Test bank for MCQs in Pediatrics Review of Nelson T
m m m m m m m m m
extbook of Pediatrics 20 Edition
m m m m m
, Nelson Pediatrics Review(MCQs) 19 Edition
m m m m
1. Whichm ofm them followingm statementsm regardingm fosterm carem ism true?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
m m m m m m m m m m m m m m m m m m m m m m
□A minority of children in foster care have a history of abuse or neglect
m m m m m m m m m m m m m
□The mission of foster care is to safely care for children while providing services to families to promote reunification
m m m m m m m m m m m m m m m m m m
□Most (>70%) of children in foster care are reunited with their families
m m m m m m m m m m m
■ AmandmC
descriptionmThemmissionmofmfostermcaremismtomprovidemformthemhealth,msafety,mandmwell-
beingmofmchildrenmwhilemassistingmtheirmfamiliesmwithmservicesmtompromotemreunification.mChildrenmenteringmfostermcaremhavemf
requentlymexperiencedmearlymchildhoodmtrauma.mMoremthanm70%mhavemamhistorymofmabuse,mneglect,mormboth.mOnlymaboutm50
%mofmchildrenmachievemreunification.mInmthemUSA,mthemAdoptionmandmSafemFamiliesmActm(P.L.m105-
89)mpassedminm1997mrequiresmthatmampermanencymplanmbemmademformeachmchildmnomlatermthanm12mmomaftermentrymtomfostermc
aremandmthatmampetitionmtomterminatemparentalmrightsmtypicallymmustmbemfiledmwhenmamchildmhasmbeenminmfostermcaremformatmlea
stm15mofmthempreviousm22mmo.m(SeemChapterm35,mpagem134,mandme35-1.)
2. Am4myrmoldmgirlmismadmittedmtomthemhospitalmformhermthirdmevaluationmformvaginalmbleeding.mThe
mothermnotedmbrightmredmbloodmonmthemchild'smunderwear.mPreviousmexaminationsmrevealedmam
normalm4myrmoldmgirl,mTannermstagem1,mwithmnormalmexternalmgenitalia.mPelvicmultrasoundmresults
mweremnormal,mas mwas mthemserum mestradiolmlevel. mThemhemoglobin mand mplatelet mcountsmweremn
ormal,masmweremthembleedingmtimemandmcoagulationmstudies.mFindingsmonmpelvicmexaminationmc
onductedmundermanesthesiamalsomweremnormal.mThemnextmstepminmthemexaminationmismto:
■ Determinemthembloodmtypemofmthembloodmonmthemunderwear
□Interrogate the father
m m
□Isolate the parents and child
m m m m
□Determine m vonm Willebrandm factorm levels
, □Measure fibronectin in the vagina
m m m m
descriptionmConsiderationmofmfactitiousmdisordermbymproxymshouldmbemtriggeredmwhenmthemreportedmsymptomsmaremrepeat
edlymnotedmbymonlymonemparent,mappropriatemtestingmfailsmtomconfirmmamdiagnosis,mandmseeminglymappropriatemtreatmentmismineff
ective.m Atmtimes,mthemchild'smsymptoms,mtheirmcourse,mormthemresponsemtomtreatmentmmaymbemincompatiblemwithmanymrecognized
mdisease.m Preverbalmchildrenmaremusuallyminvolved.mBleedingmismamparticularlymcommon mpresentation.mThismmaymbemcausedmbym
addingmdyesm tomsamples,maddingmbloodm(e.g.,mfrommthemmother)mtomthemchild'smsample,mormgivingmthemchildmanmanticoagulan
tm(e.g.,mwarfarin).m(SeemChapterm37,mpagem146.)
3. Munchausenmsyndromem bym proxym ism characterizedm bym allm ofm them followingm EXCEPT:
□Mother who appears devoted and wins over members of care team
m m m m m m m m m m
□Multiple hospitalizations and investigations without diagnosis
m m m m m
□Symptoms on history but not witnessed by medical team
m m m m m m m m
■ Symptomsmoccurringminmpresencemofmdifferentmcaregiversm(e.g.,mwhilemmothermismoutmofmtown)
□Use of medications or toxins
m m m m
descriptionmSymptomsminmyoungmchildrenmaremmostlymassociatedmwithmproximitymofmthemoffendingmcaregivermtomthemchild.mT
hemmothermmaympresentmasmamdevotedmormevenmmodelmparentmwhomformsmclosemrelationshipsmwithmmembersmofmthemheal
thmcaremteam.mWhilemappearingmveryminterestedminmhermchild'smcondition,mshemmaymbemrelativelymdistantmemotionally.m(SeemCh
apterm37,mpagem146.)
