, Nelson j Pediatrics j Review(MCQs) j19 jEdition
1. Which jof jthe jfollowing jstatements jregarding jfoster jcare jis jtrue?
□A jpermanency jplan jmust jbe jmade j for ja jchild jin jfoster jcare j no jlater jthan j 12 jmo jfrom jthe jchild's jentry jinto jcare
□A jminority jof jchildren jin jfoster jcare jhave ja jhistory jof jabuse jor jneglect
□The jmission jof jfoster jcare jis jto jsafely jcare jfor jchildren jwhile jproviding jservices jto jfamilies jto jpromote jreunification
□Most j(>70%) jof jchildren jin jfoster jcare jare jreunited jwith jtheir jfamilies
■ A jand jC
description j The j mission j of j foster j care j is j to j provide j for j the j health, j safety, j and j well-being j of j children j while j assisting
j their jfamilies j with j services j to j promote j reunification. j Children j entering j foster j care j have j frequently j experienced j early
j childhood jtrauma. j More j than j 70% j have j a j history j of j abuse, j neglect, j or j both. j Only j about j 50% j of j children j achieve
j reunification. j In j the jUSA, jthe jAdoption jand jSafe jFamilies jAct j(P.L. j105-89) jpassed jin j1997 jrequires jthat ja
jpermanency jplan jbe jmade jfor jeach j child j no j later j than j 12 j mo j after j entry j to j foster j care j and j that j a j petition j to
j terminate j parental j rights j typically j must j be j filedjwhen ja jchild jhas jbeen jin jfoster jcare jfor jat jleast j15 jof jthe jprevious
j22 jmo. j(See jChapter j35, jpage j134, jand je35-1.)
2. A j4 jyr jold jgirl jis jadmitted jto jthe jhospital jfor jher jthird jevaluation jfor jvaginal jbleeding. jThe
mother jnoted jbright jred jblood jon jthe jchild's junderwear. jPrevious jexaminations jrevealed ja
jnormal j 4 j yr j old j girl, j Tanner j stage j 1, j with j normal j external j genitalia. j Pelvic j ultrasound
j resultsjwere jnormal, jas jwas jthe jserum jestradiol jlevel. jThe jhemoglobin jand jplatelet jcounts
jwere jnormal, jas jwere jthe jbleeding jtime jand jcoagulation jstudies. jFindings jon jpelvic
jexamination jconducted junder janesthesia jalso jwere jnormal. jThe jnext jstep jin jthe
jexamination jis jto:
■ Determine jthe jblood jtype jof jthe jblood jon jthe junderwear
□Interrogate jthe jfather
□Isolate jthe jparents jand jchild
□Determine jvon jWillebrand jfactor jlevels
, □Measure jfibronectin jin jthe jvagina
description jConsideration jof jfactitious jdisorder jby jproxy jshould jbe jtriggered jwhen jthe jreported jsymptoms jare
jrepeatedly jnoted j by j only j one j parent, j appropriate j testing j fails j to j confirm j a j diagnosis, j and j seemingly j appropriate
j treatment j is j ineffective. jAt j times, j the j child's j symptoms, j their j course, j or j the j response j to j treatment j may j be
j incompatible j with j any j recognized j disease.jPreverbal j children j are j usually j involved. j Bleeding j is j a j particularly j common
j presentation. j This j may j be j caused j by j adding j dyes jto j samples, j adding j blood j (e.g., j from j the j mother) j to j the j child's
j sample, j or j giving j the j child j an j anticoagulant j (e.g., j warfarin). j(See jChapter j37, jpage j146.)
3. Munchausen j syndrome j by j proxy j is j characterized j by j all j of j the j following j EXCEPT:
□Mother jwho jappears jdevoted jand jwins jover jmembers jof jcare jteam
□Multiple j hospitalizations j and j investigations j without j diagnosis
□Symptoms jon jhistory jbut jnot jwitnessed jby jmedical jteam
■ Symptoms j occurring j in j presence j of j different j caregivers j (e.g., j while j mother j is j out j of j town)
□Use jof jmedications jor jtoxins
description jSymptoms jin jyoung jchildren jare jmostly jassociated jwith jproximity jof jthe joffending jcaregiver jto jthe jchild.
jThe jmother jmay jpresent jas ja jdevoted jor jeven jmodel jparent jwho jforms jclose jrelationships jwith jmembers jof jthe
jhealth jcare jteam. jWhile jappearing jvery jinterested jin jher jchild's jcondition, jshe jmay jbe jrelatively jdistant jemotionally.
j(See jChapter j37, jpage j146.)
