, Nelson Pediatrics Review(MCQs) 19 Edition
m m m m
1. Which mofmthemfollowing mstatementsmregarding mfostermcaremismtrue?
□A pe rma ne n cy p la n mu st b e m ad e fo r a ch ild in fo ster ca re n o la te r tha n 1 2 mo fro m the child's e n try in to ca re
m m m m m m m m m m m m m m m m m m m m m m
□A mino rity o f child ren in foste r ca re ha ve a histo ry o f a b u se o r ne gle ct
m m m m m m m m m m m m m
□The mission o f fo ste r ca re is to sa fe ly ca re fo r child re n wh ile p ro vid in g se rvice s to fa milie s to p ro m o te re un ifica tio n
m m m m m m m m m m m m m m m m m m
□Most (>7 0% ) o f ch ild re n in foste r ca re a re re un ite d with th e ir fa milie s
m m m m m m m m m m m
■ AmandmC
description mTh e mmission mo fmfo ste r mcare mis mto mp ro vid e mfo r mth e mh ea lth , msa fe ty,ma n d mwell-
being mofmch ild re n mwhile ma ssistin g mth eir m fa milie s mwith mse rvice s mto mpro mo te mreu nifica tio n . mCh ild re n me n te ring mfo ster mca re mh a ve mfreq ue n tly me xpe r
ienced me a rly mch ild h oo d m tra u ma .m Mo re mtha n m7 0% mh a ve ma mhistory mo fma bu se ,mne g le ct,mo r mbo th .mOn ly mab ou tm 50 % mo fmchild re n ma ch ie ve m reun ifi
cation .m In mthe m USA,mthemAdoptionmandmSafemFamiliesmActm(P.L.m105-
89)mpassedminm1997mrequiresmthatmampermanencymplanmbemmademformm each mchild mno mla te r mtha n m1 2 mmo ma fte r me n try mto mfoste r mca re man d mtha t
ma mpe tition mto mte rmina te mp aren ta l mrigh ts mtyp ica lly mmu st mb e mfile d m when mamchild mhasmbeenminmfostermcaremformatmleastm15mofmthempreviousm22m
mo.m(SeemChapterm35,mpagem134,mandme35-1.)
2. Am4myrmold mgirlmismadmitted mtomthemhospitalmformhermthird mevaluation mformvaginalmbleeding.mThe
mothermnoted mbrightmredmblood monmthemchild'smunderwear.mPreviousmexaminationsmrevealed mam normalm4
myrmold mgirl,mTannermstage m1,mwith mnormal mexternal mgenitalia. mPelvic multrasound mresults m were mnormal, mas m
wasmthemserummestradiolmlevel.mThemhemoglobin mandmplateletmcountsmwerem normal,masmweremthembleedin
gmtimemand mcoagulation mstudies.mFindingsmonmpelvicmexamination m conducted mundermanesthesiamalso mw
eremnormal.mThemnextmstep minmthemexamination mismto:
■ Determinemthembloodmtypemofmthembloodmonmthemunderwear
□Interroga te th e fa the r
m m
□Isolate the pa re n ts an d child
m m m m
□Determine von W illeb rand factor le ve ls
m m m m
, □Measure fib ron ectin in th e vagina
m m m m
description m Con sid e ra tion mo fmfa ctitio u s mdiso rd e r mb y mp ro xy msho uld mbe m trigg e re d mwh en mth e mrep o rte d msymp to m s ma re mrep e a te d ly m no te d mb y mo
nlymone mpa ren t,map p rop ria te mte stin g mfa ils mto mcon firm ma mdiag no sis, ma nd mse e ming ly map p ro pria te mtrea tme n tmis min e ffe ctive .m Atmtime s,mthe mchild's ms
ympto ms, mthe ir mcou rse ,mo r mthe mre spo n se mto mtrea tme n tmm a y mb e min co mp a tib le mwith ma n y mre co gn ized md isea se .m Pre ve rba l mchild ren mare mu sually m
involved .mBle ed ing mis ma mp a rticula rly mco m m on mp re se n ta tion . mTh is mma y mb e mcau sed mb y ma dd in g md ye s m to msa mp le s,ma dd ing mbloo d m(e .g .,mfro m mth e m
mother) mto mth e mchild 's msa mp le ,mo r mg iving mthe mchild ma n ma n ticoa gu la n t m(e .g ., mwa rfa rin ).m (SeemChapterm37,mpagem146.)
