, Nelsong Pediatricsg Review(MCQs)g19gEdition
1. Whichg ofg theg followingg statementsg regardingg fosterg careg isg true?
□Agpermanencygplangmustgbegmadegforgagchildgingfostergcaregnoglatergthang12gmogfromgthegchild'sgentrygintogcare
□Agminoritygofgchildrengingfostergcareghavegaghistorygofgabusegorgneglect
□Thegmissiongofgfostergcaregisgtogsafelygcaregforgchildrengwhilegprovidinggservicesgtogfamiliesgtogpromotegreunification
□Mostg(>70%)gofgchildrengingfostergcaregaregreunitedgwithgtheirgfamilies
■ AgandgC
descriptiongThegmissiongofgfostergcaregisgtogprovidegforgtheghealth,gsafety,gandgwell-
beinggofgchildrengwhilegassistinggtheirgfamiliesgwithgservicesgtogpromotegreunification.gChildrengenteringgfostergcareghavegfr
equentlygexperiencedgearlygchildhoodgtrauma.gMoregthang70%ghavegaghistorygofgabuse,gneglect,gorgboth.gOnlygaboutg50%g
ofgchildrengachievegreunification.gIngthegUSA,gthegAdoptiongandgSafegFamiliesgActg(P.L.g105-
89)gpassedging1997grequiresgthatgagpermanencygplangbegmadegforgeachgchildgnoglatergthang12gmogaftergentrygtogfostergcar
egandgthatgagpetitiongtogterminategparentalgrightsgtypicallygmustgbegfiledgwhengagchildghasgbeengingfostergcaregforgatgleastg1
5gofgthegpreviousg22gmo.g(SeegChapterg35,gpageg134,gandge35-1.)
2. Ag4gyrgoldggirlgisgadmittedgtogtheghospitalgforghergthirdgevaluationgforgvaginalgbleeding.gThe
mothergnotedgbrightgredgbloodgongthegchild'sgunderwear.gPreviousgexaminationsgrevealedgagn
ormalg4gyrgoldggirl,gTannergstageg1,gwithgnormalgexternalggenitalia.gPelvicgultrasoundgresultsgw
eregnormal,gasgwasgthegserumgestradiolglevel.gTheghemoglobingandgplateletgcountsgweregnorm
al,gasgweregthegbleedinggtimegandgcoagulationgstudies.gFindingsgongpelvicgexaminationgconduc
tedgunderganesthesiagalsogweregnormal.gThegnextgstepgingthegexaminationgisgto:
■ Determinegthegbloodgtypegofgthegbloodgongthegunderwear
□Interrogateg theg father
□Isolategthegparentsgandgchild
□Determineg vong Willebrandg factorg levels
, □Measureg fibronecting ingthegvagina
descriptiongConsiderationgofgfactitiousgdisordergbygproxygshouldgbegtriggeredgwhengthegreportedgsymptomsgaregrepeated
lygnotedgbygonlygonegparent,gappropriategtestinggfailsgtogconfirmgagdiagnosis,gandgseeminglygappropriategtreatmentgisgineffecti
ve.g Atgtimes,gthegchild'sgsymptoms,gtheirgcourse,gorgthegresponsegtogtreatmentgmaygbegincompatiblegwithganygrecognizedgdise
ase.g Preverbalgchildrengaregusuallyginvolved.gBleedinggisgagparticularlygcommongpresentation.gThisgmaygbegcausedgbygaddin
ggdyesg togsamples,gaddinggbloodg(e.g.,gfromgthegmother)gtogthegchild'sgsample,gorggivinggthegchildganganticoagulantg(e.g.,g
warfarin).g(SeegChapterg37,gpageg146.)
3. Munchauseng syndromeg byg proxyg isg characterizedg byg allg ofg theg followingg EXCEPT:
□Mothergwhogappearsgdevotedgandgwinsgovergmembersgofgcaregteam
□Multipleg hospitalizationsg andg investigationsg withoutg diagnosis
□Symptomsgonghistorygbutgnotgwitnessedgbygmedicalgteam
■ Symptomsgoccurringgingpresencegofgdifferentgcaregiversg(e.g.,gwhilegmothergisgoutgofgtown)
□Usegofgmedicationsgorgtoxins
descriptiongSymptomsgingyounggchildrengaregmostlygassociatedgwithgproximitygofgthegoffendinggcaregivergtogthegchild.gThe
gmothergmaygpresentgasgagdevotedgorgevengmodelgparentgwhogformsgclosegrelationshipsgwithgmembersgofgtheghealthgc
aregteam.gWhilegappearinggveryginterestedginghergchild'sgcondition,gshegmaygbegrelativelygdistantgemotionally.g(SeegChapter
g37,gpageg146.)