4. Which jstatement jis jfalse?
■ Malnutrition jis j the j second j leading j cause j of j acquired j immune j deficiency j worldwide j behind j HIV jinfection
□Zinc j is j important j in j immune j function j and j linear j growth
□Kwashiorkor jand j marasmus j are j rare j in j developed j countries
□The j Western j diet jis jassociated j with jincreased j noncommunicable j disease
description j The j significant j global j burden j of j malnutrition j and j undernutrition jis jthe jleading j worldwide j cause j of jacquired
jimmunodeficiency jand jthe j major j underlying j factor j for j morbidity jand j mortality j globally jfor jchildren j<5 j yr j of jage. j Zinc
j is ja jmicronutrient jthat jsupports jmultiple j metabolic j functions jin jthe j body, jis jessential j for j normal jimmune j functioning,
jand jis jrequired j to j support j linear j growth; j zinc j deficiency j is j associated j with j impaired j immune j functioning j and j poor
j linear j growth. j In jparallel j to j the j risk j for j nutrient j and j energy j deficiencies, j issues j relating j to j excesses j pose j important
j challenges j because j of j theirjnegative jhealth jeffects, jsuch jas jobesity jor jcardiovascular jdisease jrisk jfactors. jThe jnutrition
jtransition junder jway jin jthe
, developing j world j from j traditional j diets j to j the j Western j diet j has j been j associated j with j increases j in jnoncommunicable
jdiseases, j often j coexisting j with j undernutrition j and j malnutrition, j observed j sometimes j in j the j same j communities j or j even
j thejsame jfamilies. j(See je41-1.)
5. Components j of j energy j expenditure j in j children j include:
□Thermal j effect j of j food
□Basal j metabolic j rate
□Energy jfor j physical j activity
□Energy jto jsupport jgrowth
■ All jof jthe jabove
description jThe j3 jcomponents jof jenergy jexpenditure jin jadults jare jthe jbasal jmetabolic jrate, jthe jthermal jeffect jof
jfood j(energy jrequired jfor jdigestion jand jabsorption), jand jenergy jfor jphysical jactivity. jAdditional jenergy jintake jand
jexpenditure jare jrequired jto jsupport jgrowth jand jdevelopment jfor jchildren. j(See je41-4.)
6. Which jof jthe jfollowing jclinical jscenarios jincreases jthe jrisk jof jvitamin jA jdeficiency?
□Vegetarian j diet
□Chronic j intestinal j disorders
□Zinc jdeficiency
■ B jand jC
□All jof jthe jabove
description jVitamin jA jis jan jessential jmicronutrient jbecause jit jcannot jbe jbiogenerated jde jnovo jby janimals. jIt
jmust jbe jobtained j from j plants j in j the j form j of j provitamin-A j carotenoids. j In j the j USA, j grains j and j vegetables j supply
j approximately j55% jand jdairy jand jmeat jproducts jsupply japproximately j30% jof jvitamin jA jintake jfrom jfood.
jVitamin jA jand jthe jprovitamins-A j are j fat j soluble, j and j their j absorption j depends j on j the j presence j of j adequate j lipid
j and j protein j within j the j meal.jChronic j intestinal j disorders j or j lipid j malabsorption j syndromes j can j result j in j vitamin j A
j deficiency. j In j developing j countries, jsubclinical j or jclinical jzinc j deficiency jcan jincrease jthe jrisk jof jvitamin j A
jdeficiency. jThere jis jalso jsome j evidence j of jmarginal jzinc jintakes jin jchildren jin jthe jUSA. j(See jChapter j45, jpage
j188.)