3. Munchausen msyndromembymproxymismcharacterized mbymallmofmthemfollowing mEXCEPT:
□Mothe r wh o ap p ea rs de vo te d an d win s o ve r m e mb e rs o f ca re te a m
m m m m m m m m m m
□Multiple hospitaliza tion s and in vestiga tion s withou t diagnosis
m m m m m
□Symp to m s o n histo ry b u t no t witne sse d b y me dical te a m
m m m m m m m m
■ Symp to m s mo ccu rring min mp re se n ce mo fmd ifferen t mca re give rs m(e .g ., mwhile mmo th er mis mo u tmo fmto wn )
□Use of med ica tio ns o r to xin s
m m m m
description mSymptomsmin myoung mchildren mare mmostlymassociated mwith mproximitymofmthe moffending mcaregivermto mthe mchild.mThe m mothermm
aympresentmasmamdevotedmormevenmmodelmparentmwhomformsmclosemrelationshipsmwithmmembersmofmthemhealthmcarem team.mWhile mappe
aring mve ry min te re ste d min mhe r mchild 's mcon dition ,msh e mm ay mbe m re la tive ly md ista n tme mo tio na lly. m(Se e mCh ap te r m3 7 ,mmpagem146.)
4. Which mstatementmismfalse?
■ Malnutrition mis mthe mse co nd mle ad ing mca u se mo f ma cqu ire d mim m un e mde ficie n cy mwo rld wide mbe h in d mH IV min fe ctio n
□Zinc is imp ortan t in im mu ne fun ction a nd linear gro wth
m m m m m m m m
□Kwa shio rko r a n d ma ra smu s are rare in de ve lo pe d co un trie s
m m m m m m m
□The Weste rn die t is asso cia ted with in crea sed non co mmun ica ble disea se
m m m m m m m m
description mThe msig nifica n tmglob al mbu rde n mo fmm alnu trition ma nd mu nd ernu tritio n mis mthe mlea d in g mwo rld wid e mcau se mo f ma cqu ired m im mu no d e ficien c
ymand mth e mm a jo r mu n de rlyin g mfa cto r mfor mmo rbidity ma nd mmo rtality mglob ally mfo r mchild ren m<5 myr mo fma g e .mZin c mis ma m micro nu trie n t mth a tmsu pp o rts mm ultipl
e mmetab olic mfun ctio ns min mthe mb od y,mis me ssen tial mfo r mno rma l mimm un e mfun ctio ning ,ma n d mis m req uired mto msu pp o rtmlin e a r mgro wth ;mzin c mde ficien cy mis ma
ssocia ted mwith mimp a ire d mim mu n e mfun ctio ning ma n d mpo o r mlin e a r mgro wth .mIn m p aralle l mto mthe mrisk mfo r mnu trie n tma n d me ne rgy mde ficien cie s, missu es mrel
ating mto me xce sse s mp o se mimp o rta n tmch alle ng e s mb e ca use mo fmth e ir m ne ga tive mh e alth me ffe cts,msu ch ma s mob e sity mo r mca rd io va scu la r md ise a se mrisk mf
actors.mTh e mn u tritio n mtran sitio n mu nd e r mwa y min mth e
, developing m world mfro m m tra ditio na l mdie ts mto mth e mWe ste rn mdie tmha s mb ee n masso cia te d mwith mincrea ses min mn on co m mun ica ble m d ise ase s,mo fte n mco
existing mwith mun de rn u tritio n ma nd mmalnu tritio n , mob served mso me time s min mth e msa m e mco mm un itie s mo r me ve n mth e m samemfamilies.m(Seeme41-1.)