4. Whichg statementg isg false?
■ MalnutritiongisgthegsecondgleadinggcausegofgacquiredgimmunegdeficiencygworldwidegbehindgHIVginfection
□Zincgisgimportantgingimmunegfunctiongandglinearggrowth
□Kwashiorkorgandgmarasmusgaregraregingdevelopedgcountries
□ThegWesterngdietgisgassociatedgwithgincreasedgnoncommunicablegdisease
descriptiongThegsignificantgglobalgburdengofgmalnutritiongandgundernutritiongisgthegleadinggworldwidegcausegofgacquiredgim
munodeficiencygandgthegmajorgunderlyinggfactorgforgmorbiditygandgmortalityggloballygforgchildreng<5gyrgofgage.gZincgisgagmi
cronutrientgthatgsupportsgmultiplegmetabolicgfunctionsgingthegbody,gisgessentialgforgnormalgimmunegfunctioning,gandgisgrequir
edgtogsupportglinearggrowth;gzincgdeficiencygisgassociatedgwithgimpairedgimmunegfunctioninggandgpoorglinearggrowth.gIngpara
llelgtogthegriskgforgnutrientgandgenergygdeficiencies,gissuesgrelatinggtogexcessesgposegimportantgchallengesgbecausegofgtheirgne
gativeghealthgeffects,gsuchgasgobesitygorgcardiovasculargdiseasegriskgfactors.gThegnutritiongtransitiongundergwaygingthe
, developinggworldgfromgtraditionalgdietsgtogthegWesterngdietghasgbeengassociatedgwithgincreasesgingnoncommunicablegdisea
ses,goftengcoexistinggwithgundernutritiongandgmalnutrition,gobservedgsometimesgingthegsamegcommunitiesgorgevengthegsamegf
amilies.g(Seege41-1.)
5. Componentsg ofg energyg expenditureg ing childreng include:
□Thermalgeffectgofgfood
□Basalgmetabolicgrate
□Energygforgphysicalgactivity
□Energygtog supportg growth
■ Allgofgthegabove
descriptiongTheg3gcomponentsgofgenergygexpendituregingadultsgaregthegbasalgmetabolicgrate,gthegthermalgeffectgofgfo
odg(energygrequiredgforgdigestiongandgabsorption),gandgenergygforgphysicalgactivity.gAdditionalgenergygintakegandgexpendit
uregaregrequiredgtogsupportggrowthgandgdevelopmentgforgchildren.g(Seege41-4.)
6. WhichgofgthegfollowinggclinicalgscenariosgincreasesgthegriskgofgvitamingAgdeficiency?
□Vegetariangdiet
□Chronicgintestinalg disorders
□Zincg deficiency
■ BgandgC
□Allgofgthegabove
descriptiongVitamingAgisgangessentialgmicronutrientgbecausegitgcannotgbegbiogeneratedgdegnovogbyganimals.gItgmustg
begobtainedgfromgplantsgingthegformgofgprovitamin-
Agcarotenoids.gIngthegUSA,ggrainsgandgvegetablesgsupplygapproximatelyg55%gandgdairygandgmeatgproductsgsupplygapp
roximatelyg30%gofgvitamingAgintakegfromgfood.gVitamingAgandgthegprovitamins-
Agaregfatgsoluble,gandgtheirgabsorptiongdependsgongthegpresencegofgadequateglipidgandgproteingwithingthegmeal.g Chronicgint
estinalgdisordersgorglipidgmalabsorptiongsyndromesgcangresultgingvitamingAgdeficiency.gIngdevelopinggcountries,gsubclinicalg
orgclinicalgzincgdeficiencygcangincreasegthegriskgofgvitamingAgdeficiency.gTheregisgalsogsomegevidencegofgmarginalgzincgint
akesgingchildrengingthegUSA.g(SeegChapterg45,gpageg188.)
