Test bank for MCQs in Pediatrics Review of Nelson Textbook of
Pediatrics 20 Edition
,1. Which of the following statements regarding foster care is true?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
□A minority of children in foster care have a history of abuse or neglect
□The mission of foster care is to safely care for children while providing services to families to promote reunification
□Most (>70%) of children in foster care are reunited with their families
■ A and C
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting their
families with services to promote reunification. Children entering foster care have frequently experienced early childhood
trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve reunification. In
the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a permanency plan be
made for each child no later than 12 mo after entry to foster care and that a petition to terminate parental rights
typically must be filed when a child has been in foster care for at least 15 of the previous 22 mo. (See Chapter 35,
page 134, and e35-1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
mother noted bright red blood on the child's underwear. Previous examinations revealed a normal 4
yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results were normal, as
was the serum estradiol level. The hemoglobin and platelet counts were normal, as were the
bleeding time and coagulation studies. Findings on pelvic examination conducted under anesthesia
also were normal. The next step in the examination is to:
■ Determine the blood type of the blood on the underwear
□Interrogate the father
□Isolate the parents and child
□Determine von Willebrand factor levels
, □Measure fibronectin in thevagina yr yr yr yr
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are repeat
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
edly notedbyonlyoneparent,appropriatetestingfailstoconfirmadiagnosis,andseeminglyappropriatetreatmentisineffe
r y yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr
ctive.
Attimes,thechild'ssymptoms,theircourse,ortheresponsetotreatmentmaybeincompatiblewithanyrecognizeddisease. Pr
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y
everbalchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes
yr yr yr to yr yr yr yr yr yr yr yr yr yr yr yr yr yr ryr y r
samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an anticoagulant (e.g., warfarin).
y ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r
y (See Chapter 37, page 146.)
ry ry ry ry
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT: ry ry ry ry ry ry ry ry ry ry ry
□Mother who appears devoted and wins over members of care team
ry yr ry ry ry ry ry ry yr yr
□Multiple hospitalizations and investigations without diagnosis
ry ry ry ry ry
□Symptomsonhistorybutnotwitnessedbymedicalteam yr yr yr yr yr yr yr yr
■ Symptoms occurringin presence of different caregivers (e.g., while motheris out of town)
yr yr yr yr yr yr yr yr yr yr yr yr ry
□Use of medications or toxins
ry ry ry ry
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child. The
ry ry yr ry yr ry yr yr ry ry yr ry ry yr yr ry ry r y
mother may present as a devoted or even model parent who forms close relationships with members of the health ca
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
re team. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Chap
r y ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
ter 37, page 146.)
ry ryry ry
4. Which statement is false? ry ry ry
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
ry ry ry ry ry ry ry ry ry ry ry ry ry
□Zinc is important in immune function and linear growth
yr ry ry yr yr yr yr yr
□Kwashiorkor and marasmus are rare in developed countries ry ry ry ry ry ry ry
□The Western diet is associated with increased noncommunicable disease
ry ry ry ry ry ry ry ry
descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquired im
ry yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y
munodeficiencyandthemajorunderlyingfactorformorbidity andmortalitygloballyforchildren<5yr ofage. Zincis a mic
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y
ronutrientthatsupportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis requiredto
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y yr yr
supportlineargrowth;zincdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.In paralleltot
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y yr yr
heriskfornutrientandenergydeficiencies,issuesrelatingtoexcessesposeimportantchallengesbecauseoftheir negative
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y ry
health effects, such as obesity or cardiovascular disease risk factors. The nutrition transition under way in the
yr ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r y
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the s
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r y
ame families. (See e41-1.)
ry ry ry
5. Components of energy expenditure in children include: ry ry ry ry ry ry
□Thermaleffectoffood yr yr yr
□Basal metabolic rate ry ry
□Energy for physical activity ry ry ry
□Energy to support growth yr yr yr
■ All of the above
ry ry ry
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of fo
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
od (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and exp
r y ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
enditure are required to support growth and development for children. (See e41-4.)
r y ry ry ry ry ry ry ry ry ry ry
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
ry ry ry ry ry ry ry ry ry ry ry ry
□Vegetarian diet ry
□Chronic intestinal disorders ry ry
□Zinc deficiency ry
■ B and C
ry ry
□All of the above
yr yr yr
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must be
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
r obtained from plants in the form of provitamin-
y ry ry ry ry ry ry ry
A carotenoids. In the USA, grains and vegetables supply approximately 55% and dairy and meat products supply a
ry ry ry ry ry ry ry ry ry r y ry ry yr ry ry ry ry
pproximately 30% of vitamin A intake from food. Vitamin A and the provitamins-
ry ry ry ry ry ry ry ry ry ry ry r y
Aarefatsoluble,andtheirabsorptiondependsonthepresenceofadequate lipidand proteinwithinthemeal.
