, Nelson j Pediatrics j Review(MCQs) j19 jEdition j2024/2025
1. Which jof jthe jfollowing jstatements j regarding jfoster jcare jis jtrue?
□A j permanency j plan j must j be j made j for ja j child jin j foster jcare j no jlater j than j 12 j mo j from jthe j child's j entry j into jcare
□A jminority jof jchildren jin jfoster jcare jhave ja jhistory jof jabuse jor jneglect
□The jmission jof jfoster jcare jis jto jsafely jcare jfor jchildren jwhile jproviding jservices jto jfamilies jto jpromote jreunification
□Most j(>70%) jof jchildren jin jfoster jcare jare jreunited jwith jtheir jfamilies
■ A j and j C
description j The j mission j of j foster j care j is j to j provide j for j the j health, j safety, j and j well-being j of j children j while
j assistingjtheir jfamilies j with jservices j to j promote j reunification. j Children jentering j foster jcare j have jfrequently
jexperienced jearly jchildhood jtrauma. j More j than j 70% j have j a j history j of j abuse, j neglect, j or j both. j Only j about
j 50% j of j children j achieve jreunification. jIn jthe jUSA, jthe jAdoption jand jSafe jFamilies jAct j(P.L. j105-89)
jpassed jin j1997 jrequires jthat ja jpermanency jplan jbe jmade jfor jeach j child j no j later j than j12 jmo jafter jentry jto
jfoster jcare j and jthat j a j petition jto jterminate jparental jrights jtypically jmust j be j filedwhen ja jchild jhas jbeen jin
jfoster j care jfor jat jleast j 15 jof jthe jpreviousj22 j mo. j (See j Chapter j 35, j page j 134, j and j e35-1.)
2. A j 4 j yr j old j girl j is j admitted j to jthe j hospital j for j her j third j evaluation j for j vaginal j bleeding.
j The
mother j noted j bright j red j blood j on j the j child's j underwear. j Previous j examinations
j revealed j ajnormal j 4 jyr j old jgirl, jTanner jstage j1, jwith jnormal jexternal jgenitalia. jPelvic
jultrasound jresultswere j normal, j as j was j the j serum j estradiol j level. j The j hemoglobin
j and j platelet j counts jwere jnormal, j as jwere jthe jbleeding jtime jand jcoagulation jstudies.
jFindings jon jpelvic jexamination jconducted j under j anesthesia j jalso j were jnormal. j jThe j
jnext jstep jin jthe j examination j is j to:
■ Determine jthe j blood j type jof j the j blood jon jthe j underwear
□Interrogate jthe jfather
□Isolate j the j parents j and jchild
□Determine j von j Willebrand j factor jlevels
, □Measure j fibronectin j in jthe jvagina
description jConsideration jof jfactitious jdisorder jby jproxy jshould jbe jtriggered jwhen jthe jreported jsymptoms jare
jrepeatedly j noted j by j only j one j parent, j appropriate j testing j fails j to j confirm j a j diagnosis, j and j seemingly
j appropriate jtreatment j is j ineffective. jAt j times, j the j child's j symptoms, j their j course, j or j the j response jto
j treatment j may j be jincompatible j with j any j recognized jdisease.Preverbal j children j are j usually j involved. j Bleeding
j is j a j particularly j common j presentation. jThis jmay jbe jcaused jby jadding jdyes jto jsamples, jadding jblood j(e.g.,
jfrom jthe jmother) jto jthe jchild's jsample, j or j giving j the j child j an j anticoagulant j (e.g., j warfarin). j(See j Chapter
j 37, jpage j 146.)
