, Nelson Pediatrics Review(MCQs) 19 Edition
1. Which q of q the q following q statements q regarding q foster q care q is q 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
q q q q q q q q q q q q q q q q q q q q q q
□A minority of children in foster care have a history of abuse or neglect
q q q q q q q q q q q q q
□The mission of foster care is to safely care for children while providing services to families to promote reunification
q q q q q q q q q q q q q q q q q q
□Most (>70%) of children in foster care are reunited with their families
q q q q q q q q q q q
■ A qand qC
descriptionqThe qmissionqof qfoster qcare qis qto qprovide qfor qthe qhealth, qsafety, qand qwell-being qof qchildren qwhile qassisting
qtheir qfamilies qwith qservices qto qpromote q reunification. q Children qentering qfoster qcare q have qfrequently qexperienced qearly
qchildhood qtrauma. qMore qthan q70% qhave qa qhistory qof qabuse, qneglect, qor qboth. qOnly qabout q50% qof qchildren qachieve
qreunification. qIn qthe qUSA, qthe qAdoption qand qSafe qFamilies qAct q(P.L. q105-89) qpassed qin q1997 qrequires qthat qa
qpermanency qplan qbe qmade qfor qeach qchild q no qlater qthan q 12 q mo qafter qentry qto qfoster qcare qand qthat qa qpetition qto qterminate
qparental qrights qtypically qmust q be q filed qwhen qa qchild qhas qbeen qin qfoster qcare qfor qat qleast q15 qof qthe qprevious q22 qmo. q(See
qChapter q35, qpage q134, qand qe35-1.)
2. A q4 qyr qold qgirl qis qadmitted qto qthe qhospital qfor qher qthird qevaluation qfor qvaginal qbleeding. qThe
mother qnoted qbright qred qblood qon qthe qchild's qunderwear. qPrevious qexaminations qrevealed qa
qnormal q4 qyr qold qgirl, qTanner qstage q1, qwith qnormal qexternal qgenitalia. qPelvic qultrasound qresults
qwere qnormal, qas qwas qthe qserum qestradiol qlevel. qThe qhemoglobin qand qplatelet qcounts q were
qnormal, qas qwere qthe qbleeding qtime qand qcoagulation qstudies. qFindings qon qpelvic qexamination
qconducted qunder qanesthesia qalso qwere qnormal. qThe qnext qstep qin qthe qexamination qis qto:
■ Determine qthe qblood qtype qof qthe qblood qon qthe qunderwear
□Interrogate the q q father
□Isolate the parents and child
q q q q
□Determine q von q Willebrand q factor q levels
, □Measure q fibronectin q in qthe qvagina
description qConsideration qof qfactitious qdisorder qbyqproxy qshould qbe qtriggered qwhen qthe qreported qsymptoms qare
qrepeatedly qnoted qby q only qone qparent, qappropriate qtesting q fails qto qconfirm qa q diagnosis, qand qseemingly qappropriate qtreatment
qis qineffective. q At qtimes, qthe qchild's qsymptoms, qtheir qcourse, qor qthe q response qto qtreatment qmay q be qincompatible qwith qany
qrecognized q disease. q Preverbal qchildren qare qusually qinvolved. q Bleeding qis qa q particularly qcommon q presentation. qThis qmay qbe
qcaused qby qadding qdyes q to qsamples, qadding qblood q(e.g., qfrom qthe qmother) qto qthe qchild's qsample, qor qgiving qthe qchild qan
qanticoagulant q(e.g., qwarfarin). q(See qChapter q37, qpage q146.)
3. Munchausen qsyndrome qby qproxy qis qcharacterized q by q all qof q the qfollowing q EXCEPT:
□Mother who appears devoted and wins over members of care team
q q q q q q q q q q
□Multiple q hospitalizations q and q investigations q without q diagnosis
□Symptoms on history but not witnessed by medical team
q q q q q q q q
■ Symptoms qoccurring qin qpresence qof qdifferent qcaregivers q(e.g., qwhile qmother qis qout qof qtown)
□Use of medications or toxins
q q q q
description qSymptoms qin qyoung qchildren qare qmostly qassociated qwith qproximity qof qthe qoffending qcaregiver qto qthe qchild.
qThe qmother qmay qpresent qas qa qdevoted qor qeven qmodel qparent qwho qforms qclose qrelationships qwith qmembers qof qthe
qhealth qcare qteam. q While qappearing qvery qinterested qin qher qchild's qcondition, qshe qmay q be qrelatively qdistant qemotionally.
q(See q Chapter q 37, qpage q146.)
