Test bank for MCQs in Pediatrics Review of Nelson
Textbook of Pediatrics 20 Edition x
, Nelsonx Pediatricsx Review(MCQs)x19xEdition
1. Whichx ofx thex followingx statementsx regardingx fosterx carex isx true?
□Axpermanencyxplanxmustxbexmadexforxaxchildxinxfosterxcarexnoxlaterxthanx12xmoxfromxthexchild'sxentryxintoxcare
□Axminorityxofxchildrenxinxfosterxcarexhavexaxhistoryxofxabusexorxneglect
□Thexmissionxofxfosterxcarexisxtoxsafelyxcarexforxchildrenxwhilexprovidingxservicesxtoxfamiliesxtoxpromotexreunification
□Mostx(>70%)xofxchildrenxinxfosterxcarexarexreunitedxwithxtheirxfamilies
■ AxandxC
descriptionxThexmissionxofxfosterxcarexisxtoxprovidexforxthexhealth,xsafety,xandxwell-
beingxofxchildrenxwhilexassistingxtheirxfamiliesxwithxservicesxtoxpromotexreunification.xChildrenxenteringxfosterxcarexhavexf
requentlyxexperiencedxearlyxchildhoodxtrauma.xMorexthanx70%xhavexaxhistoryxofxabuse,xneglect,xorxboth.xOnlyxaboutx50
%xofxchildrenxachievexreunification.xInxthexUSA,xthexAdoptionxandxSafexFamiliesxActx(P.L.x105-
89)xpassedxinx1997xrequiresxthatxaxpermanencyxplanxbexmadexforxeachxchildxnoxlaterxthanx12xmoxafterxentryxtoxfosterxcare
xandxthatxaxpetitionxtoxterminatexparentalxrightsxtypicallyxmustxbexfiledxwhenxaxchildxhasxbeenxinxfosterxcarexforxatxleastx15x
ofxthexpreviousx22xmo.x(SeexChapterx35,xpagex134,xandxe35-1.)
2. Ax4xyrxoldxgirlxisxadmittedxtoxthexhospitalxforxherxthirdxevaluationxforxvaginalxbleeding.xThe
motherxnotedxbrightxredxbloodxonxthexchild'sxunderwear.xPreviousxexaminationsxrevealedxaxnormalx
4xyrxoldxgirl,xTannerxstagex1,xwithxnormalxexternalxgenitalia.xPelvicxultrasoundxresultsxwerexnormal,xa
sxwasxthexserumxestradiolxlevel.xThexhemoglobinxandxplateletxcountsxwerexnormal,xasxwerexthexbleedi
ngxtimexandxcoagulationxstudies.xFindingsxonxpelvicxexaminationxconductedxunderxanesthesiaxalsoxw
erexnormal.xThexnextxstepxinxthexexaminationxisxto:
■ Determinexthexbloodxtypexofxthexbloodxonxthexunderwear
□Interrogatex thex father
□Isolatexthexparentsxandxchild
□Determinex vonx Willebrandx factorx levels
, □Measurex fibronectinx inxthexvagina
descriptionxConsiderationxofxfactitiousxdisorderxbyxproxyxshouldxbextriggeredxwhenxthexreportedxsymptomsxarexrepeat
edlyxnotedxbyxonlyxonexparent,xappropriatextestingxfailsxtoxconfirmxaxdiagnosis,xandxseeminglyxappropriatextreatmentxisxineff
ective.x Atxtimes,xthexchild'sxsymptoms,xtheirxcourse,xorxthexresponsextoxtreatmentxmayxbexincompatiblexwithxanyxrecognizedx
disease.x Preverbalxchildrenxarexusuallyxinvolved.xBleedingxisxaxparticularlyxcommonxpresentation.xThisxmayxbexcausedxbyxa
ddingxdyesx toxsamples,xaddingxbloodx(e.g.,xfromxthexmother)xtoxthexchild'sxsample,xorxgivingxthexchildxanxanticoagulantx(
e.g.,xwarfarin).x(SeexChapterx37,xpagex146.)
3. Munchausenx syndromex byx proxyx isx characterizedx byx allx ofx thex followingx EXCEPT:
□Motherx whoxappearsx devotedx andx winsxoverx membersx ofx carexteam
□Multiplex hospitalizationsx andx investigationsx withoutx diagnosis
□Symptomsxonxhistoryxbutxnotxwitnessedxbyxmedicalxteam
■ Symptomsxoccurringxinxpresencexofxdifferentxcaregiversx(e.g.,xwhilexmotherxisxoutxofxtown)
□Usexofxmedicationsxorxtoxins
descriptionxSymptomsxinxyoungxchildrenxarexmostlyxassociatedxwithxproximityxofxthexoffendingxcaregiverxtoxthexchild.xT
hexmotherxmayxpresentxasxaxdevotedxorxevenxmodelxparentxwhoxformsxclosexrelationshipsxwithxmembersxofxthexhealt
hxcarexteam.xWhilexappearingxveryxinterestedxinxherxchild'sxcondition,xshexmayxbexrelativelyxdistantxemotionally.x(SeexCha
pterx37,xpagex146.)
