Test bank for MCQs in Pediatrics Review of Nelson
Textbook of Pediatrics 20 Edition
, Nelson Pediatrics Review(MCQs) 19 Edition
1. Which of the following statements regarding foster care is true?
□A permanency plan must be made for a child in foster care no later than 12 moxfrom the child's entry into care
□A minority of children in foster care havexaxhistory of abuse or neglect
□The missionxof foster care is to safely care for children while providing services to families toxpromote reunification
□Most (>70%) of children in foster care arexreunited with their families
■ A and C
description Thexmission of foster care is to provide for the health, safety,xand well-
being of children whilexassistingxtheir families with services to promote reunification. Children entering foster care havexf
requently experienced early childhood trauma. More than 70% havexaxhistory of abuse, neglect, or both. Only about 50
%xof children achievexreunification. In the USA, the Adoption and Safe FamiliesxAct (P.L. 105-
89) passed inx1997 requires that a permanency plan be madexfor each child no later than 12 mo after entry toxfoster care
and that a petition to terminate parental rightsxtypically must be filed when a child hasxbeen in foster care for at least 15
of the previous 22 mo. (See Chapter 35, page 134, and e35-1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
mother noted bright red blood on thexchild's underwear. Previous examinations revealed a normal
4 yr old girl, Tanner stage 1, with normal externalxgenitalia. Pelvic ultrasound results were normal, a
s was the serum estradiol level. The hemoglobin and platelet counts werexnormal, as were the bleedi
ng time and coagulation studies. Findings on pelvicxexamination conducted under anesthesia also w
ere normal. The next step in thexexamination is to:
■ Determinexthexblood typexofxthexblood on thexunderwear
□Interrogatex the father
□Isolate the parents and child
□Determine von Willebrand factor levels
, □Measure fibronectin in the vagina
description Considerationxof factitious disorder by proxy should bextriggeredxwhenxthexreportedxsymptoms arexrepeat
edly noted by only onexparent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment isxineff
ective. At times, the child's symptoms, their course, or the response to treatment may be incompatible with any recognized
disease. Preverbal children are usually involved. Bleedingxis a particularly common presentation. This may be caused by a
dding dyes toxsamples, addingxbloodx(e.g., fromxthe mother) to the child's sample,xor giving the childxanxanticoagulant (
e.g., warfarin). (SeexChapter 37, page 146.)
3. Munchausen syndrome by proxy is characterized by all of thexfollowing EXCEPT:
□Mother who appears devoted and wins over members of care team
□Multiple hospitalizations and investigations without diagnosis
□Symptoms on history but not witnessed by medical team
■ Symptomsxoccurring in presence of differentxcaregivers (e.g., while mother is outxof town)
□Usexof medications or toxins
description Symptomsxin young children arexmostly associatedxwith proximity of the offendingxcaregiver toxthe child. T
he mother may present as a devotedxor even model parentxwho forms closexrelationships with membersxof the healt
h carexteam. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Cha
pter 37, page 146.)
4. Which statement isx false?
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
□Zinc is importantxin immune function and linear growth
□Kwashiorkor and marasmus are rare in developed countries
□The Western diet is associated with increased noncommunicable disease
description The significant global burdenxof malnutrition and undernutrition is the leading worldwide cause of acquired i
mmunodeficiency andxthe major underlying factor for morbidity and mortality globally for childrenx<5 yr of age. Zinc is a
micronutrient that supports multiple metabolicxfunctions in the body, is essential for normal immune functioning, and isxre
quired to support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear growth. In
parallel to the risk for nutrient and energy deficiencies, issues relatingxto excessesxpose important challenges because of th
eir negativexhealth effects, suchxas obesity or cardiovascular disease risk factors. The nutrition transition under way in
the
, developing worldxfrom traditional dietsxto the Western dietxhas beenxassociatedxwithxincreasesxinxnoncommunicablexdis
eases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communitiesxor even the sa
me families. (See e41-1.)
5. Components of energy expenditurex in children include:
□Thermal effect of food
□Basal metabolicxrate
□Energy for physical activity
□Energy to support growth
■ Allxof the above
description The 3 components of energy expenditure in adults are thexbasal metabolic rate, the thermal effect of f
ood (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and expen
diture are required to support growth and development for children. (See e41-4.)
6. Which of the following clinical scenarios increases thexrisk of vitamin A deficiency?
□Vegetarian diet
□Chronic intestinal disorders
□Zinc deficiency
■ B and C
□All of thexabove
description Vitamin A isxan essential micronutrientxbecause it cannot be biogenerated de novoxby animals. It must
be obtainedxfromxplantsxinxthexformxof provitamin-
A carotenoids. In the USA, grains and vegetables supply approximately 55% and dairy and meat products supply ap
proximately 30% of vitamin A intakexfrom food. Vitamin A and the provitamins-
A are fat soluble, and their absorption depends on the presence of adequate lipid and protein within the meal. Chronic int
estinal disordersxor lipid malabsorption syndromes can result in vitamin A deficiency. In developing countries, subclinica
l or clinical zinc deficiency canxincrease thexrisk of vitamin A deficiency. Therexis alsoxsomexevidence of marginal zinc in
takes in children in the USA. (See Chapter 45, page 188.)
