Test bank for MCQs in Pediatrics Review of Nelson
bb bb bb bb bb bb bb bb
bb Textbook of Pediatrics 20 Edition
bb bb bb bb bb
, Nelson Pediatrics Review(MCQs) 19 Edition bb bb bb bb
1. Which of the following statements regarding foster care is true?
bb bb bb bb bb bb bb bb bb
□A permanency plan must
bb bb bb bb be made for a child in foster care no later than 12 mo from the child's entry into care
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
□A minority of children in foster care have a history of abuse or neglect
bb bb bb bb bb bb bb bb bb bb bb bb bb
□The mission of foster care is to safely care for children while providing services to families to promote reunification
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
□Most (>70%) of children in foster care are reunited with their families
bb bb bb bb bb bb bb bb bb bb bb
■ A and C bb bb
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
their families with services to promote reunification. Children entering foster care have frequently experienced early
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
terminate parental rights typically must be filed when a child has been in foster care for at least 15 of the previous
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
22 mo. (See Chapter 35, page 134, and e35-1.)
bb bb bb bb bb bb bb bb bb
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
mother noted bright red blood on the child's underwear. Previous examinations revealed
bb bb bb bb bb bb bb bb bb bb bb
a normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
results were normal, as was the serum estradiol level. The hemoglobin and platelet
bb bb bb bb bb bb bb bb bb bb bb bb bb
counts were normal, as were the bleeding time and coagulation studies. Findings on
bb bb bb bb bb bb bb bb bb bb bb bb bb
pelvic examination conducted under anesthesia also were normal. The next step in the
bb bb bb bb bb bb bb bb bb bb bb bb bb
examination is to:
bb bb bb
■ Determine the blood type of the blood on the underwear
bb bb bb bb bb bb bb bb bb
□Interrogate bb the father bb
□Isolate the parents and child bb bb bb bb
□Determine bb von Willebrand factor levels
bb bb bb
, □Measure bb fibronectin in the vagina bb bb bb
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
treatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
bb bb bb b b bb bb bb bb bb bb bb bb bb bb bb bb bb
incompatible with any recognized disease. Preverbal children are usually involved. Bleeding is a particularly
bb bb bb bb bb b b bb bb bb bb bb bb bb bb
common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
bb bb bb bb bb bb bb bb bb b b bb bb bb bb bb bb bb bb bb
child's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
bb bb bb bb bb bb bb bb bb bb bb
□Mother bb who appears devoted and wins over members of care team
bb bb bb bb bb bb bb bb bb
□Multiple bb hospitalizations and investigations without diagnosis bb bb bb bb
□Symptoms on history but not witnessed by medical team
bb bb bb bb bb bb bb bb
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
bb bb bb bb bb bb bb bb bb bb bb bb bb
□Use of medications or toxins
bb bb bb bb
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
child. The mother may present as a devoted or even model parent who forms close relationships with members
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
of the health care team. While appearing very interested in her child's condition, she may be relatively distant
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
emotionally. (See Chapter 37, page 146.)
bb bb bb bb bb bb
4. Which statement is false? bb bb bb
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
bb bb bb bb bb bb bb bb bb bb bb bb bb
□Zinc bb is important in immune function and linear growth
bb bb bb bb bb bb bb
□Kwashiorkor and bb bb marasmus are rare in developed countries bb bb bb bb bb
□The Western diet is associated with increased noncommunicable disease
bb bb bb bb bb bb bb bb
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
acquired immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
age. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
functioning, and is required to support linear growth; zinc deficiency is associated with impaired immune functioning
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
important challenges because of their negative health effects, such as obesity or cardiovascular disease risk factors.
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
The nutrition transition under way in the
bb bb bb bb bb bb bb
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
the same families. (See e41-1.)
bb bb bb bb bb
5. Components of energy expenditure in children include: bb bb bb bb bb bb
□Thermal bb effect of food bb bb
□Basal bb metabolic rate bb
□Energy for bb bb physical activity bb
□Energy bb to support growth
bb bb
■ All of the above
bb bb bb
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
expenditure are required to support growth and development for children. (See e41-4.)
bb bb bb bb bb bb bb bb bb bb bb bb
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
bb bb bb bb bb bb bb bb bb bb bb bb
□Vegetarian diet bb
□Chronic bb intestinal disorders bb
□Zinc bb deficiency
■ B and C
bb bb
□All of the above
bb bb bb
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
supply approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
food. Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
lipid and protein within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in
bb bb bb bb bb bb b b bb bb bb bb bb bb bb bb bb
vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See Chapter 45,
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
page 188.)
