Test bank for MCQs in Pediatrics Review of Nelson
ss ss ss ss ss ss ss ss
Textbook of Pediatrics 20 Edition
ss ss ss ss ss ss
, Nelson Pediatrics Review(MCQs) 19 Edition ss ss ss ss
1. Which of the following statements regarding foster care is true?
ss ss ss ss ss ss ss ss ss
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
□A minority of children in foster care have a history of abuse or neglect
ss ss ss ss ss ss ss ss ss ss ss ss ss
□The mission of foster care is to safely care for children while providing services to families to promote reunification
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
□Most (>70%) of children in foster care are reunited with their families
ss ss ss ss ss ss ss ss ss ss ss
■ A and C
ss ss
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
their families with services to promote reunification. Children entering foster care have frequently experienced early
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to terminate
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
parental rights typically must be filed when a child has been in foster care for at least 15 of the previous 22 mo. (See
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Chapter 35, page 134, and e35-1.)
ss ss ss ss ss ss
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
mother noted bright red blood on the child's underwear. Previous examinations revealed a
ss ss ss ss ss ss ss ss ss ss ss ss
normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
were normal, as was the serum estradiol level. The hemoglobin and platelet counts were
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
normal, as were the bleeding time and coagulation studies. Findings on pelvic examination
ss ss ss ss ss ss ss ss ss ss ss ss ss
conducted under anesthesia also were normal. The next step in the examination is to:
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
■ Determine the blood type of the blood on the underwear ss ss ss ss ss ss ss ss ss
□Interrogate ss the father ss
□Isolate the parents and child ss ss ss ss
□Determine ss von Willebrand factor levels
ss ss ss
, □Measure ss fibronectin in the vagina ss ss ss
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
is ineffective. At times, the child's symptoms, their course, or the response to treatment may be incompatible with any
ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
recognized disease. Preverbal children are usually involved. Bleeding is a particularly common presentation. This may
ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss
be caused by adding dyes to samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an
ss ss ss ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
ss ss ss ss ss ss ss ss
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT: ss ss ss ss ss ss ss ss ss ss ss
□Mother who appears ss ss ss devoted and wins over members of care team
ss ss ss ss ss ss ss
□Multiple ss hospitalizations and investigations without diagnosis ss ss ss ss
□Symptoms on history but not witnessed by medical team ss ss ss ss ss ss ss ss
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
ss ss ss ss ss ss ss ss ss ss ss ss ss
□Use of medications or toxins
ss ss ss ss
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
The mother may present as a devoted or even model parent who forms close relationships with members of the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
health care team. While appearing very interested in her child's condition, she may be relatively distant emotionally.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
(See Chapter 37, page 146.)
ss ss ss ss ss
4. Which statement is false? ss ss ss
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
ss ss ss ss ss ss ss ss ss ss ss ss ss
□Zinc is ss ss important in immune function and linear growth ss ss ss ss ss ss
□Kwashiorkor and marasmus are rare in developed countries ss ss ss ss ss ss ss
□The Western diet is associated with increased noncommunicable disease
ss ss ss ss ss ss ss ss
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of acquired
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of age. Zinc is
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune functioning, and is
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
required to support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose important challenges
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
because of their negative health effects, such as obesity or cardiovascular disease risk factors. The nutrition transition
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
under way in the
ss ss ss ss
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
same families. (See e41-1.)
ss ss ss ss
5. Components of energy expenditure in children include: ss ss ss ss ss ss
□Thermal effect of food ss ss ss
□Basal metabolic rate ss ss
□Energy for physical activity ss ss ss
□Energy ss to support growth
ss ss
■ All of the above ss ss ss
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
expenditure are required to support growth and development for children. (See e41-4.)
ss ss ss ss ss ss ss ss ss ss ss ss
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
ss ss ss ss ss ss ss ss ss ss ss ss
□Vegetarian diet ss
□Chronic ss intestinal disorders ss
□Zinc ss deficiency
■ B and C ss ss
□All of the above ss ss ss
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables supply
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from food. Vitamin
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate lipid and protein
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In
ss ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss
developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin A deficiency. There is also
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
some evidence of marginal zinc intakes in children in the USA. (See Chapter 45, page 188.)