4. Which q statement q is q false?
■ Malnutrition qis qthe qsecond qleading qcause qof qacquired qimmune qdeficiency qworldwide qbehind qHIV qinfection
□Zinc is important in immune function and linear growth
q q q q q q q q
□Kwashiorkor and marasmus are rare in developed countries
q q q q q q q
□The Western diet is associated with increased noncommunicable disease
q q q q q q q q
description qThe qsignificant qglobal qburden qof qmalnutrition qand qundernutrition qis qthe qleading qworldwide qcause qof qacquired
qimmunodeficiency qand qthe qmajor q underlying qfactor q for qmorbidity qand qmortality q globally q for qchildren q<5 qyr qof q age. q Zinc qis qa
qmicronutrient qthat qsupports q multiple qmetabolic q functions q in qthe q body, qis qessential qfor q normal qimmune q functioning, q and qis
qrequired qto qsupport qlinear qgrowth; q zinc q deficiency qis qassociated qwith qimpaired qimmune qfunctioning qand q poor qlinear q growth.
qIn q parallel qto qthe q risk qfor q nutrient qand q energy qdeficiencies, qissues qrelating qto qexcesses qpose qimportant qchallenges q because qof
qtheir q negative qhealth qeffects, qsuch qas qobesityqor qcardiovascular qdisease qrisk qfactors. qThe qnutrition qtransition qunder qway qin
qthe
, developing qworld qfrom qtraditional qdiets qto qthe qWestern qdiet qhas qbeen qassociated qwith qincreases qin qnoncommunicable
qdiseases, qoften qcoexisting qwith qundernutrition qand q malnutrition, q observed qsometimes qin qthe qsame qcommunities qor qeven qthe
qsame qfamilies. q(See qe41-1.)
5. Components q of q energy q expenditure q in q children q include:
□Thermal effect of foodq q q
□Basal metabolic rate
q q
□Energy for physical activity
q q q
□Energy to support q q q growth
■ All qof qthe qabove
description qThe q3 qcomponents qof qenergy qexpenditure qin qadults qare qthe qbasal qmetabolic qrate, qthe qthermal qeffect qof
qfood q(energy qrequired qfor q digestion qand qabsorption), qand q energy qfor qphysical qactivity. qAdditional qenergy qintake qand
qexpenditure qare qrequired qto qsupport qgrowth qand qdevelopment qfor qchildren. q(See qe41-4.)
6. Which qof qthe qfollowing qclinical qscenarios qincreases qthe qrisk qof qvitamin qA qdeficiency?
□Vegetarian diet q
□Chronic intestinal disorders
q q
□Zinc q deficiency
■ B qand qC
□All of the above
q q q
description qVitamin qA qis qan qessential qmicronutrient qbecause qit qcannot qbe qbiogenerated qde qnovo qby qanimals. qIt qmust
qbe qobtained qfrom qplants qin qthe qform qof qprovitamin-A qcarotenoids. qIn qthe qUSA, qgrains qand qvegetables qsupply
qapproximately q55% qand qdairy qand qmeat qproducts qsupply qapproximately q30% qof qvitamin qA qintake qfrom qfood. qVitamin
qA qand qthe qprovitamins-A qare qfat qsoluble, qand qtheir qabsorption qdepends qon qthe q presence qof qadequate qlipid qand qprotein
qwithin qthe q meal. q Chronic qintestinal qdisorders qor qlipid qmalabsorption qsyndromes q can q result qin q vitamin qA q deficiency. q In
qdeveloping qcountries, qsubclinical qor qclinical qzinc q deficiency qcan qincrease qthe qrisk q of q vitamin qA qdeficiency. qThere qis qalso
qsome qevidence q of q marginal qzinc qintakes qin qchildren qin qthe qUSA. q(See qChapter q45, qpage q188.)