7. Whichg statementg aboutg vitaming Ag toxicityg isg NOTg true?
1. Whichg ofg theg followingg statementsg regardingg fosterg careg isg true?
□Agpermanencygplangmustgbegmadegforgagchildgingfostergcaregnoglatergthang12gmogfromgthegchild'sgentrygintogcare
□Agminoritygofgchildrengingfostergcareghavegaghistorygofgabusegorgneglect
□Thegmissiongofgfostergcaregisgtogsafelygcaregforgchildrengwhilegprovidinggservicesgtogfamiliesgtogpromotegreunification
□Mostg(>70%)gofgchildrengingfostergcaregaregreunitedgwithgtheirgfamilies
■ AgandgC
descriptiongThegmissiongofgfostergcaregisgtogprovidegforgtheghealth,gsafety,gandgwell-
beinggofgchildrengwhilegassistinggtheirgfamiliesgwithgservicesgtogpromotegreunification.gChildrengenteringgfostergcareghavegfr
equentlygexperiencedgearlygchildhoodgtrauma.gMoregthang70%ghavegaghistorygofgabuse,gneglect,gorgboth.gOnlygaboutg50%g
ofgchildrengachievegreunification.gIngthegUSA,gthegAdoptiongandgSafegFamiliesgActg(P.L.g105-
89)gpassedging1997grequiresgthatgagpermanencygplangbegmadegforgeachgchildgnoglatergthang12gmogaftergentrygtogfostergcar
egandgthatgagpetitiongtogterminategparentalgrightsgtypicallygmustgbegfiledgwhengagchildghasgbeengingfostergcaregforgatgleastg1
5gofgthegpreviousg22gmo.g(SeegChapterg35,gpageg134,gandge35-1.)
2. Ag4gyrgoldggirlgisgadmittedgtogtheghospitalgforghergthirdgevaluationgforgvaginalgbleeding.gThe
mothergnotedgbrightgredgbloodgongthegchild'sgunderwear.gPreviousgexaminationsgrevealedgagn
ormalg4gyrgoldggirl,gTannergstageg1,gwithgnormalgexternalggenitalia.gPelvicgultrasoundgresultsgw
eregnormal,gasgwasgthegserumgestradiolglevel.gTheghemoglobingandgplateletgcountsgweregnorm
al,gasgweregthegbleedinggtimegandgcoagulationgstudies.gFindingsgongpelvicgexaminationgconduc
tedgunderganesthesiagalsogweregnormal.gThegnextgstepgingthegexaminationgisgto:
■ Determinegthegbloodgtypegofgthegbloodgongthegunderwear
□Interrogateg theg father
□Isolategthegparentsgandgchild
□Determineg vong Willebrandg factorg levels
, □Measureg fibronecting ingthegvagina
descriptiongConsiderationgofgfactitiousgdisordergbygproxygshouldgbegtriggeredgwhengthegreportedgsymptomsgaregrepeated
lygnotedgbygonlygonegparent,gappropriategtestinggfailsgtogconfirmgagdiagnosis,gandgseeminglygappropriategtreatmentgisgineffecti
ve.g Atgtimes,gthegchild'sgsymptoms,gtheirgcourse,gorgthegresponsegtogtreatmentgmaygbegincompatiblegwithganygrecognizedgdise
ase.g Preverbalgchildrengaregusuallyginvolved.gBleedinggisgagparticularlygcommongpresentation.gThisgmaygbegcausedgbygaddin
ggdyesg togsamples,gaddinggbloodg(e.g.,gfromgthegmother)gtogthegchild'sgsample,gorggivinggthegchildganganticoagulantg(e.g.,g
warfarin).g(SeegChapterg37,gpageg146.)
3. Munchauseng syndromeg byg proxyg isg characterizedg byg allg ofg theg followingg EXCEPT:
□Mothergwhogappearsgdevotedgandgwinsgovergmembersgofgcaregteam
□Multipleg hospitalizationsg andg investigationsg withoutg diagnosis
□Symptomsgonghistorygbutgnotgwitnessedgbygmedicalgteam
■ Symptomsgoccurringgingpresencegofgdifferentgcaregiversg(e.g.,gwhilegmothergisgoutgofgtown)
□Usegofgmedicationsgorgtoxins
descriptiongSymptomsgingyounggchildrengaregmostlygassociatedgwithgproximitygofgthegoffendinggcaregivergtogthegchild.gThe
gmothergmaygpresentgasgagdevotedgorgevengmodelgparentgwhogformsgclosegrelationshipsgwithgmembersgofgtheghealthgc
aregteam.gWhilegappearinggveryginterestedginghergchild'sgcondition,gshegmaygbegrelativelygdistantgemotionally.g(SeegChapter
g37,gpageg146.)