5. Componentsmofmenergymexpenditureminmchildren minclude:
□Thermal e ffe ct o f fo od
m m m
□Basal metabolic ra te
m m
□Energy for physica l activity
m m m
□Energy to suppo rt gro wth
m m m
■ Allmo fmthe ma bo ve
description mThem3mcomponentsmofmenergymexpenditureminmadultsmaremthembasalmmetabolicmrate,mthemthermalmeffectmofmfoodm (energym
required mformdigestion mand mabsorption),mand menergymformphysicalmactivity.mAdditionalmenergymintake mand mexpenditure m aremrequiredmtoms
upportmgrowthmandmdevelopmentmformchildren.m(Seeme41-4.)
6. Which mofmthemfollowing mclinicalmscenariosmincreasesmthemriskmofmvitamin mAmdeficiency?
□Vegetarian diet m
□Chronic intestinal disorde rs
m m
□Zinc deficiency
m
■ BmandmC
□All o f the abo ve
m m m
description mVitaminmAmismanmessentialmmicronutrientmbecausemitmcannotmbembiogeneratedmdemnovombymanimals.mItmmustmbem obtained mfr
ommplan ts min mthe mfo rm mo f mp ro vita m in -
Amca ro ten oid s. mIn mth e mUSA, mg rain s ma nd mveg e ta ble s msu pp ly ma pp ro xima te ly m 55% mandmdairymandmmeatmproductsmsupplymapproximatelym30
% mofmvitaminmAmintakemfrommfood.mVitaminmAmandmthem provitamin s-
Amare mfa tmsolu ble ,man d mth eir ma b so rp tion md ep en ds mo n mthe mp re se nce mo fma de q ua te mlipid man d mp ro tein mwith in mth e mme a l.m Ch ro nic min te stin al md iso
rdersmo r mlipid mmalab so rp tio n msynd ro m es mcan mre su ltmin mvita m in mA md e ficie n cy. mIn mde velop in g mco un tries, m su b clin ica l mo r mclin ica l mzin c md e ficie n cy m
can mincrea se mthe mrisk mo f mvita min mAmde ficien cy.mTh ere mis ma lso mso m e me vide nce mo f mma rgina l m zincmintakesminmchildrenminmthemUSA.m(SeemCh
apterm45,mpagem188.)
7. Which mstatementmaboutmvitamin mAmtoxicitymismNOT mtrue?
m m m m
1. Which mofmthemfollowing mstatementsmregarding mfostermcaremismtrue?
□A pe rma ne n cy p la n mu st b e m ad e fo r a ch ild in fo ster ca re n o la te r tha n 1 2 mo fro m the child's e n try in to ca re
m m m m m m m m m m m m m m m m m m m m m m
□A mino rity o f child ren in foste r ca re ha ve a histo ry o f a b u se o r ne gle ct
m m m m m m m m m m m m m
□The mission o f fo ste r ca re is to sa fe ly ca re fo r child re n wh ile p ro vid in g se rvice s to fa milie s to p ro m o te re un ifica tio n
m m m m m m m m m m m m m m m m m m
□Most (>7 0% ) o f ch ild re n in foste r ca re a re re un ite d with th e ir fa milie s
m m m m m m m m m m m
■ AmandmC
description mTh e mmission mo fmfo ste r mcare mis mto mp ro vid e mfo r mth e mh ea lth , msa fe ty,ma n d mwell-
being mofmch ild re n mwhile ma ssistin g mth eir m fa milie s mwith mse rvice s mto mpro mo te mreu nifica tio n . mCh ild re n me n te ring mfo ster mca re mh a ve mfreq ue n tly me xpe r
ienced me a rly mch ild h oo d m tra u ma .m Mo re mtha n m7 0% mh a ve ma mhistory mo fma bu se ,mne g le ct,mo r mbo th .mOn ly mab ou tm 50 % mo fmchild re n ma ch ie ve m reun ifi
cation .m In mthe m USA,mthemAdoptionmandmSafemFamiliesmActm(P.L.m105-
89)mpassedminm1997mrequiresmthatmampermanencymplanmbemmademformm each mchild mno mla te r mtha n m1 2 mmo ma fte r me n try mto mfoste r mca re man d mtha t
ma mpe tition mto mte rmina te mp aren ta l mrigh ts mtyp ica lly mmu st mb e mfile d m when mamchild mhasmbeenminmfostermcaremformatmleastm15mofmthempreviousm22m
mo.m(SeemChapterm35,mpagem134,mandme35-1.)
