, Nelson Pediatrics Review(MCQs) 19 Edition
l l l l
1. Whichloflthelfollowinglstatementslregardinglfosterlcarelisltrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
l l l l l l l l l l l l l l l l l l l l l l
□A minority of children in foster care have a history of abuse or neglect
l l l l l l l l l l l l l
□The mission of foster care is to safely care for children while providing services to families to promote reunification
l l l l l l l l l l l l l l l l l l
□Most (>70%) of children in foster care are reunited with their families
l l l l l l l l l l l
■ AlandlC
descriptionl Thel missionl ofl fosterl carelisl tol providel forlthel health,l safety,landl well-
beingl ofl childrenl whilel assistingl theirlfamiliesl withl servicesltol promotel reunification.l Childrenl enteringl fosterlcarel havel frequently
l experiencedl earlyl childhoodltrauma.l Morel thanl 70%l havel al historyl ofl abuse,l neglect,l orl both.l Onlyl aboutl 50%l ofl childrenl achieve
l reunification.l Inl thelUSA,lthelAdoptionlandlSafelFamilieslActl(P.L.l105-
89)lpassedlinl1997lrequireslthatlalpermanencylplanlbelmadelforleachl childl nollaterlthanl 12l molafterlentryltol fosterlcarel andlthatl al
petitionltolterminatel parentall rightsltypicallyl mustl bel filedlwhenlalchildlhaslbeenlinlfosterlcarelforlatlleastl15loflthelpreviousl22lmo
.l(SeelChapterl35,lpagel134,landle35-1.)
2. Al4lyrloldlgirllisladmittedltolthelhospitallforlherlthirdlevaluationlforlvaginallbleeding.lThe
motherlnotedlbrightlredlbloodlonlthelchild'slunderwear.lPreviouslexaminationslrevealedlalnormall
4l yrl oldl girl,l Tannerl stagel 1,l withl normall externall genitalia.l Pelvicl ultrasoundl resultslwerelnormal,la
slwaslthelserumlestradiolllevel.lThelhemoglobinlandlplateletlcountslwerelnormal,laslwerelthelbleedi
ngltimelandlcoagulationlstudies.lFindingslonlpelviclexaminationlconductedlunderlanesthesialalsol
werelnormal.lThelnextlsteplinlthelexaminationlislto:
■ Determinelthelbloodltypeloflthelbloodlonlthelunderwear
□Interrogate the father l l
□Isolate the parents and child
l l l l
□Determine von Willebrand factor levels
l l l l
, □Measure fibronectin in the vagina
l l l l
descriptionlConsiderationloflfactitiousldisorderlbylproxylshouldlbeltriggeredlwhenlthelreportedlsymptomslarelrepeatedlylnotedl
byl onlyl onel parent,l appropriatel testingl failsl tol confirmlal diagnosis,l andl seeminglyl appropriatel treatmentl isl ineffective.lAtl times,l th
el child'sl symptoms,l theirl course,l orl thel responsel tol treatmentl mayl bel incompatiblel withl anyl recognizedl disease.lPreverball childre
nl arel usuallylinvolved.l Bleedinglisl al particularlylcommonl presentation.l Thisl mayl bel causedl byl addingl dyesltol samples,l addingl bloo
dl(e.g.,l fromlthel mother)ltolthelchild'sl sample,l orl givinglthelchildlanlanticoagulantl (e.g.,l warfarin).l(SeelChapterl37,lpagel146.)
3. Munchausenl syndromel byl proxyl isl characterizedl byl alll ofl thel followingl EXCEPT:
□Mother who appears devoted and wins over members of care team
l l l l l l l l l l
□Multiple hospitalizations and investigations without diagnosis
l l l l l
□Symptoms on history but not witnessed by medical team
l l l l l l l l
■ Symptomsl occurringlinl presencel ofl differentl caregiversl (e.g.,l whilel motherlisl outl ofltown)
□Use of medications or toxins
l l l l
descriptionlSymptomslinlyounglchildrenlarelmostlylassociatedlwithlproximitylofltheloffendinglcaregiverltolthelchild.lThelmother
lmaylpresentlaslaldevotedlorlevenlmodellparentlwholformslcloselrelationshipslwithlmembersloflthelhealthlcarelteam.lWhilela
ppearinglverylinterestedlinlherlchild'slcondition,lshelmaylbelrelativelyldistantlemotionally.l(SeelChapterl37,lpagel146.)