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr
Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In developing countries, s
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r y
ubclinicalorclinical zincdeficiency can increasetheriskofvitaminA deficiency.Thereis alsosomeevidenceofmarginal zinc
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y r
intakes in children in the USA. (See Chapter 45, page 188.)
y ry ry ry ry ry ry ry ry ry ry
7. Which statement about vitamin A toxicity is NOT true?
ry ry ry ry ry ry ry ry
Pediatrics 20 Edition
,1. Which of the following statements regarding foster care is true?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
□A minority of children in foster care have a history of abuse or neglect
□The mission of foster care is to safely care for children while providing services to families to promote reunification
□Most (>70%) of children in foster care are reunited with their families
■ A and C
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting their
families with services to promote reunification. Children entering foster care have frequently experienced early childhood
trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve reunification. In
the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a permanency plan be
made for each child no later than 12 mo after entry to foster care and that a petition to terminate parental rights
typically must be filed when a child has been in foster care for at least 15 of the previous 22 mo. (See Chapter 35,
page 134, and e35-1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
mother noted bright red blood on the child's underwear. Previous examinations revealed a normal 4
yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results were normal, as
was the serum estradiol level. The hemoglobin and platelet counts were normal, as were the
bleeding time and coagulation studies. Findings on pelvic examination conducted under anesthesia
also were normal. The next step in the examination is to:
■ Determine the blood type of the blood on the underwear
□Interrogate the father
□Isolate the parents and child
□Determine von Willebrand factor levels
, □Measure fibronectin in thevagina yr yr yr yr
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are repeat
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
edly notedbyonlyoneparent,appropriatetestingfailstoconfirmadiagnosis,andseeminglyappropriatetreatmentisineffe
r y yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr
ctive.
Attimes,thechild'ssymptoms,theircourse,ortheresponsetotreatmentmaybeincompatiblewithanyrecognizeddisease. Pr
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y
everbalchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes
yr yr yr to yr yr yr yr yr yr yr yr yr yr yr yr yr yr ryr y r
samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an anticoagulant (e.g., warfarin).
y ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r
y (See Chapter 37, page 146.)
ry ry ry ry
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT: ry ry ry ry ry ry ry ry ry ry ry
□Mother who appears devoted and wins over members of care team
ry yr ry ry ry ry ry ry yr yr
□Multiple hospitalizations and investigations without diagnosis
ry ry ry ry ry
□Symptomsonhistorybutnotwitnessedbymedicalteam yr yr yr yr yr yr yr yr
■ Symptoms occurringin presence of different caregivers (e.g., while motheris out of town)
yr yr yr yr yr yr yr yr yr yr yr yr ry
□Use of medications or toxins
ry ry ry ry
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child. The
ry ry yr ry yr ry yr yr ry ry yr ry ry yr yr ry ry r y
mother may present as a devoted or even model parent who forms close relationships with members of the health ca
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
re team. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Chap
r y ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
ter 37, page 146.)
ry ryry ry
4. Which statement is false? ry ry ry
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
ry ry ry ry ry ry ry ry ry ry ry ry ry
□Zinc is important in immune function and linear growth
yr ry ry yr yr yr yr yr
□Kwashiorkor and marasmus are rare in developed countries ry ry ry ry ry ry ry
□The Western diet is associated with increased noncommunicable disease
ry ry ry ry ry ry ry ry
descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquired im
ry yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y
munodeficiencyandthemajorunderlyingfactorformorbidity andmortalitygloballyforchildren<5yr ofage. Zincis a mic
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y
ronutrientthatsupportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis requiredto
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y yr yr
supportlineargrowth;zincdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.In paralleltot
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y yr yr
heriskfornutrientandenergydeficiencies,issuesrelatingtoexcessesposeimportantchallengesbecauseoftheir negative
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y ry
health effects, such as obesity or cardiovascular disease risk factors. The nutrition transition under way in the
yr ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r y
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the s
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r y
ame families. (See e41-1.)
ry ry ry
5. Components of energy expenditure in children include: ry ry ry ry ry ry
□Thermaleffectoffood yr yr yr
□Basal metabolic rate ry ry
□Energy for physical activity ry ry ry
□Energy to support growth yr yr yr
■ All of the above
ry ry ry
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of fo
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
od (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and exp
r y ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
enditure are required to support growth and development for children. (See e41-4.)
r y ry ry ry ry ry ry ry ry ry ry
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
ry ry ry ry ry ry ry ry ry ry ry ry
□Vegetarian diet ry
□Chronic intestinal disorders ry ry
□Zinc deficiency ry
■ B and C
ry ry
□All of the above
yr yr yr
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must be
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry
r obtained from plants in the form of provitamin-
y ry ry ry ry ry ry ry
A carotenoids. In the USA, grains and vegetables supply approximately 55% and dairy and meat products supply a
ry ry ry ry ry ry ry ry ry r y ry ry yr ry ry ry ry
pproximately 30% of vitamin A intake from food. Vitamin A and the provitamins-
ry ry ry ry ry ry ry ry ry ry ry r y
Aarefatsoluble,andtheirabsorptiondependsonthepresenceofadequate lipidand proteinwithinthemeal.
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr
Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In developing countries, s
ry ry ry ry ry ry ry ry ry ry ry ry ry ry ry r y
ubclinicalorclinical zincdeficiency can increasetheriskofvitaminA deficiency.Thereis alsosomeevidenceofmarginal zinc
yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr yr r y r
intakes in children in the USA. (See Chapter 45, page 188.)
y ry ry ry ry ry ry ry ry ry ry
7. Which statement about vitamin A toxicity is NOT true?
ry ry ry ry ry ry ry ry