4. Whichx statementx isx false?
■ MalnutritionxisxthexsecondxleadingxcausexofxacquiredximmunexdeficiencyxworldwidexbehindxHIVxinfection
□Zincxisx importantxinximmunexfunctionx andx linearx growth
□Kwashiorkorxandxmarasmusxarexrarexinxdevelopedxcountries
□ThexWesternxdietxisxassociatedxwithxincreasedxnoncommunicablexdisease
descriptionxThexsignificantxglobalxburdenxofxmalnutritionxandxundernutritionxisxthexleadingxworldwidexcausexofxacquiredxi
mmunodeficiencyxandxthexmajorxunderlyingxfactorxforxmorbidityxandxmortalityxgloballyxforxchildrenx<5xyrxofxage.xZincxisxax
micronutrientxthatxsupportsxmultiplexmetabolicxfunctionsxinxthexbody,xisxessentialxforxnormalximmunexfunctioning,xandxisxre
quiredxtoxsupportxlinearxgrowth;xzincxdeficiencyxisxassociatedxwithximpairedximmunexfunctioningxandxpoorxlinearxgrowth.xIn
xparallelxtoxthexriskxforxnutrientxandxenergyxdeficiencies,xissuesxrelatingxtoxexcessesxposeximportantxchallengesxbecausexofxth
eirxnegativexhealthxeffects,xsuchxasxobesityxorxcardiovascularxdiseasexriskxfactors.xThexnutritionxtransitionxunderxwayxin
xthe
, developingxworldxfromxtraditionalxdietsxtoxthexWesternxdietxhasxbeenxassociatedxwithxincreasesxinxnoncommunicablexdis
eases,xoftenxcoexistingxwithxundernutritionxandxmalnutrition,xobservedxsometimesxinxthexsamexcommunitiesxorxevenxthexsa
mexfamilies.x(Seexe41-1.)
5. Componentsx ofx energyx expenditurex inx childrenx include:
□Thermalxeffectxofxfood
□Basalxmetabolicx rate
□Energyxforxphysicalxactivity
□Energyx tox supportx growth
■ Allxofxthexabove
descriptionxThex3xcomponentsxofxenergyxexpenditurexinxadultsxarexthexbasalxmetabolicxrate,xthexthermalxeffectxofxf
oodx(energyxrequiredxforxdigestionxandxabsorption),xandxenergyxforxphysicalxactivity.xAdditionalxenergyxintakexandxexpen
diturexarexrequiredxtoxsupportxgrowthxandxdevelopmentxforxchildren.x(Seexe41-4.)
6. WhichxofxthexfollowingxclinicalxscenariosxincreasesxthexriskxofxvitaminxAxdeficiency?
□Vegetarianxdiet
□Chronicx intestinalx disorders
□Zincx deficiency
■ BxandxC
□Allxofxthexabove
descriptionxVitaminxAxisxanxessentialxmicronutrientxbecausexitxcannotxbexbiogeneratedxdexnovoxbyxanimals.xItxmust
xbexobtainedxfromxplantsxinxthexformxofxprovitamin-
Axcarotenoids.xInxthexUSA,xgrainsxandxvegetablesxsupplyxapproximatelyx55%xandxdairyxandxmeatxproductsxsupplyxap
proximatelyx30%xofxvitaminxAxintakexfromxfood.xVitaminxAxandxthexprovitamins-
Axarexfatxsoluble,xandxtheirxabsorptionxdependsxonxthexpresencexofxadequatexlipidxandxproteinxwithinxthexmeal.x Chronicxint
estinalxdisordersxorxlipidxmalabsorptionxsyndromesxcanxresultxinxvitaminxAxdeficiency.xInxdevelopingxcountries,xsubclinica
lxorxclinicalxzincxdeficiencyxcanxincreasexthexriskxofxvitaminxAxdeficiency.xTherexisxalsoxsomexevidencexofxmarginalxzincxin
takesxinxchildrenxinxthexUSA.x(SeexChapterx45,xpagex188.)
