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1. ANSWER: D Achievement of fine motor milestones during the second year of life requires evolution beyond the neat pincer grasp that is present at 12 months of age. With improved cortical control of the upper extremi- ties and better truncal balance, the hands are more available, and the child can learn to manipulate objects during functional play. Throwing a ball with an overhand motion is most typical of a 24-month-old child. The ability to build a tower of two cubes emerges at 14 months of age; by 24 months, the tower should be six or more blocks tall. Imitative scribbling appears at 16 months; spontaneous scribbling appears at 18 months. The ability to copy a circle usually is not seen until 3 years of age. Walking backwards is an appropriate milestone for a 16-month-old child; an ability to walk down steps holding onto the rail bet- ter describes the gross motor abilities of a 24-month- old. Other normal motor milestones for 24 months of age include the ability to wash and dry hands, remove clothing, put on a hat, kick a ball, and jump with two feet off the floor. 2. ANSWER: B The loss of developmental milestones in a previously healthy child is suggestive of an inborn error of metab- olism. A number of such disorders can result in the loss of milestones that present among children 1 to 5 years of age. If visceral, craniofacial, or other somatic abnormalities are present, the diagnosis of a lysoso- mal storage disease should be considered. These dis- orders include mucopolysaccharidosis types I (Hurler disease), II (Hunter disease), and III (Sanfilippo syn- drome); mucolipidoses types III and IV; and the oligosaccharidoses (mannosidosis, fucosidosis, aspartylglycosaminuria), all of which may present with regression of skills and associated somatic manifesta- tions. Ifneurologic symptoms predominate, other dis- orders, such as metachromatic leukodystrophy, which is characterized by hypotonia, progressive parapare- sis, and weakness, must be considered. If unst