bb bb
7. Which statement about vitamin A toxicity is NOT true?
bb bb bb bb bb bb bb bb
bb bb bb bb bb bb bb bb
bb Textbook of Pediatrics 20 Edition
bb bb bb bb bb
, Nelson Pediatrics Review(MCQs) 19 Edition bb bb bb bb
1. Which of the following statements regarding foster care is true?
bb bb bb bb bb bb bb bb bb
□A permanency plan must
bb bb bb bb be made for a child in foster care no later than 12 mo from the child's entry into care
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
□A minority of children in foster care have a history of abuse or neglect
bb bb bb bb bb bb bb bb bb bb bb bb bb
□The mission of foster care is to safely care for children while providing services to families to promote reunification
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
□Most (>70%) of children in foster care are reunited with their families
bb bb bb bb bb bb bb bb bb bb bb
■ A and C bb bb
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
their families with services to promote reunification. Children entering foster care have frequently experienced early
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
terminate parental rights typically must be filed when a child has been in foster care for at least 15 of the previous
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
22 mo. (See Chapter 35, page 134, and e35-1.)
bb bb bb bb bb bb bb bb bb
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
mother noted bright red blood on the child's underwear. Previous examinations revealed
bb bb bb bb bb bb bb bb bb bb bb
a normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
results were normal, as was the serum estradiol level. The hemoglobin and platelet
bb bb bb bb bb bb bb bb bb bb bb bb bb
counts were normal, as were the bleeding time and coagulation studies. Findings on
bb bb bb bb bb bb bb bb bb bb bb bb bb
pelvic examination conducted under anesthesia also were normal. The next step in the
bb bb bb bb bb bb bb bb bb bb bb bb bb
examination is to:
bb bb bb
■ Determine the blood type of the blood on the underwear
bb bb bb bb bb bb bb bb bb
□Interrogate bb the father bb
□Isolate the parents and child bb bb bb bb
□Determine bb von Willebrand factor levels
bb bb bb
, □Measure bb fibronectin in the vagina bb bb bb
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
treatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
bb bb bb b b bb bb bb bb bb bb bb bb bb bb bb bb bb
incompatible with any recognized disease. Preverbal children are usually involved. Bleeding is a particularly
bb bb bb bb bb b b bb bb bb bb bb bb bb bb
common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
bb bb bb bb bb bb bb bb bb b b bb bb bb bb bb bb bb bb bb
child's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
bb bb bb bb bb bb bb bb bb bb bb
□Mother bb who appears devoted and wins over members of care team
bb bb bb bb bb bb bb bb bb
□Multiple bb hospitalizations and investigations without diagnosis bb bb bb bb
□Symptoms on history but not witnessed by medical team
bb bb bb bb bb bb bb bb
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
bb bb bb bb bb bb bb bb bb bb bb bb bb
□Use of medications or toxins
bb bb bb bb
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
child. The mother may present as a devoted or even model parent who forms close relationships with members
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
of the health care team. While appearing very interested in her child's condition, she may be relatively distant
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
emotionally. (See Chapter 37, page 146.)
bb bb bb bb bb bb
4. Which statement is false? bb bb bb
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
bb bb bb bb bb bb bb bb bb bb bb bb bb
□Zinc bb is important in immune function and linear growth
bb bb bb bb bb bb bb
□Kwashiorkor and bb bb marasmus are rare in developed countries bb bb bb bb bb
□The Western diet is associated with increased noncommunicable disease
bb bb bb bb bb bb bb bb
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
acquired immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
age. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
functioning, and is required to support linear growth; zinc deficiency is associated with impaired immune functioning
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
important challenges because of their negative health effects, such as obesity or cardiovascular disease risk factors.
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
The nutrition transition under way in the
bb bb bb bb bb bb bb
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
the same families. (See e41-1.)
bb bb bb bb bb
5. Components of energy expenditure in children include: bb bb bb bb bb bb
□Thermal bb effect of food bb bb
□Basal bb metabolic rate bb
□Energy for bb bb physical activity bb
□Energy bb to support growth
bb bb
■ All of the above
bb bb bb
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
expenditure are required to support growth and development for children. (See e41-4.)
bb bb bb bb bb bb bb bb bb bb bb bb
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
bb bb bb bb bb bb bb bb bb bb bb bb
□Vegetarian diet bb
□Chronic bb intestinal disorders bb
□Zinc bb deficiency
■ B and C
bb bb
□All of the above
bb bb bb
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
supply approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
food. Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
lipid and protein within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in
bb bb bb bb bb bb b b bb bb bb bb bb bb bb bb bb
vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See Chapter 45,
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
page 188.)
bb bb
7. Which statement about vitamin A toxicity is NOT true?
bb bb bb bb bb bb bb bb
