, Nelson Pediatrics Review(MCQs) 19 Edition nb nb nb nb
1. Which of the following statements regarding foster care is true?
nb nb nb nb nb nb nb nb nb
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
□A minority of children in foster care have a history of abuse or neglect
nb nb nb nb nb nb nb nb nb nb nb nb nb
□The mission of foster care is to safely care for children while providing services to families to promote reunification
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
□Most (>70%) of children in foster care are reunited with their families
nb nb nb nb nb nb nb nb nb nb nb
■ A and C nb nb
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting their
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
families with services to promote reunification. Children entering foster care have frequently experienced early childhood
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve reunification. In
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a permanency plan be made
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
for each child no later than 12 mo after entry to foster care and that a petition to terminate parental rights typically must
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
be filed when a child has been in foster care for at least 15 of the previous 22 mo. (See Chapter 35, page 134, and e35-
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
mother noted bright red blood on the child's underwear. Previous examinations revealed a
nb nb nb nb nb nb nb nb nb nb nb nb
normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
were normal, as was the serum estradiol level. The hemoglobin and platelet counts were
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
normal, as were the bleeding time and coagulation studies. Findings on pelvic examination
nb nb nb nb nb nb nb nb nb nb nb nb nb
conducted under anesthesia also were normal. The next step in the examination is to:
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
■ Determine the blood type of the blood on the underwearnb nb nb nb nb nb nb nb nb
□Interrogate nb the father nb
□Isolate the parents and child nb nb nb nb
□Determine n b von Willebrand factor levels
nb nb nb
, □Measure nb fibronectin in the vagina nb nb nb
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
is ineffective. At times, the child's symptoms, their course, or the response to treatment may be incompatible with any
nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
recognized disease. Preverbal children are usually involved. Bleeding is a particularly common presentation. This may
nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb
be caused by adding dyes to samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an
nb nb nb nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
nb nb nb nb nb nb nb nb
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
nb nb nb nb nb nb nb nb nb nb nb
□Mother who appears devoted and wins over members
nb nb nb nb nb nb nb nb of care team
nb nb
□Multiple nb hospitalizations and investigations without diagnosis nb nb nb nb
□Symptoms on history but not witnessed by medical team nb nb nb nb nb nb nb nb
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
nb nb nb nb nb nb nb nb nb nb nb nb nb
□Use of medications or toxins
nb nb nb nb
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child.
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
The mother may present as a devoted or even model parent who forms close relationships with members of the health
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
care team. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
Chapter 37, page 146.)
nb nb nb nb
4. Which statement is false? nb nb nb
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
nb nb nb nb nb nb nb nb nb nb nb nb nb
□Zinc is important in immune function
nb nb nb nb nb nb and linear growth
nb nb
□Kwashiorkor and marasmus are rare in developed countries nb nb nb nb nb nb nb
□The Western diet is associated with increased noncommunicable disease
nb nb nb nb nb nb nb nb
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of acquired
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of age. Zinc is
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune functioning, and is
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
required to support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear growth.
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose important challenges because of
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
their negative health effects, such as obesity or cardiovascular disease risk factors. The nutrition transition under way in
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
the
nb
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
same families. (See e41-1.)
nb nb nb nb
5. Components of energy expenditure in children include: nb nb nb nb nb nb
□Thermal effect of food nb nb nb
□Basal metabolic rate nb nb
□Energy for physical activity nb nb nb
□Energy to nb nb support growth nb
■ All of the above nb nb nb
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of food
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
(energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
expenditure are required to support growth and development for children. (See e41-4.)
nb nb nb nb nb nb nb nb nb nb nb nb
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
nb nb nb nb nb nb nb nb nb nb nb nb
□Vegetarian diet nb
□Chronic nb intestinal disorders nb
□Zinc nb deficiency
■ B and C nb nb
□All of the above nb nb nb
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables supply
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from food. Vitamin
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate lipid and protein
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In
nb nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb nb
developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin A deficiency. There is also
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
some evidence of marginal zinc intakes in children in the USA. (See Chapter 45, page 188.)