4. Whichlstatementlislfalse?
■ Malnutritionlislthel secondlleadinglcausel oflacquiredlimmunel deficiencyl worldwidel behindl HIVlinfection
□Zinc is important in immune function and linear growth
l l l l l l l l
□Kwashiorkor and marasmus are rare in developed countries
l l l l l l l
□The Western diet is associated with increased noncommunicable disease
l l l l l l l l
descriptionl Thelsignificantl globall burdenl ofl malnutritionlandlundernutritionlislthelleadingl worldwidelcausel oflacquiredlimmunode
ficiencylandlthelmajorlunderlyinglfactorlforlmorbiditylandl mortalitylgloballylforlchildrenl<5lyrloflage.lZinclislalmicronutrientlthatlsu
pportslmultiplelmetaboliclfunctionslinlthelbody,lislessentiallforlnormallimmunelfunctioning,landlislrequiredltolsupportllinearl growth
;l zincl deficiencylislassociatedl withlimpairedlimmunelfunctioninglandl poorllinearl growth.l Inlparallell tolthel riskl forl nutrientl andl ener
gyl deficiencies,l issuesl relatingltol excessesl posel importantl challengesl becausel ofltheirlnegativelhealthleffects,lsuchlaslobesitylorlcar
diovascularldiseaselrisklfactors.lThelnutritionltransitionlunderlwaylinlthe
, developingl worldl froml traditionall dietsl tolthel Westernl dietl hasl beenl associatedl withl increasesl inlnoncommunicableldiseases,l oft
enlcoexistingl withl undernutritionlandl malnutrition,l observedl sometimeslinlthel samelcommunitiesl orl evenlthelsamelfamilies.l(Se
ele41-1.)
5. Componentsl ofl energyl expenditurel inl childrenl include:
□Thermal effect of food l l l
□Basal metabolic rate
l l
□Energy for physical activity
l l l
□Energy to support growth
l l l
■ Allloflthelabove
descriptionlThel3lcomponentsloflenergylexpenditurelinladultslarelthelbasallmetaboliclrate,lthelthermalleffectloflfoodl(energ
ylrequiredlforldigestionlandlabsorption),landlenergylforlphysicallactivity.lAdditionallenergylintakelandlexpenditurelarelrequiredl
tolsupportlgrowthlandldevelopmentlforlchildren.l(Seele41-4.)
6. WhichloflthelfollowinglclinicallscenarioslincreaseslthelriskloflvitaminlAldeficiency?
□Vegetarian diet l
□Chronic intestinal disorders
l l
□Zinc deficiency
l
■ BlandlC
□All of the above
l l l
descriptionlVitaminlAlislanlessentiallmicronutrientlbecauselitlcannotlbelbiogeneratedldelnovolbylanimals.lItlmustlbelobtain
edl froml plantsl inl thel forml ofl provitamin-
Al carotenoids.l Inl thel USA,l grainsl andl vegetablesl supplyl approximatelyl55%landldairylandlmeatlproductslsupplylapproximatel
yl30%loflvitaminlAlintakelfromlfood.lVitaminlAlandlthelprovitamins-
Al arel fatl soluble,l andl theirl absorptionl dependsl onl thel presencel ofl adequatel lipidl andl proteinl withinl thel meal.lChroniclintestinall d
isordersl orllipidl malabsorptionlsyndromeslcanlresultlinl vitaminl Aldeficiency.l Inldevelopinglcountries,lsubclinicallorlclinicallzincl
deficiencylcanlincreaselthelriskloflvitaminlAldeficiency.lTherelislalsolsomelevidenceloflmarginallzinclintakeslinlchildrenlinlthel
USA.l(SeelChapterl45,lpagel188.)
