent ulcer have been
described in the chapter on Tumors.
More deeply seated Fig. 108
carcinomas of the
skin infiltrate in both
directions alike, and
grow downward,
sometimes in cylinder
form, thus giving rise
to a clinical type
called cylindroma.
Lenticular carcinoma
is also described as
differing from the
ordinary epithelioma,
in that it exhibits a
true alveolar
structure. This form is
rare, and is
distinguished from the Epithelioma.
common form by the
absence of the so-called “pearly bodies,” which characterize
common epithelioma. The lenticular form is most often seen in
recurring cancer of the breast, or in the vicinity of scars showing
where deep-seated cancer had existed.
Diagnosis.—Epithelioma in its various forms should be
distinguished from skin lesions due to syphilis and tuberculosis. A
diagnostic table has been given (see p. 293) by which diagnosis as
between it and lupus may ordinarily be made. The lesions of syphilis
are usually multiple and accompanied by other manifestations which
stamp their character. There is, moreover, usually a history which will
be suggestive if not actually helpful. In cases of actual doubt, as
upon the tongue and elsewhere, the therapeutic test may be applied.
If resorted to, it should be vigorously made. When mercurial
inunction is thoroughly practised, and the internal administration of
the iodides effects no improvement within three weeks, the
hypothesis of syphilis may be abandoned.
All cancerous lesions tend to advance and to destroy in spite of all
local measures. There never appears about them any indication of a
tendency toward cicatrization, and, while the edges of malignant
ulcers may be thickened and everted, the more central portions are
always excavated. They cause, moreover, involvement of the
adjoining lymphatics, although this may be said as well of syphilitic
and tuberculous lesions.
Treatment.—Concerning the treatment of epithelioma and other
malignant skin diseases there is little to be said which has not
already been summarized in the general considerations concerning
the treatment of cancer. Radical excision of the original lesion, in its
early stages, will usually lead to final recovery. If there be
involvement of the lymphatics the indication is made thereby more
positive for cleaning out all infected areas, while, at the same time,
the prognosis is rendered less favorable. There comes a time in the
history of all these cases when excision can be recommended only
as a palliative measure, i. e., when it may be regarded as useless. In
the more hopeless cases benefit will but rarely be obtained from the
use of x-rays, ultraviolet light, or radium.
Paget’s Disease.—Paget’s disease includes lesions now
regarded as a precancerous stage, which
appear upon the breasts and around the nipples of women during
the middle decades of life. Something similar is seen in other parts of
the body and in both sexes, but it is most common around the nipple
on one side. For a long time it appears as an ordinary eczema,
which, however, does not tend to heal but to spread, while the skin
beneath becomes more or less infiltrated. A gradual retrocession of
the nipple is usually seen. Certain discomfort accompanies the
lesion, which may go on indefinitely until it becomes unmistakably
cancerous. This is a precursor not so much of round-cell cancer