7. Whichx statementx aboutx vitaminx Ax toxicityx isx NOTx true?
Textbook of Pediatrics 20 Edition x
, Nelsonx Pediatricsx Review(MCQs)x19xEdition
1. Whichx ofx thex followingx statementsx regardingx fosterx carex isx true?
□Axpermanencyxplanxmustxbexmadexforxaxchildxinxfosterxcarexnoxlaterxthanx12xmoxfromxthexchild'sxentryxintoxcare
□Axminorityxofxchildrenxinxfosterxcarexhavexaxhistoryxofxabusexorxneglect
□Thexmissionxofxfosterxcarexisxtoxsafelyxcarexforxchildrenxwhilexprovidingxservicesxtoxfamiliesxtoxpromotexreunification
□Mostx(>70%)xofxchildrenxinxfosterxcarexarexreunitedxwithxtheirxfamilies
■ AxandxC
descriptionxThexmissionxofxfosterxcarexisxtoxprovidexforxthexhealth,xsafety,xandxwell-
beingxofxchildrenxwhilexassistingxtheirxfamiliesxwithxservicesxtoxpromotexreunification.xChildrenxenteringxfosterxcarexhavexf
requentlyxexperiencedxearlyxchildhoodxtrauma.xMorexthanx70%xhavexaxhistoryxofxabuse,xneglect,xorxboth.xOnlyxaboutx50
%xofxchildrenxachievexreunification.xInxthexUSA,xthexAdoptionxandxSafexFamiliesxActx(P.L.x105-
89)xpassedxinx1997xrequiresxthatxaxpermanencyxplanxbexmadexforxeachxchildxnoxlaterxthanx12xmoxafterxentryxtoxfosterxcare
xandxthatxaxpetitionxtoxterminatexparentalxrightsxtypicallyxmustxbexfiledxwhenxaxchildxhasxbeenxinxfosterxcarexforxatxleastx15x
ofxthexpreviousx22xmo.x(SeexChapterx35,xpagex134,xandxe35-1.)
2. Ax4xyrxoldxgirlxisxadmittedxtoxthexhospitalxforxherxthirdxevaluationxforxvaginalxbleeding.xThe
motherxnotedxbrightxredxbloodxonxthexchild'sxunderwear.xPreviousxexaminationsxrevealedxaxnormalx
4xyrxoldxgirl,xTannerxstagex1,xwithxnormalxexternalxgenitalia.xPelvicxultrasoundxresultsxwerexnormal,xa
sxwasxthexserumxestradiolxlevel.xThexhemoglobinxandxplateletxcountsxwerexnormal,xasxwerexthexbleedi
ngxtimexandxcoagulationxstudies.xFindingsxonxpelvicxexaminationxconductedxunderxanesthesiaxalsoxw
erexnormal.xThexnextxstepxinxthexexaminationxisxto:
■ Determinexthexbloodxtypexofxthexbloodxonxthexunderwear
□Interrogatex thex father
□Isolatexthexparentsxandxchild
□Determinex vonx Willebrandx factorx levels
, □Measurex fibronectinx inxthexvagina
descriptionxConsiderationxofxfactitiousxdisorderxbyxproxyxshouldxbextriggeredxwhenxthexreportedxsymptomsxarexrepeat
edlyxnotedxbyxonlyxonexparent,xappropriatextestingxfailsxtoxconfirmxaxdiagnosis,xandxseeminglyxappropriatextreatmentxisxineff
ective.x Atxtimes,xthexchild'sxsymptoms,xtheirxcourse,xorxthexresponsextoxtreatmentxmayxbexincompatiblexwithxanyxrecognizedx
disease.x Preverbalxchildrenxarexusuallyxinvolved.xBleedingxisxaxparticularlyxcommonxpresentation.xThisxmayxbexcausedxbyxa
ddingxdyesx toxsamples,xaddingxbloodx(e.g.,xfromxthexmother)xtoxthexchild'sxsample,xorxgivingxthexchildxanxanticoagulantx(
e.g.,xwarfarin).x(SeexChapterx37,xpagex146.)
3. Munchausenx syndromex byx proxyx isx characterizedx byx allx ofx thex followingx EXCEPT:
□Motherx whoxappearsx devotedx andx winsxoverx membersx ofx carexteam
□Multiplex hospitalizationsx andx investigationsx withoutx diagnosis
□Symptomsxonxhistoryxbutxnotxwitnessedxbyxmedicalxteam
■ Symptomsxoccurringxinxpresencexofxdifferentxcaregiversx(e.g.,xwhilexmotherxisxoutxofxtown)
□Usexofxmedicationsxorxtoxins
descriptionxSymptomsxinxyoungxchildrenxarexmostlyxassociatedxwithxproximityxofxthexoffendingxcaregiverxtoxthexchild.xT
hexmotherxmayxpresentxasxaxdevotedxorxevenxmodelxparentxwhoxformsxclosexrelationshipsxwithxmembersxofxthexhealt
hxcarexteam.xWhilexappearingxveryxinterestedxinxherxchild'sxcondition,xshexmayxbexrelativelyxdistantxemotionally.x(SeexCha
pterx37,xpagex146.)