7. WhichlstatementlaboutlvitaminlAltoxicitylislNOTltrue?
l l l l
1. Whichloflthelfollowinglstatementslregardinglfosterlcarelisltrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
l l l l l l l l l l l l l l l l l l l l l l
□A minority of children in foster care have a history of abuse or neglect
l l l l l l l l l l l l l
□The mission of foster care is to safely care for children while providing services to families to promote reunification
l l l l l l l l l l l l l l l l l l
□Most (>70%) of children in foster care are reunited with their families
l l l l l l l l l l l
■ AlandlC
descriptionl Thel missionl ofl fosterl carelisl tol providel forlthel health,l safety,landl well-
beingl ofl childrenl whilel assistingl theirlfamiliesl withl servicesltol promotel reunification.l Childrenl enteringl fosterlcarel havel frequently
l experiencedl earlyl childhoodltrauma.l Morel thanl 70%l havel al historyl ofl abuse,l neglect,l orl both.l Onlyl aboutl 50%l ofl childrenl achieve
l reunification.l Inl thelUSA,lthelAdoptionlandlSafelFamilieslActl(P.L.l105-
89)lpassedlinl1997lrequireslthatlalpermanencylplanlbelmadelforleachl childl nollaterlthanl 12l molafterlentryltol fosterlcarel andlthatl al
petitionltolterminatel parentall rightsltypicallyl mustl bel filedlwhenlalchildlhaslbeenlinlfosterlcarelforlatlleastl15loflthelpreviousl22lmo
.l(SeelChapterl35,lpagel134,landle35-1.)
2. Al4lyrloldlgirllisladmittedltolthelhospitallforlherlthirdlevaluationlforlvaginallbleeding.lThe
motherlnotedlbrightlredlbloodlonlthelchild'slunderwear.lPreviouslexaminationslrevealedlalnormall
4l yrl oldl girl,l Tannerl stagel 1,l withl normall externall genitalia.l Pelvicl ultrasoundl resultslwerelnormal,la
slwaslthelserumlestradiolllevel.lThelhemoglobinlandlplateletlcountslwerelnormal,laslwerelthelbleedi
ngltimelandlcoagulationlstudies.lFindingslonlpelviclexaminationlconductedlunderlanesthesialalsol
werelnormal.lThelnextlsteplinlthelexaminationlislto:
■ Determinelthelbloodltypeloflthelbloodlonlthelunderwear
□Interrogate the father l l
□Isolate the parents and child
l l l l
□Determine von Willebrand factor levels
l l l l
, □Measure fibronectin in the vagina
l l l l
descriptionlConsiderationloflfactitiousldisorderlbylproxylshouldlbeltriggeredlwhenlthelreportedlsymptomslarelrepeatedlylnotedl
byl onlyl onel parent,l appropriatel testingl failsl tol confirmlal diagnosis,l andl seeminglyl appropriatel treatmentl isl ineffective.lAtl times,l th
el child'sl symptoms,l theirl course,l orl thel responsel tol treatmentl mayl bel incompatiblel withl anyl recognizedl disease.lPreverball childre
nl arel usuallylinvolved.l Bleedinglisl al particularlylcommonl presentation.l Thisl mayl bel causedl byl addingl dyesltol samples,l addingl bloo
dl(e.g.,l fromlthel mother)ltolthelchild'sl sample,l orl givinglthelchildlanlanticoagulantl (e.g.,l warfarin).l(SeelChapterl37,lpagel146.)
3. Munchausenl syndromel byl proxyl isl characterizedl byl alll ofl thel followingl EXCEPT:
□Mother who appears devoted and wins over members of care team
l l l l l l l l l l
□Multiple hospitalizations and investigations without diagnosis
l l l l l
□Symptoms on history but not witnessed by medical team
l l l l l l l l
■ Symptomsl occurringlinl presencel ofl differentl caregiversl (e.g.,l whilel motherlisl outl ofltown)
□Use of medications or toxins
l l l l
descriptionlSymptomslinlyounglchildrenlarelmostlylassociatedlwithlproximitylofltheloffendinglcaregiverltolthelchild.lThelmother
lmaylpresentlaslaldevotedlorlevenlmodellparentlwholformslcloselrelationshipslwithlmembersloflthelhealthlcarelteam.lWhilela
ppearinglverylinterestedlinlherlchild'slcondition,lshelmaylbelrelativelyldistantlemotionally.l(SeelChapterl37,lpagel146.)