3. Munchausen j syndrome j by j proxy j is j characterized jby j all j of j the j following j EXCEPT:
□Mother jwho jappears jdevoted jand jwins jover jmembers jof jcare jteam
□Multiple j hospitalizations j and j investigations j without j diagnosis
□Symptoms jon jhistory jbut jnot jwitnessed jby jmedical jteam
■ Symptoms j occurring j in j presence j of j different j caregivers j (e.g., j while j mother j is j out j of j town)
□Use j of j medications j or j toxins
description j Symptoms j in j young j children j are j mostly j associated j with j proximity j of j the j offending j caregiver j to
j the j child. jThe jmother jmay jpresent jas ja jdevoted jor jeven jmodel jparent jwho jforms jclose jrelationships jwith
jmembers jof jthe jhealth j care jteam. j While jappearing j very jinterested jin j her jchild's jcondition, jshe j may jbe
j relatively j distant jemotionally. j(See j Chapter j 37, j page j 146.)
4. Which jstatement jis jfalse?
■ Malnutrition jis j the j second jleading jcause j of jacquired j immune j deficiency j worldwide j behind j HIV jinfection
□Zinc j is j important j in j immune j function j and j linear j growth
□Kwashiorkor jand j marasmus jare j rare jin j developed jcountries
□The j Western j diet j is j associated j with j increased j noncommunicable j disease
description j The j significant j global j burden j of j malnutrition j and j undernutrition j is j the j leading j worldwide j cause j of
j acquiredjimmunodeficiency jand jthe jmajor junderlying jfactor jfor jmorbidity jand jmortality jglobally jfor jchildren j<5 jyr
jof jage. jZinc jis ja jmicronutrient jthat jsupports jmultiple jmetabolic jfunctions jin jthe jbody, jis jessential jfor jnormal
jimmune jfunctioning, jand jis jrequired jto j support j linear j growth; j zinc j deficiency j is j associated j with j impaired
j immune j functioning j and j poor jlinear jgrowth. jIn jparallel jto jthe jrisk jfor jnutrient jand jenergy jdeficiencies, jissues
jrelating jto jexcesses jpose jimportant jchallenges jbecause jof jtheirjnegative jhealth jeffects, jsuch jas jobesity jor
, jcardiovascular jdisease jrisk jfactors. jThe jnutrition jtransition junder jway jin jthe
1. Which jof jthe jfollowing jstatements j regarding jfoster jcare jis jtrue?
□A j permanency j plan j must j be j made j for ja j child jin j foster jcare j no jlater j than j 12 j mo j from jthe j child's j entry j into jcare
□A jminority jof jchildren jin jfoster jcare jhave ja jhistory jof jabuse jor jneglect
□The jmission jof jfoster jcare jis jto jsafely jcare jfor jchildren jwhile jproviding jservices jto jfamilies jto jpromote jreunification
□Most j(>70%) jof jchildren jin jfoster jcare jare jreunited jwith jtheir jfamilies
■ A j and j C
description j The j mission j of j foster j care j is j to j provide j for j the j health, j safety, j and j well-being j of j children j while
j assistingjtheir jfamilies j with jservices j to j promote j reunification. j Children jentering j foster jcare j have jfrequently
jexperienced jearly jchildhood jtrauma. j More j than j 70% j have j a j history j of j abuse, j neglect, j or j both. j Only j about
j 50% j of j children j achieve jreunification. jIn jthe jUSA, jthe jAdoption jand jSafe jFamilies jAct j(P.L. j105-89)
jpassed jin j1997 jrequires jthat ja jpermanency jplan jbe jmade jfor jeach j child j no j later j than j12 jmo jafter jentry jto
jfoster jcare j and jthat j a j petition jto jterminate jparental jrights jtypically jmust j be j filedwhen ja jchild jhas jbeen jin
jfoster j care jfor jat jleast j 15 jof jthe jpreviousj22 j mo. j (See j Chapter j 35, j page j 134, j and j e35-1.)
