***INSTANT DOWNLOAD***TEST BANK FOR NELSON PEDIATRICS REVIEW(MCQS) 19 EDITION

Test bank for MCQs in Pediatrics Review of Nelson
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Textbook of Pediatrics 20 Edition
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,1. Which of the following statements regarding foster care is true?
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□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
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□A minority of children in foster care have a history of abuse or neglect
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□The mission of foster care is to safely care for children while providing services to families to promote reunification
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□Most (>70%) of children in foster care are reunited with their families
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■ A and C b b




descriptionThe mission of foster careisto provide for the health, safety, and well-being ofchildren while assistingtheir families
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with services to promote reunification. Children entering foster care have frequently experienced early childhood trauma.More
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than70% have ahistoryofabuse,neglect, orboth. Onlyabout 50%of children achieve reunification. Inthe USA,theAdoption
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andSafe FamiliesAct(P.L. 105-89)passedin1997 requiresthatapermanencyplanbe madefor each child no later than 12 mo
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after entry to foster care and that a petition to terminate parental rights typically must be filed when a child hasbeenin foster care
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for at least 15 of the previous 22 mo. (SeeChapter 35,page 134, ande35-1.)
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2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
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mother noted bright red blood on the child's underwear. Previous examinations revealed a
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normal 4 yroldgirl,Tanner stage 1, with normalexternal genitalia. Pelvic ultrasound results were
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normal, as was the serum estradiol level. The hemoglobin and platelet counts were normal, as
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were the bleeding time and coagulation studies. Findings on pelvic examination conducted under
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anesthesia also were normal. The next step in the examination is to:
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■ Determine the blood type of the blood on the underwear b b b b b b b b b




□Interrogate the father b b




□Isolate the parentsandchild b b b b




□Determine von Willebrand factor levels b b b b

, □Measure fibronectin in the vagina b b b b




description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are repeatedly noted
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by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate treatment is ineffective. At times,
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the child's symptoms, their course, or the response to treatment may be incompatible with any recognized disease. Preverbal
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children are usually involved. Bleeding is a particularly common presentation. This may be caused by adding dyes to samples,
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addingblood (e.g., fromthe mother) tothe child'ssample, or givingthe child ananticoagulant (e.g.,warfarin). (See Chapter 37,
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page 146.)
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3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT: b b b b b b b b b b b




□Mother who appears devoted and wins over members of care team
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□Multiple hospitalizations and investigations without diagnosis
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□Symptoms on history but not witnessed by medical team b b b b b b b b




■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
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□Use of medications or toxins
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description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child. The
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mother may present as a devoted or even model parent who forms close relationships with members of the health care team.
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While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Chapter 37, page 146.)
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4. Which statement is false? b b b




■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
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□Zinc is important in immune function and linear growth
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□Kwashiorkor and marasmus are rare in developed countries b b b b b b b




□The Western diet is associated with increased noncommunicable disease
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description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of acquired
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immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of age. Zinc is a
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micronutrient that supports multiple metabolic functions in the body, is essential for normal immune functioning, and is required to
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support linear growth; zinc deficiency is associated with impaired immune functioning and poor linear growth. In parallel to the risk
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for nutrient and energy deficiencies, issues relating to excesses pose important challenges because of their negativehealtheffects,
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suchasobesityorcardiovasculardiseaseriskfactors.Thenutritiontransitionunderwayinthe
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, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable diseases,
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often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the same families.
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(See e41-1.)
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5. Components of energy expenditure in children include: b b b b b b




□Thermal effect of food b b b




□Basal metabolic rate b b




□Energy for physical activity b b b




□Energy to support growth b b b




■ All ofthe above b b b




description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of food (energy
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required for digestion and absorption), and energy for physical activity. Additional energy intake and expenditure are required
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to support growth and development for children. (See e41-4.)
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6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
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□Vegetarian diet b




□Chronic intestinal disorders b b




□Zinc deficiency b




■ B and C b b




□All of the above b b b




description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must be
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obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables supply approximately55%
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anddairyandmeatproductssupplyapproximately30%ofvitaminAintake fromfood. VitaminAandthe provitamins-A are
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fat soluble, and their absorption depends on the presence of adequate lipid and protein within the meal. Chronic intestinal
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disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In developing countries, subclinical or clinical zinc
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deficiency can increase the risk of vitamin A deficiency. There is also some evidence of marginal zinc intakes in children in the
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USA. (See Chapter 45, page 188.)
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7. Which statement about vitamin A toxicity is NOT true?
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