4. Whichm statementm ism false?
■ MalnutritionmismthemsecondmleadingmcausemofmacquiredmimmunemdeficiencymworldwidembehindmHIVminfection
□Zinc is important in immune function and linear growth
m m m m m m m m
□Kwashiorkor and marasmus are rare in developed countries
m m m m m m m
□The Western diet is associated with increased noncommunicable disease
m m m m m m m m
descriptionmThemsignificantmglobalmburdenmofmmalnutritionmandmundernutritionmismthemleadingmworldwidemcausemofmacquiredmi
mmunodeficiencymandmthemmajormunderlyingmfactormformmorbiditymandmmortalitymgloballymformchildrenm<5myrmofmage.mZincmisma
mmicronutrientmthatmsupportsmmultiplemmetabolicmfunctionsminmthembody,mismessentialmformnormalmimmunemfunctioning,mandmismre
quiredmtomsupportmlinearmgrowth;mzincmdeficiencymismassociatedmwithmimpairedmimmunemfunctioningmandmpoormlinearmgrowth.mIn
mparallelmtomthemriskmformnutrientmandmenergymdeficiencies,missuesmrelatingmtomexcessesmposemimportantmchallengesmbecausemofmth
eirmnegativemhealthmeffects,msuchmasmobesitymormcardiovascularmdiseasemriskmfactors.mThemnutritionmtransitionmundermwaymi
nmthe
, developingmworldmfrommtraditionalmdietsmtomthemWesternmdietmhasmbeenmassociatedmwithmincreasesminmnoncommunicablemdis
eases,moftenmcoexistingmwithmundernutritionmandmmalnutrition,mobservedmsometimesminmthemsamemcommunitiesmormevenmthemsa
memfamilies.m(Seeme41-1.)
5. Componentsm ofm energym expenditurem inm childrenm include:
□Thermal effect of food
m m m
□Basal metabolic rate
m m
□Energy for physical activity
m m m
□Energy to support growth
m m m
■ Allmofmthemabove
descriptionmThem3mcomponentsmofmenergymexpenditureminmadultsmaremthembasalmmetabolicmrate,mthemthermalmeffectmofmf
oodm(energymrequiredmformdigestionmandmabsorption),mandmenergymformphysicalmactivity.mAdditionalmenergymintakemandmexpen
dituremaremrequiredmtomsupportmgrowthmandmdevelopmentmformchildren.m(Seeme41-4.)
6. WhichmofmthemfollowingmclinicalmscenariosmincreasesmthemriskmofmvitaminmAmdeficiency?
□Vegetarian diet m
□Chronic intestinal disorders
m m
□Zinc deficiency
m
■ BmandmC
□All of the above
m m m
descriptionmVitaminmAmismanmessentialmmicronutrientmbecausemitmcannotmbembiogeneratedmdemnovombymanimals.mItmmus
tmbemobtainedmfrommplantsminmthemformmofmprovitamin-
Amcarotenoids.mInmthemUSA,mgrainsmandmvegetablesmsupplymapproximatelym55%mandmdairymandmmeatmproductsmsupplymap
proximatelym30%mofmvitaminmAmintakemfrommfood.mVitaminmAmandmthemprovitamins-
Amaremfatmsoluble,mandmtheirmabsorptionmdependsmonmthempresencemofmadequatemlipidmandmproteinmwithinmthemmeal.m Chronicmin
testinalmdisordersmormlipidmmalabsorptionmsyndromesmcanmresultminmvitaminmAmdeficiency.mInmdevelopingmcountries,msubclinica
lmormclinicalmzincmdeficiencymcanmincreasemthemriskmofmvitaminmAmdeficiency.mTheremismalsomsomemevidencemofmmarginalmzincmi
ntakesminmchildrenminmthemUSA.m(SeemChapterm45,mpagem188.)