2. Am4myrmold mgirlmismadmitted mtomthemhospitalmformhermthird mevaluation mformvaginalmbleeding.mThe
mothermnoted mbrightmredmblood monmthemchild'smunderwear.mPreviousmexaminationsmrevealed mam normalm4
myrmold mgirl,mTannermstage m1,mwith mnormal mexternal mgenitalia. mPelvic multrasound mresults m were mnormal, mas m
wasmthemserummestradiolmlevel.mThemhemoglobin mandmplateletmcountsmwerem normal,masmweremthembleedin
gmtimemand mcoagulation mstudies.mFindingsmonmpelvicmexamination m conducted mundermanesthesiamalso mw
eremnormal.mThemnextmstep minmthemexamination mismto:
■ Determinemthembloodmtypemofmthembloodmonmthemunderwear
□Interroga te th e fa the r
m m
□Isolate the pa re n ts an d child
m m m m
□Determine von W illeb rand factor le ve ls
m m m m
, □Measure fib ron ectin in th e vagina
m m m m
description m Con sid e ra tion mo fmfa ctitio u s mdiso rd e r mb y mp ro xy msho uld mbe m trigg e re d mwh en mth e mrep o rte d msymp to m s ma re mrep e a te d ly m no te d mb y mo
nlymone mpa ren t,map p rop ria te mte stin g mfa ils mto mcon firm ma mdiag no sis, ma nd mse e ming ly map p ro pria te mtrea tme n tmis min e ffe ctive .m Atmtime s,mthe mchild's ms
ympto ms, mthe ir mcou rse ,mo r mthe mre spo n se mto mtrea tme n tmm a y mb e min co mp a tib le mwith ma n y mre co gn ized md isea se .m Pre ve rba l mchild ren mare mu sually m
involved .mBle ed ing mis ma mp a rticula rly mco m m on mp re se n ta tion . mTh is mma y mb e mcau sed mb y ma dd in g md ye s m to msa mp le s,ma dd ing mbloo d m(e .g .,mfro m mth e m
mother) mto mth e mchild 's msa mp le ,mo r mg iving mthe mchild ma n ma n ticoa gu la n t m(e .g ., mwa rfa rin ).m (SeemChapterm37,mpagem146.)
3. Munchausen msyndromembymproxymismcharacterized mbymallmofmthemfollowing mEXCEPT:
□Mothe r wh o ap p ea rs de vo te d an d win s o ve r m e mb e rs o f ca re te a m
m m m m m m m m m m
□Multiple hospitaliza tion s and in vestiga tion s withou t diagnosis
m m m m m
□Symp to m s o n histo ry b u t no t witne sse d b y me dical te a m
m m m m m m m m
■ Symp to m s mo ccu rring min mp re se n ce mo fmd ifferen t mca re give rs m(e .g ., mwhile mmo th er mis mo u tmo fmto wn )
□Use of med ica tio ns o r to xin s
m m m m
description mSymptomsmin myoung mchildren mare mmostlymassociated mwith mproximitymofmthe moffending mcaregivermto mthe mchild.mThe m mothermm
aympresentmasmamdevotedmormevenmmodelmparentmwhomformsmclosemrelationshipsmwithmmembersmofmthemhealthmcarem team.mWhile mappe
aring mve ry min te re ste d min mhe r mchild 's mcon dition ,msh e mm ay mbe m re la tive ly md ista n tme mo tio na lly. m(Se e mCh ap te r m3 7 ,mmpagem146.)
