TEST BANK FOR NELSON PEDIATRICS REVIEW(MCQS) 19 EDITION

, Nelson Pediatrics Review(MCQs) 19 Editionmm mm mm mm




1. Which of the following statements regarding foster care is true?
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□A permanency
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□A minority of children in foster care have a history of abuse or neglect
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□The mission of foster care is to safely care for children while providing services to families to promote reunification
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□Most (>70%) of children in foster care are reunited with their families
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■ A and C
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description The mission of foster care is to provide for the health, safety, and well-being of children while
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assisting their families with services to promote reunification. Children entering foster care have frequently
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experienced early childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of
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children achieve reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997
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requires that a permanency plan be made for each child no later than 12 mo after entry to foster care and that a
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petition to terminate parental rights typically must be filed when a child has been in foster care for at least 15 of
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the previous 22 mo. (See Chapter 35, page 134, and e35-1.)
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2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
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mother noted bright red blood on the child's underwear. Previous examinations
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revealed a normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic
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ultrasound results were normal, as was the serum estradiol level. The hemoglobin and
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platelet counts were normal, as were the bleeding time and coagulation studies.
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Findings on pelvic examination conducted under anesthesia also were normal. The next
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step in the examination is to:
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■ Determine the blood type of the blood on the underwear
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□Interrogate mm the father mm




□Isolate the parents and child
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□Determine m m von Willebrand factor levels
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, □Measure mm fibronectin in the vagina mm mm mm




description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
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repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
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treatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
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incompatible with any recognized disease.
mm mm Preverbal children are usually involved. Bleeding is a particularly
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common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
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child's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
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3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
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□Mother mm who appears devoted and wins over members of care team
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□Multiple mm hospitalizations and investigations without diagnosis mm mm mm mm




□Symptoms on history but not witnessed by medical team
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■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
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□Use of medications or toxins
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description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
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child. The mother may present as a devoted or even model parent who forms close relationships with members
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of the health care team. While appearing very interested in her child's condition, she may be relatively distant
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emotionally. (See Chapter 37, page 146.)
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4. Which statement is false?
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■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
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□Zinc mm is important in immune function and linear growth
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□Kwashiorkor mm and marasmus are rare in developed countries
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□The mm Western diet is associated with increased noncommunicable disease
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description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
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acquired immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr
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of age. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal
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immune functioning, and is required to support linear growth; zinc deficiency is associated with impaired immune
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functioning and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to
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excesses pose important challenges because of their negative health effects, such as obesity or cardiovascular
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disease risk factors. The nutrition transition under way in the
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, developing world from traditional diets to the Western diet has been associated with increases in
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noncommunicable diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same
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communities or even the same families. (See e41-1.)
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5. Components of energy expenditure in children include:
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□Thermal mm effect of food mm mm




□Basal mm metabolic rate mm




□Energy mm for physical activity
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□Energy mm to support growth
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■ All of the above
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description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect
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of food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake
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and expenditure are required to support growth and development for children. (See e41-4.)
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6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
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□Vegetarian diet mm




□Chronic mm intestinal disorders mm




□Zinc mm deficiency


■ B and C
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□All mm of the above
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description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
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must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
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supply approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
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food. Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
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lipid and protein within the meal.
mm mm mm Chronic intestinal disorders or lipid malabsorption syndromes can result in
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vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of
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vitamin A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See
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Chapter 45, page 188.)
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7. Which statement about vitamin A toxicity is NOT true?
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