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
7. Which statement about vitamin A toxicity is NOT true?
ss ss ss ss ss ss ss ss
ss ss ss ss ss ss ss ss
Textbook of Pediatrics 20 Edition
ss ss ss ss ss ss
, Nelson Pediatrics Review(MCQs) 19 Edition ss ss ss ss
1. Which of the following statements regarding foster care is true?
ss ss ss ss ss ss ss ss ss
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
□A minority of children in foster care have a history of abuse or neglect
ss ss ss ss ss ss ss ss ss ss ss ss ss
□The mission of foster care is to safely care for children while providing services to families to promote reunification
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
□Most (>70%) of children in foster care are reunited with their families
ss ss ss ss ss ss ss ss ss ss ss
■ A and C
ss ss
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
their families with services to promote reunification. Children entering foster care have frequently experienced early
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to terminate
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
parental rights typically must be filed when a child has been in foster care for at least 15 of the previous 22 mo. (See
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Chapter 35, page 134, and e35-1.)
ss ss ss ss ss ss
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
mother noted bright red blood on the child's underwear. Previous examinations revealed a
ss ss ss ss ss ss ss ss ss ss ss ss
normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
were normal, as was the serum estradiol level. The hemoglobin and platelet counts were
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
normal, as were the bleeding time and coagulation studies. Findings on pelvic examination
ss ss ss ss ss ss ss ss ss ss ss ss ss
conducted under anesthesia also were normal. The next step in the examination is to:
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
■ Determine the blood type of the blood on the underwear ss ss ss ss ss ss ss ss ss
□Interrogate ss the father ss
□Isolate the parents and child ss ss ss ss
□Determine ss von Willebrand factor levels
ss ss ss
, □Measure ss fibronectin in the vagina ss ss ss
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
is ineffective. At times, the child's symptoms, their course, or the response to treatment may be incompatible with any
ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
recognized disease. Preverbal children are usually involved. Bleeding is a particularly common presentation. This may
ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss
be caused by adding dyes to samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an
ss ss ss ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
ss ss ss ss ss ss ss ss
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT: ss ss ss ss ss ss ss ss ss ss ss
□Mother who appears ss ss ss devoted and wins over members of care team
ss ss ss ss ss ss ss
□Multiple ss hospitalizations and investigations without diagnosis ss ss ss ss
□Symptoms on history but not witnessed by medical team ss ss ss ss ss ss ss ss
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
ss ss ss ss ss ss ss ss ss ss ss ss ss
□Use of medications or toxins
ss ss ss ss
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
The mother may present as a devoted or even model parent who forms close relationships with members of the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
health care team. While appearing very interested in her child's condition, she may be relatively distant emotionally.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
(See Chapter 37, page 146.)
ss ss ss ss ss
4. Which statement is false? ss ss ss
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
ss ss ss ss ss ss ss ss ss ss ss ss ss
□Zinc is ss ss important in immune function and linear growth ss ss ss ss ss ss
□Kwashiorkor and marasmus are rare in developed countries ss ss ss ss ss ss ss
□The Western diet is associated with increased noncommunicable disease
ss ss ss ss ss ss ss ss
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of acquired
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of age. Zinc is
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune functioning, and is
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
required to support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose important challenges
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
because of their negative health effects, such as obesity or cardiovascular disease risk factors. The nutrition transition
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
under way in the
ss ss ss ss
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
same families. (See e41-1.)
ss ss ss ss
5. Components of energy expenditure in children include: ss ss ss ss ss ss
□Thermal effect of food ss ss ss
□Basal metabolic rate ss ss
□Energy for physical activity ss ss ss
□Energy ss to support growth
ss ss
■ All of the above ss ss ss
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
expenditure are required to support growth and development for children. (See e41-4.)
ss ss ss ss ss ss ss ss ss ss ss ss
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
ss ss ss ss ss ss ss ss ss ss ss ss
□Vegetarian diet ss
□Chronic ss intestinal disorders ss
□Zinc ss deficiency
■ B and C ss ss
□All of the above ss ss ss
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables supply
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from food. Vitamin
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate lipid and protein
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In
ss ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss
developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin A deficiency. There is also
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
some evidence of marginal zinc intakes in children in the USA. (See Chapter 45, page 188.)
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
7. Which statement about vitamin A toxicity is NOT true?
ss ss ss ss ss ss ss ss
