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