7. Which jstatement jabout jvitamin jA jtoxicity jis jNOT jtrue?
1. Which jof jthe jfollowing jstatements jregarding jfoster jcare jis jtrue?
□A jpermanency jplan jmust jbe jmade j for ja jchild jin jfoster jcare j no jlater jthan j 12 jmo jfrom jthe jchild's jentry jinto jcare
□A jminority jof jchildren jin jfoster jcare jhave ja jhistory jof jabuse jor jneglect
□The jmission jof jfoster jcare jis jto jsafely jcare jfor jchildren jwhile jproviding jservices jto jfamilies jto jpromote jreunification
□Most j(>70%) jof jchildren jin jfoster jcare jare jreunited jwith jtheir jfamilies
■ A jand jC
description j The j mission j of j foster j care j is j to j provide j for j the j health, j safety, j and j well-being j of j children j while j assisting
j their jfamilies j with j services j to j promote j reunification. j Children j entering j foster j care j have j frequently j experienced j early
j childhood jtrauma. j More j than j 70% j have j a j history j of j abuse, j neglect, j or j both. j Only j about j 50% j of j children j achieve
j reunification. j In j the jUSA, jthe jAdoption jand jSafe jFamilies jAct j(P.L. j105-89) jpassed jin j1997 jrequires jthat ja
jpermanency jplan jbe jmade jfor jeach j child j no j later j than j 12 j mo j after j entry j to j foster j care j and j that j a j petition j to
j terminate j parental j rights j typically j must j be j filedjwhen ja jchild jhas jbeen jin jfoster jcare jfor jat jleast j15 jof jthe jprevious
j22 jmo. j(See jChapter j35, jpage j134, jand je35-1.)
2. A j4 jyr jold jgirl jis jadmitted jto jthe jhospital jfor jher jthird jevaluation jfor jvaginal jbleeding. jThe
mother jnoted jbright jred jblood jon jthe jchild's junderwear. jPrevious jexaminations jrevealed ja
jnormal j 4 j yr j old j girl, j Tanner j stage j 1, j with j normal j external j genitalia. j Pelvic j ultrasound
j resultsjwere jnormal, jas jwas jthe jserum jestradiol jlevel. jThe jhemoglobin jand jplatelet jcounts
jwere jnormal, jas jwere jthe jbleeding jtime jand jcoagulation jstudies. jFindings jon jpelvic
jexamination jconducted junder janesthesia jalso jwere jnormal. jThe jnext jstep jin jthe
jexamination jis jto:
■ Determine jthe jblood jtype jof jthe jblood jon jthe junderwear
□Interrogate jthe jfather
□Isolate jthe jparents jand jchild
□Determine jvon jWillebrand jfactor jlevels
, □Measure jfibronectin jin jthe jvagina
description jConsideration jof jfactitious jdisorder jby jproxy jshould jbe jtriggered jwhen jthe jreported jsymptoms jare
jrepeatedly jnoted j by j only j one j parent, j appropriate j testing j fails j to j confirm j a j diagnosis, j and j seemingly j appropriate
j treatment j is j ineffective. jAt j times, j the j child's j symptoms, j their j course, j or j the j response j to j treatment j may j be
j incompatible j with j any j recognized j disease.jPreverbal j children j are j usually j involved. j Bleeding j is j a j particularly j common
j presentation. j This j may j be j caused j by j adding j dyes jto j samples, j adding j blood j (e.g., j from j the j mother) j to j the j child's
j sample, j or j giving j the j child j an j anticoagulant j (e.g., j warfarin). j(See jChapter j37, jpage j146.)
3. Munchausen j syndrome j by j proxy j is j characterized j by j all j of j the j following j EXCEPT:
□Mother jwho jappears jdevoted jand jwins jover jmembers jof jcare jteam
□Multiple j hospitalizations j and j investigations j without j diagnosis
□Symptoms jon jhistory jbut jnot jwitnessed jby jmedical jteam
■ Symptoms j occurring j in j presence j of j different j caregivers j (e.g., j while j mother j is j out j of j town)
□Use jof jmedications jor jtoxins
description jSymptoms jin jyoung jchildren jare jmostly jassociated jwith jproximity jof jthe joffending jcaregiver jto jthe jchild.
jThe jmother jmay jpresent jas ja jdevoted jor jeven jmodel jparent jwho jforms jclose jrelationships jwith jmembers jof jthe
jhealth jcare jteam. jWhile jappearing jvery jinterested jin jher jchild's jcondition, jshe jmay jbe jrelatively jdistant jemotionally.
j(See jChapter j37, jpage j146.)