7. Which statement about vitamin A toxicity is NOT true?
Textbook of Pediatrics 20 Edition
, Nelson Pediatrics Review(MCQs) 19 Edition
1. Which of the following statements regarding foster care is true?
□A permanency plan must be made for a child in foster care no later than 12 moxfrom the child's entry into care
□A minority of children in foster care havexaxhistory of abuse or neglect
□The missionxof foster care is to safely care for children while providing services to families toxpromote reunification
□Most (>70%) of children in foster care arexreunited with their families
■ A and C
description Thexmission of foster care is to provide for the health, safety,xand well-
being of children whilexassistingxtheir families with services to promote reunification. Children entering foster care havexf
requently experienced early childhood trauma. More than 70% havexaxhistory of abuse, neglect, or both. Only about 50
%xof children achievexreunification. In the USA, the Adoption and Safe FamiliesxAct (P.L. 105-
89) passed inx1997 requires that a permanency plan be madexfor each child no later than 12 mo after entry toxfoster care
and that a petition to terminate parental rightsxtypically must be filed when a child hasxbeen in foster care for at least 15
of the previous 22 mo. (See Chapter 35, page 134, and e35-1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
mother noted bright red blood on thexchild's underwear. Previous examinations revealed a normal
4 yr old girl, Tanner stage 1, with normal externalxgenitalia. Pelvic ultrasound results were normal, a
s was the serum estradiol level. The hemoglobin and platelet counts werexnormal, as were the bleedi
ng time and coagulation studies. Findings on pelvicxexamination conducted under anesthesia also w
ere normal. The next step in thexexamination is to:
■ Determinexthexblood typexofxthexblood on thexunderwear
□Interrogatex the father
□Isolate the parents and child
□Determine von Willebrand factor levels
, □Measure fibronectin in the vagina
description Considerationxof factitious disorder by proxy should bextriggeredxwhenxthexreportedxsymptoms arexrepeat
edly noted by only onexparent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment isxineff
ective. At times, the child's symptoms, their course, or the response to treatment may be incompatible with any recognized
disease. Preverbal children are usually involved. Bleedingxis a particularly common presentation. This may be caused by a
dding dyes toxsamples, addingxbloodx(e.g., fromxthe mother) to the child's sample,xor giving the childxanxanticoagulant (
e.g., warfarin). (SeexChapter 37, page 146.)
3. Munchausen syndrome by proxy is characterized by all of thexfollowing EXCEPT:
□Mother who appears devoted and wins over members of care team
□Multiple hospitalizations and investigations without diagnosis
□Symptoms on history but not witnessed by medical team
■ Symptomsxoccurring in presence of differentxcaregivers (e.g., while mother is outxof town)
□Usexof medications or toxins
description Symptomsxin young children arexmostly associatedxwith proximity of the offendingxcaregiver toxthe child. T
he mother may present as a devotedxor even model parentxwho forms closexrelationships with membersxof the healt
h carexteam. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Cha
pter 37, page 146.)
4. Which statement isx false?
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
□Zinc is importantxin immune function and linear growth
□Kwashiorkor and marasmus are rare in developed countries
□The Western diet is associated with increased noncommunicable disease
description The significant global burdenxof malnutrition and undernutrition is the leading worldwide cause of acquired i
mmunodeficiency andxthe major underlying factor for morbidity and mortality globally for childrenx<5 yr of age. Zinc is a
micronutrient that supports multiple metabolicxfunctions in the body, is essential for normal immune functioning, and isxre
quired to support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear growth. In
parallel to the risk for nutrient and energy deficiencies, issues relatingxto excessesxpose important challenges because of th
eir negativexhealth effects, suchxas obesity or cardiovascular disease risk factors. The nutrition transition under way in
the
, developing worldxfrom traditional dietsxto the Western dietxhas beenxassociatedxwithxincreasesxinxnoncommunicablexdis
eases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communitiesxor even the sa
me families. (See e41-1.)
5. Components of energy expenditurex in children include:
□Thermal effect of food
□Basal metabolicxrate
□Energy for physical activity
□Energy to support growth
■ Allxof the above
description The 3 components of energy expenditure in adults are thexbasal metabolic rate, the thermal effect of f
ood (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and expen
diture are required to support growth and development for children. (See e41-4.)
6. Which of the following clinical scenarios increases thexrisk of vitamin A deficiency?
□Vegetarian diet
□Chronic intestinal disorders
□Zinc deficiency
■ B and C
□All of thexabove
description Vitamin A isxan essential micronutrientxbecause it cannot be biogenerated de novoxby animals. It must
be obtainedxfromxplantsxinxthexformxof provitamin-
A carotenoids. In the USA, grains and vegetables supply approximately 55% and dairy and meat products supply ap
proximately 30% of vitamin A intakexfrom food. Vitamin A and the provitamins-
A are fat soluble, and their absorption depends on the presence of adequate lipid and protein within the meal. Chronic int
estinal disordersxor lipid malabsorption syndromes can result in vitamin A deficiency. In developing countries, subclinica
l or clinical zinc deficiency canxincrease thexrisk of vitamin A deficiency. Therexis alsoxsomexevidence of marginal zinc in
takes in children in the USA. (See Chapter 45, page 188.)
7. Which statement about vitamin A toxicity is NOT true?