7. Whichm statementm aboutm vitaminm Am toxicitym ism NOTm true?
m m m m m m m m m
extbook of Pediatrics 20 Edition
m m m m m
, Nelson Pediatrics Review(MCQs) 19 Edition
m m m m
1. Whichm ofm them followingm statementsm regardingm fosterm carem ism true?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
m m m m m m m m m m m m m m m m m m m m m m
□A minority of children in foster care have a history of abuse or neglect
m m m m m m m m m m m m m
□The mission of foster care is to safely care for children while providing services to families to promote reunification
m m m m m m m m m m m m m m m m m m
□Most (>70%) of children in foster care are reunited with their families
m m m m m m m m m m m
■ AmandmC
descriptionmThemmissionmofmfostermcaremismtomprovidemformthemhealth,msafety,mandmwell-
beingmofmchildrenmwhilemassistingmtheirmfamiliesmwithmservicesmtompromotemreunification.mChildrenmenteringmfostermcaremhavemf
requentlymexperiencedmearlymchildhoodmtrauma.mMoremthanm70%mhavemamhistorymofmabuse,mneglect,mormboth.mOnlymaboutm50
%mofmchildrenmachievemreunification.mInmthemUSA,mthemAdoptionmandmSafemFamiliesmActm(P.L.m105-
89)mpassedminm1997mrequiresmthatmampermanencymplanmbemmademformeachmchildmnomlatermthanm12mmomaftermentrymtomfostermc
aremandmthatmampetitionmtomterminatemparentalmrightsmtypicallymmustmbemfiledmwhenmamchildmhasmbeenminmfostermcaremformatmlea
stm15mofmthempreviousm22mmo.m(SeemChapterm35,mpagem134,mandme35-1.)
2. Am4myrmoldmgirlmismadmittedmtomthemhospitalmformhermthirdmevaluationmformvaginalmbleeding.mThe
mothermnotedmbrightmredmbloodmonmthemchild'smunderwear.mPreviousmexaminationsmrevealedmam
normalm4myrmoldmgirl,mTannermstagem1,mwithmnormalmexternalmgenitalia.mPelvicmultrasoundmresults
mweremnormal,mas mwas mthemserum mestradiolmlevel. mThemhemoglobin mand mplatelet mcountsmweremn
ormal,masmweremthembleedingmtimemandmcoagulationmstudies.mFindingsmonmpelvicmexaminationmc
onductedmundermanesthesiamalsomweremnormal.mThemnextmstepminmthemexaminationmismto:
■ Determinemthembloodmtypemofmthembloodmonmthemunderwear
□Interrogate the father
m m
□Isolate the parents and child
m m m m
□Determine m vonm Willebrandm factorm levels
, □Measure fibronectin in the vagina
m m m m
descriptionmConsiderationmofmfactitiousmdisordermbymproxymshouldmbemtriggeredmwhenmthemreportedmsymptomsmaremrepeat
edlymnotedmbymonlymonemparent,mappropriatemtestingmfailsmtomconfirmmamdiagnosis,mandmseeminglymappropriatemtreatmentmismineff
ective.m Atmtimes,mthemchild'smsymptoms,mtheirmcourse,mormthemresponsemtomtreatmentmmaymbemincompatiblemwithmanymrecognized
mdisease.m Preverbalmchildrenmaremusuallyminvolved.mBleedingmismamparticularlymcommon mpresentation.mThismmaymbemcausedmbym
addingmdyesm tomsamples,maddingmbloodm(e.g.,mfrommthemmother)mtomthemchild'smsample,mormgivingmthemchildmanmanticoagulan
tm(e.g.,mwarfarin).m(SeemChapterm37,mpagem146.)
3. Munchausenmsyndromem bym proxym ism characterizedm bym allm ofm them followingm EXCEPT:
□Mother who appears devoted and wins over members of care team
m m m m m m m m m m
□Multiple hospitalizations and investigations without diagnosis
m m m m m
□Symptoms on history but not witnessed by medical team
m m m m m m m m
■ Symptomsmoccurringminmpresencemofmdifferentmcaregiversm(e.g.,mwhilemmothermismoutmofmtown)
□Use of medications or toxins
m m m m
descriptionmSymptomsminmyoungmchildrenmaremmostlymassociatedmwithmproximitymofmthemoffendingmcaregivermtomthemchild.mT
hemmothermmaympresentmasmamdevotedmormevenmmodelmparentmwhomformsmclosemrelationshipsmwithmmembersmofmthemheal
thmcaremteam.mWhilemappearingmveryminterestedminmhermchild'smcondition,mshemmaymbemrelativelymdistantmemotionally.m(SeemCh
apterm37,mpagem146.)