4. Whichg statementg isg false?
■ MalnutritiongisgthegsecondgleadinggcausegofgacquiredgimmunegdeficiencygworldwidegbehindgHIVginfection
□Zincgisgimportantgingimmunegfunctiongandglinearggrowth
□Kwashiorkorgandgmarasmusgaregraregingdevelopedgcountries
□ThegWesterngdietgisgassociatedgwithgincreasedgnoncommunicablegdisease
descriptiongThegsignificantgglobalgburdengofgmalnutritiongandgundernutritiongisgthegleadinggworldwidegcausegofgacquiredgim
munodeficiencygandgthegmajorgunderlyinggfactorgforgmorbiditygandgmortalityggloballygforgchildreng<5gyrgofgage.gZincgisgagmi
cronutrientgthatgsupportsgmultiplegmetabolicgfunctionsgingthegbody,gisgessentialgforgnormalgimmunegfunctioning,gandgisgrequir
edgtogsupportglinearggrowth;gzincgdeficiencygisgassociatedgwithgimpairedgimmunegfunctioninggandgpoorglinearggrowth.gIngpara
llelgtogthegriskgforgnutrientgandgenergygdeficiencies,gissuesgrelatinggtogexcessesgposegimportantgchallengesgbecausegofgtheirgne
gativeghealthgeffects,gsuchgasgobesitygorgcardiovasculargdiseasegriskgfactors.gThegnutritiongtransitiongundergwaygingthe
, developinggworldgfromgtraditionalgdietsgtogthegWesterngdietghasgbeengassociatedgwithgincreasesgingnoncommunicablegdisea
ses,goftengcoexistinggwithgundernutritiongandgmalnutrition,gobservedgsometimesgingthegsamegcommunitiesgorgevengthegsamegf
amilies.g(Seege41-1.)
5. Componentsg ofg energyg expenditureg ing childreng include:
□Thermalgeffectgofgfood
□Basalgmetabolicgrate
□Energygforgphysicalgactivity
□Energygtog supportg growth
■ Allgofgthegabove
descriptiongTheg3gcomponentsgofgenergygexpendituregingadultsgaregthegbasalgmetabolicgrate,gthegthermalgeffectgofgfo
odg(energygrequiredgforgdigestiongandgabsorption),gandgenergygforgphysicalgactivity.gAdditionalgenergygintakegandgexpendit
uregaregrequiredgtogsupportggrowthgandgdevelopmentgforgchildren.g(Seege41-4.)
6. WhichgofgthegfollowinggclinicalgscenariosgincreasesgthegriskgofgvitamingAgdeficiency?
□Vegetariangdiet
□Chronicgintestinalg disorders
□Zincg deficiency
■ BgandgC
□Allgofgthegabove
descriptiongVitamingAgisgangessentialgmicronutrientgbecausegitgcannotgbegbiogeneratedgdegnovogbyganimals.gItgmustg
begobtainedgfromgplantsgingthegformgofgprovitamin-
Agcarotenoids.gIngthegUSA,ggrainsgandgvegetablesgsupplygapproximatelyg55%gandgdairygandgmeatgproductsgsupplygapp
roximatelyg30%gofgvitamingAgintakegfromgfood.gVitamingAgandgthegprovitamins-
Agaregfatgsoluble,gandgtheirgabsorptiongdependsgongthegpresencegofgadequateglipidgandgproteingwithingthegmeal.g Chronicgint
estinalgdisordersgorglipidgmalabsorptiongsyndromesgcangresultgingvitamingAgdeficiency.gIngdevelopinggcountries,gsubclinicalg
orgclinicalgzincgdeficiencygcangincreasegthegriskgofgvitamingAgdeficiency.gTheregisgalsogsomegevidencegofgmarginalgzincgint
akesgingchildrengingthegUSA.g(SeegChapterg45,gpageg188.)
7. Whichg statementg aboutg vitaming Ag toxicityg isg NOTg true?