7. Which q statement q about q vitamin q A q toxicity q is q NOT q true?
1. Which q of q the q following q statements q regarding q foster q care q is q 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
q q q q q q q q q q q q q q q q q q q q q q
□A minority of children in foster care have a history of abuse or neglect
q q q q q q q q q q q q q
□The mission of foster care is to safely care for children while providing services to families to promote reunification
q q q q q q q q q q q q q q q q q q
□Most (>70%) of children in foster care are reunited with their families
q q q q q q q q q q q
■ A qand qC
descriptionqThe qmissionqof qfoster qcare qis qto qprovide qfor qthe qhealth, qsafety, qand qwell-being qof qchildren qwhile qassisting
qtheir qfamilies qwith qservices qto qpromote q reunification. q Children qentering qfoster qcare q have qfrequently qexperienced qearly
qchildhood qtrauma. qMore qthan q70% qhave qa qhistory qof qabuse, qneglect, qor qboth. qOnly qabout q50% qof qchildren qachieve
qreunification. qIn qthe qUSA, qthe qAdoption qand qSafe qFamilies qAct q(P.L. q105-89) qpassed qin q1997 qrequires qthat qa
qpermanency qplan qbe qmade qfor qeach qchild q no qlater qthan q 12 q mo qafter qentry qto qfoster qcare qand qthat qa qpetition qto qterminate
qparental qrights qtypically qmust q be q filed qwhen qa qchild qhas qbeen qin qfoster qcare qfor qat qleast q15 qof qthe qprevious q22 qmo. q(See
qChapter q35, qpage q134, qand qe35-1.)
2. A q4 qyr qold qgirl qis qadmitted qto qthe qhospital qfor qher qthird qevaluation qfor qvaginal qbleeding. qThe
mother qnoted qbright qred qblood qon qthe qchild's qunderwear. qPrevious qexaminations qrevealed qa
qnormal q4 qyr qold qgirl, qTanner qstage q1, qwith qnormal qexternal qgenitalia. qPelvic qultrasound qresults
qwere qnormal, qas qwas qthe qserum qestradiol qlevel. qThe qhemoglobin qand qplatelet qcounts q were
qnormal, qas qwere qthe qbleeding qtime qand qcoagulation qstudies. qFindings qon qpelvic qexamination
qconducted qunder qanesthesia qalso qwere qnormal. qThe qnext qstep qin qthe qexamination qis qto:
■ Determine qthe qblood qtype qof qthe qblood qon qthe qunderwear
□Interrogate the q q father
□Isolate the parents and child
q q q q
□Determine q von q Willebrand q factor q levels
, □Measure q fibronectin q in qthe qvagina
description qConsideration qof qfactitious qdisorder qbyqproxy qshould qbe qtriggered qwhen qthe qreported qsymptoms qare
qrepeatedly qnoted qby q only qone qparent, qappropriate qtesting q fails qto qconfirm qa q diagnosis, qand qseemingly qappropriate qtreatment
qis qineffective. q At qtimes, qthe qchild's qsymptoms, qtheir qcourse, qor qthe q response qto qtreatment qmay q be qincompatible qwith qany
qrecognized q disease. q Preverbal qchildren qare qusually qinvolved. q Bleeding qis qa q particularly qcommon q presentation. qThis qmay qbe
qcaused qby qadding qdyes q to qsamples, qadding qblood q(e.g., qfrom qthe qmother) qto qthe qchild's qsample, qor qgiving qthe qchild qan
qanticoagulant q(e.g., qwarfarin). q(See qChapter q37, qpage q146.)
3. Munchausen qsyndrome qby qproxy qis qcharacterized q by q all qof q the qfollowing q EXCEPT:
□Mother who appears devoted and wins over members of care team
q q q q q q q q q q
□Multiple q hospitalizations q and q investigations q without q diagnosis
□Symptoms on history but not witnessed by medical team
q q q q q q q q
■ Symptoms qoccurring qin qpresence qof qdifferent qcaregivers q(e.g., qwhile qmother qis qout qof qtown)
□Use of medications or toxins
q q q q
description qSymptoms qin qyoung qchildren qare qmostly qassociated qwith qproximity qof qthe qoffending qcaregiver qto qthe qchild.
qThe qmother qmay qpresent qas qa qdevoted qor qeven qmodel qparent qwho qforms qclose qrelationships qwith qmembers qof qthe
qhealth qcare qteam. q While qappearing qvery qinterested qin qher qchild's qcondition, qshe qmay q be qrelatively qdistant qemotionally.
q(See q Chapter q 37, qpage q146.)