4. Whichm statementm ism false?
■ MalnutritionmismthemsecondmleadingmcausemofmacquiredmimmunemdeficiencymworldwidembehindmHIVminfection
□Zinc is important in immune function and linear growth
m m m m m m m m
□Kwashiorkor and marasmus are rare in developed countries
m m m m m m m
□The Western diet is associated with increased noncommunicable disease
m m m m m m m m
descriptionmThemsignificantmglobalmburdenmofmmalnutritionmandmundernutritionmismthemleadingmworldwidemcausemofmacquiredmi
mmunodeficiencymandmthemmajormunderlyingmfactormformmorbiditymandmmortalitymgloballymformchildrenm<5myrmofmage.mZincmisma
mmicronutrientmthatmsupportsmmultiplemmetabolicmfunctionsminmthembody,mismessentialmformnormalmimmunemfunctioning,mandmismre
quiredmtomsupportmlinearmgrowth;mzincmdeficiencymismassociatedmwithmimpairedmimmunemfunctioningmandmpoormlinearmgrowth.mIn
mparallelmtomthemriskmformnutrientmandmenergymdeficiencies,missuesmrelatingmtomexcessesmposemimportantmchallengesmbecausemofmth
eirmnegativemhealthmeffects,msuchmasmobesitymormcardiovascularmdiseasemriskmfactors.mThemnutritionmtransitionmundermwaymi
nmthe
, developingmworldmfrommtraditionalmdietsmtomthemWesternmdietmhasmbeenmassociatedmwithmincreasesminmnoncommunicablemdis
eases,moftenmcoexistingmwithmundernutritionmandmmalnutrition,mobservedmsometimesminmthemsamemcommunitiesmormevenmthemsa
memfamilies.m(Seeme41-1.)
5. Componentsm ofm energym expenditurem inm childrenm include:
□Thermal effect of food
m m m
□Basal metabolic rate
m m
□Energy for physical activity
m m m
□Energy to support growth
m m m
■ Allmofmthemabove
descriptionmThem3mcomponentsmofmenergymexpenditureminmadultsmaremthembasalmmetabolicmrate,mthemthermalmeffectmofmf
oodm(energymrequiredmformdigestionmandmabsorption),mandmenergymformphysicalmactivity.mAdditionalmenergymintakemandmexpen
dituremaremrequiredmtomsupportmgrowthmandmdevelopmentmformchildren.m(Seeme41-4.)
6. WhichmofmthemfollowingmclinicalmscenariosmincreasesmthemriskmofmvitaminmAmdeficiency?
□Vegetarian diet m
□Chronic intestinal disorders
m m
□Zinc deficiency
m
■ BmandmC
□All of the above
m m m
descriptionmVitaminmAmismanmessentialmmicronutrientmbecausemitmcannotmbembiogeneratedmdemnovombymanimals.mItmmus
tmbemobtainedmfrommplantsminmthemformmofmprovitamin-
Amcarotenoids.mInmthemUSA,mgrainsmandmvegetablesmsupplymapproximatelym55%mandmdairymandmmeatmproductsmsupplymap
proximatelym30%mofmvitaminmAmintakemfrommfood.mVitaminmAmandmthemprovitamins-
Amaremfatmsoluble,mandmtheirmabsorptionmdependsmonmthempresencemofmadequatemlipidmandmproteinmwithinmthemmeal.m Chronicmin
testinalmdisordersmormlipidmmalabsorptionmsyndromesmcanmresultminmvitaminmAmdeficiency.mInmdevelopingmcountries,msubclinica
lmormclinicalmzincmdeficiencymcanmincreasemthemriskmofmvitaminmAmdeficiency.mTheremismalsomsomemevidencemofmmarginalmzincmi
ntakesminmchildrenminmthemUSA.m(SeemChapterm45,mpagem188.)
7. Whichm statementm aboutm vitaminm Am toxicitym ism NOTm true?