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
7. Which statement about vitamin A toxicity is NOT true?
nb nb nb nb nb nb nb nb
1. Which of the following statements regarding foster care is true?
nb nb nb nb nb nb nb nb nb
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
□A minority of children in foster care have a history of abuse or neglect
nb nb nb nb nb nb nb nb nb nb nb nb nb
□The mission of foster care is to safely care for children while providing services to families to promote reunification
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
□Most (>70%) of children in foster care are reunited with their families
nb nb nb nb nb nb nb nb nb nb nb
■ A and C nb nb
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting their
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
families with services to promote reunification. Children entering foster care have frequently experienced early childhood
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve reunification. In
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a permanency plan be made
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
for each child no later than 12 mo after entry to foster care and that a petition to terminate parental rights typically must
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
be filed when a child has been in foster care for at least 15 of the previous 22 mo. (See Chapter 35, page 134, and e35-
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
mother noted bright red blood on the child's underwear. Previous examinations revealed a
nb nb nb nb nb nb nb nb nb nb nb nb
normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
were normal, as was the serum estradiol level. The hemoglobin and platelet counts were
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
normal, as were the bleeding time and coagulation studies. Findings on pelvic examination
nb nb nb nb nb nb nb nb nb nb nb nb nb
conducted under anesthesia also were normal. The next step in the examination is to:
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
■ Determine the blood type of the blood on the underwearnb nb nb nb nb nb nb nb nb
□Interrogate nb the father nb
□Isolate the parents and child nb nb nb nb
□Determine n b von Willebrand factor levels
nb nb nb
, □Measure nb fibronectin in the vagina nb nb nb
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
is ineffective. At times, the child's symptoms, their course, or the response to treatment may be incompatible with any
nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
recognized disease. Preverbal children are usually involved. Bleeding is a particularly common presentation. This may
nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb
be caused by adding dyes to samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an
nb nb nb nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
nb nb nb nb nb nb nb nb
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
nb nb nb nb nb nb nb nb nb nb nb
□Mother who appears devoted and wins over members
nb nb nb nb nb nb nb nb of care team
nb nb
□Multiple nb hospitalizations and investigations without diagnosis nb nb nb nb
□Symptoms on history but not witnessed by medical team nb nb nb nb nb nb nb nb
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
nb nb nb nb nb nb nb nb nb nb nb nb nb
□Use of medications or toxins
nb nb nb nb
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child.
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
The mother may present as a devoted or even model parent who forms close relationships with members of the health
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
care team. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
Chapter 37, page 146.)
nb nb nb nb
4. Which statement is false? nb nb nb
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
nb nb nb nb nb nb nb nb nb nb nb nb nb
□Zinc is important in immune function
nb nb nb nb nb nb and linear growth
nb nb
□Kwashiorkor and marasmus are rare in developed countries nb nb nb nb nb nb nb
□The Western diet is associated with increased noncommunicable disease
nb nb nb nb nb nb nb nb
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of acquired
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of age. Zinc is
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune functioning, and is
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
required to support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear growth.
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose important challenges because of
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
their negative health effects, such as obesity or cardiovascular disease risk factors. The nutrition transition under way in
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
the
nb
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
same families. (See e41-1.)
nb nb nb nb
5. Components of energy expenditure in children include: nb nb nb nb nb nb
□Thermal effect of food nb nb nb
□Basal metabolic rate nb nb
□Energy for physical activity nb nb nb
□Energy to nb nb support growth nb
■ All of the above nb nb nb
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of food
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
(energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
expenditure are required to support growth and development for children. (See e41-4.)
nb nb nb nb nb nb nb nb nb nb nb nb
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
nb nb nb nb nb nb nb nb nb nb nb nb
□Vegetarian diet nb
□Chronic nb intestinal disorders nb
□Zinc nb deficiency
■ B and C nb nb
□All of the above nb nb nb
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables supply
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from food. Vitamin
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate lipid and protein
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In
nb nb nb n b nb nb nb nb nb nb nb nb nb nb nb nb nb
developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin A deficiency. There is also
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
some evidence of marginal zinc intakes in children in the USA. (See Chapter 45, page 188.)
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
7. Which statement about vitamin A toxicity is NOT true?
nb nb nb nb nb nb nb nb