2. A j 4 j yr j old j girl j is j admitted j to jthe j hospital j for j her j third j evaluation j for j vaginal j bleeding.
j The
mother j noted j bright j red j blood j on j the j child's j underwear. j Previous j examinations
j revealed j ajnormal j 4 jyr j old jgirl, jTanner jstage j1, jwith jnormal jexternal jgenitalia. jPelvic
jultrasound jresultswere j normal, j as j was j the j serum j estradiol j level. j The j hemoglobin
j and j platelet j counts jwere jnormal, j as jwere jthe jbleeding jtime jand jcoagulation jstudies.
jFindings jon jpelvic jexamination jconducted j under j anesthesia j jalso j were jnormal. j jThe j
jnext jstep jin jthe j examination j is j to:
■ Determine jthe j blood j type jof j the j blood jon jthe j underwear
□Interrogate jthe jfather
□Isolate j the j parents j and jchild
□Determine j von j Willebrand j factor jlevels
, □Measure j fibronectin j in jthe jvagina
description jConsideration jof jfactitious jdisorder jby jproxy jshould jbe jtriggered jwhen jthe jreported jsymptoms jare
jrepeatedly j noted j by j only j one j parent, j appropriate j testing j fails j to j confirm j a j diagnosis, j and j seemingly
j appropriate jtreatment j is j ineffective. jAt j times, j the j child's j symptoms, j their j course, j or j the j response jto
j treatment j may j be jincompatible j with j any j recognized jdisease.Preverbal j children j are j usually j involved. j Bleeding
j is j a j particularly j common j presentation. jThis jmay jbe jcaused jby jadding jdyes jto jsamples, jadding jblood j(e.g.,
jfrom jthe jmother) jto jthe jchild's jsample, j or j giving j the j child j an j anticoagulant j (e.g., j warfarin). j(See j Chapter
j 37, jpage j 146.)
3. Munchausen j syndrome j by j proxy j is j characterized jby j all j of j the j following j EXCEPT:
□Mother jwho jappears jdevoted jand jwins jover jmembers jof jcare jteam
□Multiple j hospitalizations j and j investigations j without j diagnosis
□Symptoms jon jhistory jbut jnot jwitnessed jby jmedical jteam
■ Symptoms j occurring j in j presence j of j different j caregivers j (e.g., j while j mother j is j out j of j town)
□Use j of j medications j or j toxins
description j Symptoms j in j young j children j are j mostly j associated j with j proximity j of j the j offending j caregiver j to
j the j child. jThe jmother jmay jpresent jas ja jdevoted jor jeven jmodel jparent jwho jforms jclose jrelationships jwith
jmembers jof jthe jhealth j care jteam. j While jappearing j very jinterested jin j her jchild's jcondition, jshe j may jbe
j relatively j distant jemotionally. j(See j Chapter j 37, j page j 146.)
4. Which jstatement jis jfalse?
■ Malnutrition jis j the j second jleading jcause j of jacquired j immune j deficiency j worldwide j behind j HIV jinfection
□Zinc j is j important j in j immune j function j and j linear j growth
□Kwashiorkor jand j marasmus jare j rare jin j developed jcountries
□The j Western j diet j is j associated j with j increased j noncommunicable j disease
description j The j significant j global j burden j of j malnutrition j and j undernutrition j is j the j leading j worldwide j cause j of
j acquiredjimmunodeficiency jand jthe jmajor junderlying jfactor jfor jmorbidity jand jmortality jglobally jfor jchildren j<5 jyr
jof jage. jZinc jis ja jmicronutrient jthat jsupports jmultiple jmetabolic jfunctions jin jthe jbody, jis jessential jfor jnormal
jimmune jfunctioning, jand jis jrequired jto j support j linear j growth; j zinc j deficiency j is j associated j with j impaired
j immune j functioning j and j poor jlinear jgrowth. jIn jparallel jto jthe jrisk jfor jnutrient jand jenergy jdeficiencies, jissues
jrelating jto jexcesses jpose jimportant jchallenges jbecause jof jtheirjnegative jhealth jeffects, jsuch jas jobesity jor
, jcardiovascular jdisease jrisk jfactors. jThe jnutrition jtransition junder jway jin jthe
