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