4. Which jstatement jis jfalse?
■ Malnutrition jis j the j second j leading j cause j of j acquired j immune j deficiency j worldwide j behind j HIV jinfection
□Zinc j is j important j in j immune j function j and j linear j growth
□Kwashiorkor jand j marasmus j are j rare j in j developed j countries
□The j Western j diet jis jassociated j with jincreased j noncommunicable j disease
description j The j significant j global j burden j of j malnutrition j and j undernutrition jis jthe jleading j worldwide j cause j of jacquired
jimmunodeficiency jand jthe j major j underlying j factor j for j morbidity jand j mortality j globally jfor jchildren j<5 j yr j of jage. j Zinc
j is ja jmicronutrient jthat jsupports jmultiple j metabolic j functions jin jthe j body, jis jessential j for j normal jimmune j functioning,
jand jis jrequired j to j support j linear j growth; j zinc j deficiency j is j associated j with j impaired j immune j functioning j and j poor
j linear j growth. j In jparallel j to j the j risk j for j nutrient j and j energy j deficiencies, j issues j relating j to j excesses j pose j important
j challenges j because j of j theirjnegative jhealth jeffects, jsuch jas jobesity jor jcardiovascular jdisease jrisk jfactors. jThe jnutrition
jtransition junder jway jin jthe
, developing j world j from j traditional j diets j to j the j Western j diet j has j been j associated j with j increases j in jnoncommunicable
jdiseases, j often j coexisting j with j undernutrition j and j malnutrition, j observed j sometimes j in j the j same j communities j or j even
j thejsame jfamilies. j(See je41-1.)
5. Components j of j energy j expenditure j in j children j include:
□Thermal j effect j of j food
□Basal j metabolic j rate
□Energy jfor j physical j activity
□Energy jto jsupport jgrowth
■ All jof jthe jabove
description jThe j3 jcomponents jof jenergy jexpenditure jin jadults jare jthe jbasal jmetabolic jrate, jthe jthermal jeffect jof
jfood j(energy jrequired jfor jdigestion jand jabsorption), jand jenergy jfor jphysical jactivity. jAdditional jenergy jintake jand
jexpenditure jare jrequired jto jsupport jgrowth jand jdevelopment jfor jchildren. j(See je41-4.)
6. Which jof jthe jfollowing jclinical jscenarios jincreases jthe jrisk jof jvitamin jA jdeficiency?
□Vegetarian j diet
□Chronic j intestinal j disorders
□Zinc jdeficiency
■ B jand jC
□All jof jthe jabove
description jVitamin jA jis jan jessential jmicronutrient jbecause jit jcannot jbe jbiogenerated jde jnovo jby janimals. jIt
jmust jbe jobtained j from j plants j in j the j form j of j provitamin-A j carotenoids. j In j the j USA, j grains j and j vegetables j supply
j approximately j55% jand jdairy jand jmeat jproducts jsupply japproximately j30% jof jvitamin jA jintake jfrom jfood.
jVitamin jA jand jthe jprovitamins-A j are j fat j soluble, j and j their j absorption j depends j on j the j presence j of j adequate j lipid
j and j protein j within j the j meal.jChronic j intestinal j disorders j or j lipid j malabsorption j syndromes j can j result j in j vitamin j A
j deficiency. j In j developing j countries, jsubclinical j or jclinical jzinc j deficiency jcan jincrease jthe jrisk jof jvitamin j A
jdeficiency. jThere jis jalso jsome j evidence j of jmarginal jzinc jintakes jin jchildren jin jthe jUSA. j(See jChapter j45, jpage
j188.)
7. Which jstatement jabout jvitamin jA jtoxicity jis jNOT jtrue?