4. Which q statement q is q false?
■ Malnutrition qis qthe qsecond qleading qcause qof qacquired qimmune qdeficiency qworldwide qbehind qHIV qinfection
□Zinc is important in immune function and linear growth
q q q q q q q q
□Kwashiorkor and marasmus are rare in developed countries
q q q q q q q
□The Western diet is associated with increased noncommunicable disease
q q q q q q q q
description qThe qsignificant qglobal qburden qof qmalnutrition qand qundernutrition qis qthe qleading qworldwide qcause qof qacquired
qimmunodeficiency qand qthe qmajor q underlying qfactor q for qmorbidity qand qmortality q globally q for qchildren q<5 qyr qof q age. q Zinc qis qa
qmicronutrient qthat qsupports q multiple qmetabolic q functions q in qthe q body, qis qessential qfor q normal qimmune q functioning, q and qis
qrequired qto qsupport qlinear qgrowth; q zinc q deficiency qis qassociated qwith qimpaired qimmune qfunctioning qand q poor qlinear q growth.
qIn q parallel qto qthe q risk qfor q nutrient qand q energy qdeficiencies, qissues qrelating qto qexcesses qpose qimportant qchallenges q because qof
qtheir q negative qhealth qeffects, qsuch qas qobesityqor qcardiovascular qdisease qrisk qfactors. qThe qnutrition qtransition qunder qway qin
qthe
, developing qworld qfrom qtraditional qdiets qto qthe qWestern qdiet qhas qbeen qassociated qwith qincreases qin qnoncommunicable
qdiseases, qoften qcoexisting qwith qundernutrition qand q malnutrition, q observed qsometimes qin qthe qsame qcommunities qor qeven qthe
qsame qfamilies. q(See qe41-1.)
5. Components q of q energy q expenditure q in q children q include:
□Thermal effect of foodq q q
□Basal metabolic rate
q q
□Energy for physical activity
q q q
□Energy to support q q q growth
■ All qof qthe qabove
description qThe q3 qcomponents qof qenergy qexpenditure qin qadults qare qthe qbasal qmetabolic qrate, qthe qthermal qeffect qof
qfood q(energy qrequired qfor q digestion qand qabsorption), qand q energy qfor qphysical qactivity. qAdditional qenergy qintake qand
qexpenditure qare qrequired qto qsupport qgrowth qand qdevelopment qfor qchildren. q(See qe41-4.)
6. Which qof qthe qfollowing qclinical qscenarios qincreases qthe qrisk qof qvitamin qA qdeficiency?
□Vegetarian diet q
□Chronic intestinal disorders
q q
□Zinc q deficiency
■ B qand qC
□All of the above
q q q
description qVitamin qA qis qan qessential qmicronutrient qbecause qit qcannot qbe qbiogenerated qde qnovo qby qanimals. qIt qmust
qbe qobtained qfrom qplants qin qthe qform qof qprovitamin-A qcarotenoids. qIn qthe qUSA, qgrains qand qvegetables qsupply
qapproximately q55% qand qdairy qand qmeat qproducts qsupply qapproximately q30% qof qvitamin qA qintake qfrom qfood. qVitamin
qA qand qthe qprovitamins-A qare qfat qsoluble, qand qtheir qabsorption qdepends qon qthe q presence qof qadequate qlipid qand qprotein
qwithin qthe q meal. q Chronic qintestinal qdisorders qor qlipid qmalabsorption qsyndromes q can q result qin q vitamin qA q deficiency. q In
qdeveloping qcountries, qsubclinical qor qclinical qzinc q deficiency qcan qincrease qthe qrisk q of q vitamin qA qdeficiency. qThere qis qalso
qsome qevidence q of q marginal qzinc qintakes qin qchildren qin qthe qUSA. q(See qChapter q45, qpage q188.)
7. Which q statement q about q vitamin q A q toxicity q is q NOT q true?