4. Whichlstatementlislfalse?
■ Malnutritionlislthel secondlleadinglcausel oflacquiredlimmunel deficiencyl worldwidel behindl HIVlinfection
□Zinc is important in immune function and linear growth
l l l l l l l l
□Kwashiorkor and marasmus are rare in developed countries
l l l l l l l
□The Western diet is associated with increased noncommunicable disease
l l l l l l l l
descriptionl Thelsignificantl globall burdenl ofl malnutritionlandlundernutritionlislthelleadingl worldwidelcausel oflacquiredlimmunode
ficiencylandlthelmajorlunderlyinglfactorlforlmorbiditylandl mortalitylgloballylforlchildrenl<5lyrloflage.lZinclislalmicronutrientlthatlsu
pportslmultiplelmetaboliclfunctionslinlthelbody,lislessentiallforlnormallimmunelfunctioning,landlislrequiredltolsupportllinearl growth
;l zincl deficiencylislassociatedl withlimpairedlimmunelfunctioninglandl poorllinearl growth.l Inlparallell tolthel riskl forl nutrientl andl ener
gyl deficiencies,l issuesl relatingltol excessesl posel importantl challengesl becausel ofltheirlnegativelhealthleffects,lsuchlaslobesitylorlcar
diovascularldiseaselrisklfactors.lThelnutritionltransitionlunderlwaylinlthe
, developingl worldl froml traditionall dietsl tolthel Westernl dietl hasl beenl associatedl withl increasesl inlnoncommunicableldiseases,l oft
enlcoexistingl withl undernutritionlandl malnutrition,l observedl sometimeslinlthel samelcommunitiesl orl evenlthelsamelfamilies.l(Se
ele41-1.)
5. Componentsl ofl energyl expenditurel inl childrenl include:
□Thermal effect of food l l l
□Basal metabolic rate
l l
□Energy for physical activity
l l l
□Energy to support growth
l l l
■ Allloflthelabove
descriptionlThel3lcomponentsloflenergylexpenditurelinladultslarelthelbasallmetaboliclrate,lthelthermalleffectloflfoodl(energ
ylrequiredlforldigestionlandlabsorption),landlenergylforlphysicallactivity.lAdditionallenergylintakelandlexpenditurelarelrequiredl
tolsupportlgrowthlandldevelopmentlforlchildren.l(Seele41-4.)
6. WhichloflthelfollowinglclinicallscenarioslincreaseslthelriskloflvitaminlAldeficiency?
□Vegetarian diet l
□Chronic intestinal disorders
l l
□Zinc deficiency
l
■ BlandlC
□All of the above
l l l
descriptionlVitaminlAlislanlessentiallmicronutrientlbecauselitlcannotlbelbiogeneratedldelnovolbylanimals.lItlmustlbelobtain
edl froml plantsl inl thel forml ofl provitamin-
Al carotenoids.l Inl thel USA,l grainsl andl vegetablesl supplyl approximatelyl55%landldairylandlmeatlproductslsupplylapproximatel
yl30%loflvitaminlAlintakelfromlfood.lVitaminlAlandlthelprovitamins-
Al arel fatl soluble,l andl theirl absorptionl dependsl onl thel presencel ofl adequatel lipidl andl proteinl withinl thel meal.lChroniclintestinall d
isordersl orllipidl malabsorptionlsyndromeslcanlresultlinl vitaminl Aldeficiency.l Inldevelopinglcountries,lsubclinicallorlclinicallzincl
deficiencylcanlincreaselthelriskloflvitaminlAldeficiency.lTherelislalsolsomelevidenceloflmarginallzinclintakeslinlchildrenlinlthel
USA.l(SeelChapterl45,lpagel188.)
7. WhichlstatementlaboutlvitaminlAltoxicitylislNOTltrue?