4. Whichx statementx isx false?
■ MalnutritionxisxthexsecondxleadingxcausexofxacquiredximmunexdeficiencyxworldwidexbehindxHIVxinfection
□Zincxisx importantxinximmunexfunctionx andx linearx growth
□Kwashiorkorxandxmarasmusxarexrarexinxdevelopedxcountries
□ThexWesternxdietxisxassociatedxwithxincreasedxnoncommunicablexdisease
descriptionxThexsignificantxglobalxburdenxofxmalnutritionxandxundernutritionxisxthexleadingxworldwidexcausexofxacquiredxi
mmunodeficiencyxandxthexmajorxunderlyingxfactorxforxmorbidityxandxmortalityxgloballyxforxchildrenx<5xyrxofxage.xZincxisxax
micronutrientxthatxsupportsxmultiplexmetabolicxfunctionsxinxthexbody,xisxessentialxforxnormalximmunexfunctioning,xandxisxre
quiredxtoxsupportxlinearxgrowth;xzincxdeficiencyxisxassociatedxwithximpairedximmunexfunctioningxandxpoorxlinearxgrowth.xIn
xparallelxtoxthexriskxforxnutrientxandxenergyxdeficiencies,xissuesxrelatingxtoxexcessesxposeximportantxchallengesxbecausexofxth
eirxnegativexhealthxeffects,xsuchxasxobesityxorxcardiovascularxdiseasexriskxfactors.xThexnutritionxtransitionxunderxwayxin
xthe
, developingxworldxfromxtraditionalxdietsxtoxthexWesternxdietxhasxbeenxassociatedxwithxincreasesxinxnoncommunicablexdis
eases,xoftenxcoexistingxwithxundernutritionxandxmalnutrition,xobservedxsometimesxinxthexsamexcommunitiesxorxevenxthexsa
mexfamilies.x(Seexe41-1.)
5. Componentsx ofx energyx expenditurex inx childrenx include:
□Thermalxeffectxofxfood
□Basalxmetabolicx rate
□Energyxforxphysicalxactivity
□Energyx tox supportx growth
■ Allxofxthexabove
descriptionxThex3xcomponentsxofxenergyxexpenditurexinxadultsxarexthexbasalxmetabolicxrate,xthexthermalxeffectxofxf
oodx(energyxrequiredxforxdigestionxandxabsorption),xandxenergyxforxphysicalxactivity.xAdditionalxenergyxintakexandxexpen
diturexarexrequiredxtoxsupportxgrowthxandxdevelopmentxforxchildren.x(Seexe41-4.)
6. WhichxofxthexfollowingxclinicalxscenariosxincreasesxthexriskxofxvitaminxAxdeficiency?
□Vegetarianxdiet
□Chronicx intestinalx disorders
□Zincx deficiency
■ BxandxC
□Allxofxthexabove
descriptionxVitaminxAxisxanxessentialxmicronutrientxbecausexitxcannotxbexbiogeneratedxdexnovoxbyxanimals.xItxmust
xbexobtainedxfromxplantsxinxthexformxofxprovitamin-
Axcarotenoids.xInxthexUSA,xgrainsxandxvegetablesxsupplyxapproximatelyx55%xandxdairyxandxmeatxproductsxsupplyxap
proximatelyx30%xofxvitaminxAxintakexfromxfood.xVitaminxAxandxthexprovitamins-
Axarexfatxsoluble,xandxtheirxabsorptionxdependsxonxthexpresencexofxadequatexlipidxandxproteinxwithinxthexmeal.x Chronicxint
estinalxdisordersxorxlipidxmalabsorptionxsyndromesxcanxresultxinxvitaminxAxdeficiency.xInxdevelopingxcountries,xsubclinica
lxorxclinicalxzincxdeficiencyxcanxincreasexthexriskxofxvitaminxAxdeficiency.xTherexisxalsoxsomexevidencexofxmarginalxzincxin
takesxinxchildrenxinxthexUSA.x(SeexChapterx45,xpagex188.)
7. Whichx statementx aboutx vitaminx Ax toxicityx isx NOTx true?