4. Which mstatementmismfalse?
■ Malnutrition mis mthe mse co nd mle ad ing mca u se mo f ma cqu ire d mim m un e mde ficie n cy mwo rld wide mbe h in d mH IV min fe ctio n
□Zinc is imp ortan t in im mu ne fun ction a nd linear gro wth
m m m m m m m m
□Kwa shio rko r a n d ma ra smu s are rare in de ve lo pe d co un trie s
m m m m m m m
□The Weste rn die t is asso cia ted with in crea sed non co mmun ica ble disea se
m m m m m m m m
description mThe msig nifica n tmglob al mbu rde n mo fmm alnu trition ma nd mu nd ernu tritio n mis mthe mlea d in g mwo rld wid e mcau se mo f ma cqu ired m im mu no d e ficien c
ymand mth e mm a jo r mu n de rlyin g mfa cto r mfor mmo rbidity ma nd mmo rtality mglob ally mfo r mchild ren m<5 myr mo fma g e .mZin c mis ma m micro nu trie n t mth a tmsu pp o rts mm ultipl
e mmetab olic mfun ctio ns min mthe mb od y,mis me ssen tial mfo r mno rma l mimm un e mfun ctio ning ,ma n d mis m req uired mto msu pp o rtmlin e a r mgro wth ;mzin c mde ficien cy mis ma
ssocia ted mwith mimp a ire d mim mu n e mfun ctio ning ma n d mpo o r mlin e a r mgro wth .mIn m p aralle l mto mthe mrisk mfo r mnu trie n tma n d me ne rgy mde ficien cie s, missu es mrel
ating mto me xce sse s mp o se mimp o rta n tmch alle ng e s mb e ca use mo fmth e ir m ne ga tive mh e alth me ffe cts,msu ch ma s mob e sity mo r mca rd io va scu la r md ise a se mrisk mf
actors.mTh e mn u tritio n mtran sitio n mu nd e r mwa y min mth e
, developing m world mfro m m tra ditio na l mdie ts mto mth e mWe ste rn mdie tmha s mb ee n masso cia te d mwith mincrea ses min mn on co m mun ica ble m d ise ase s,mo fte n mco
existing mwith mun de rn u tritio n ma nd mmalnu tritio n , mob served mso me time s min mth e msa m e mco mm un itie s mo r me ve n mth e m samemfamilies.m(Seeme41-1.)
5. Componentsmofmenergymexpenditureminmchildren minclude:
□Thermal e ffe ct o f fo od
m m m
□Basal metabolic ra te
m m
□Energy for physica l activity
m m m
□Energy to suppo rt gro wth
m m m
■ Allmo fmthe ma bo ve
description mThem3mcomponentsmofmenergymexpenditureminmadultsmaremthembasalmmetabolicmrate,mthemthermalmeffectmofmfoodm (energym
required mformdigestion mand mabsorption),mand menergymformphysicalmactivity.mAdditionalmenergymintake mand mexpenditure m aremrequiredmtoms
upportmgrowthmandmdevelopmentmformchildren.m(Seeme41-4.)
6. Which mofmthemfollowing mclinicalmscenariosmincreasesmthemriskmofmvitamin mAmdeficiency?
□Vegetarian diet m
□Chronic intestinal disorde rs
m m
□Zinc deficiency
m
■ BmandmC
□All o f the abo ve
m m m
description mVitaminmAmismanmessentialmmicronutrientmbecausemitmcannotmbembiogeneratedmdemnovombymanimals.mItmmustmbem obtained mfr
ommplan ts min mthe mfo rm mo f mp ro vita m in -
Amca ro ten oid s. mIn mth e mUSA, mg rain s ma nd mveg e ta ble s msu pp ly ma pp ro xima te ly m 55% mandmdairymandmmeatmproductsmsupplymapproximatelym30
% mofmvitaminmAmintakemfrommfood.mVitaminmAmandmthem provitamin s-
Amare mfa tmsolu ble ,man d mth eir ma b so rp tion md ep en ds mo n mthe mp re se nce mo fma de q ua te mlipid man d mp ro tein mwith in mth e mme a l.m Ch ro nic min te stin al md iso
rdersmo r mlipid mmalab so rp tio n msynd ro m es mcan mre su ltmin mvita m in mA md e ficie n cy. mIn mde velop in g mco un tries, m su b clin ica l mo r mclin ica l mzin c md e ficie n cy m
can mincrea se mthe mrisk mo f mvita min mAmde ficien cy.mTh ere mis ma lso mso m e me vide nce mo f mma rgina l m zincmintakesminmchildrenminmthemUSA.m(SeemCh
apterm45,mpagem188.)
7. Which mstatementmaboutmvitamin mAmtoxicitymismNOT mtrue?
