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1. Which of the following statements regarding foster care is true?
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□Apermanencyplanmustbemadeforachildinfostercarenolaterthan12mofromthechild'sentryintocare
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□Aminorityofchildreninfostercarehaveahistoryofabuseorneglect
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□Themissionoffostercareistosafelycareforchildrenwhileprovidingservicestofamiliestopromotereunification
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□Most(>70%)ofchildreninfostercarearereunitedwiththeirfamilies
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■ Aand C v v




descriptionThemissionoffostercareistoprovideforthehealth,safety,andwell-beingofchildrenwhileassistingtheir families
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with services topromote reunification. Children enteringfoster care have frequentlyexperiencedearlychildhood trauma.More
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than70%haveahistoryofabuse,neglect,orboth.Onlyabout50%ofchildrenachievereunification.Inthe USA,theAdoption
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and SafeFamiliesAct(P.L.105-89)passedin1997requiresthatapermanencyplanbemadefor eachchildnolaterthan12
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moafterentrytofostercareandthatapetitiontoterminateparentalrightstypicallymustbefiled whenachild has beeninfoster
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careforatleast15 oftheprevious 22mo. (SeeChapter35,page134, ande35-1.)
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2. A4 yroldgirlisadmittedtothe hospitalfor herthird evaluationforvaginalbleeding.The
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mother noted bright red blood on the child's underwear. Previous examinations revealed a normal4yrold
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girl,Tannerstage1,withnormalexternalgenitalia.Pelvicultrasoundresults were normal, as was the serum
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estradiol level. The hemoglobin and platelet counts were normal, as were the bleeding time and
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coagulation studies. Findings on pelvic examination conducted under anesthesia also were normal. The
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next step in the examination is to:
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■ Determinethebloodtypeofthebloodontheunderwear v v v v v v v v v




□Interrogate the father v v




□Isolatetheparentsandchild v v v v




□DeterminevonWillebrandfactorlevels v v v v

, □Measurefibronectininthevagina v v v v




descriptionConsiderationoffactitiousdisorderbyproxyshouldbetriggeredwhenthereportedsymptomsarerepeatedly
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vnotedbyonlyoneparent,appropriatetestingfailstoconfirmadiagnosis,andseeminglyappropriatetreatmentisineffective.
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Attimes,thechild'ssymptoms,theircourse,ortheresponsetotreatmentmaybeincompatiblewithanyrecognizeddisease.
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vPreverbalchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes
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v tosamples,addingblood(e.g.,fromthemother)tothechild'ssample,orgivingthechildananticoagulant(e.g.,warfarin).
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v(See Chapter 37, page 146.)
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3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT: v v v v v v v v v v v




□Motherwhoappearsdevotedandwinsovermembersofcareteam
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□Multiple hospitalizations and investigations without diagnosis
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□Symptomsonhistorybutnotwitnessedbymedicalteam v v v v v v v v




■ Symptomsoccurringinpresenceofdifferentcaregivers(e.g.,whilemotherisoutoftown) v v v v v v v v v v v v v




□Useof medications ortoxins
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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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vmother may present as a devoted or even model parent who forms close relationships with members of the health care
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vteam. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Chapter 37,
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page 146.)
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4. Which statement is false? v v v




■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection v v v v v v v v v v v v v




□Zincisimportantinimmunefunctionandlineargrowth
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□Kwashiorkor and marasmus are rare in developed countries v v v v v v v




□The Western diet is associated with increased noncommunicable disease
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descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquired
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vimmunodeficiencyandthemajorunderlyingfactorformorbidityandmortalitygloballyforchildren<5yrofage.Zincisa v v v v v v v v v v v v v v v v v v v




vmicronutrientthatsupportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis v v v v v v v v v v v v v v v v




vrequiredtosupportlineargrowth;zincdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.In
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vparalleltotheriskfornutrientandenergydeficiencies,issuesrelatingtoexcessesposeimportantchallengesbecauseoftheir
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vnegativehealtheffects,suchas obesityorcardiovasculardiseaseriskfactors.Thenutritiontransitionunderwayinthe
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, developingworld from traditionaldietstotheWesterndiet hasbeenassociatedwith increases innoncommunicable
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vdiseases, often coexistingwith undernutrition and malnutrition, observedsometimes in the same communities or even the
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families. (See e41-1.)
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5. Components of energy expenditure in children include: v v v v v v




□Thermaleffectoffood v v v




□Basal metabolic rate v v




□Energy for physical activity v v v




□Energytosupportgrowth v v v




■ Alloftheabove
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description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of food
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v(energyrequiredfordigestionandabsorption),andenergyforphysicalactivity.Additionalenergyintakeandexpenditure
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vare required to support growth and development for children. (See e41-4.)
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6. Whichofthefollowingclinicalscenarios increasestheriskofvitaminAdeficiency?
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□Vegetarian diet v




□Chronic intestinal disorders v v




□Zinc deficiency v




■ B and C
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□Alloftheabove
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descriptionVitamin A isanessentialmicronutrientbecause itcannotbebiogeneratedde novoby animals.It mustbe
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vobtained fromplants inthe form ofprovitamin-Acarotenoids. IntheUSA,grainsand vegetablessupplyapproximately
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v55%anddairyandmeatproductssupplyapproximately30%ofvitaminA intakefromfood.VitaminAandthe
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vprovitamins-Aarefatsoluble,andtheirabsorptiondependsonthepresenceofadequatelipidandproteinwithinthemeal.
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Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. Indeveloping countries,
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vsubclinicalorclinicalzincdeficiencycanincreasetheriskofvitaminAdeficiency.Thereisalsosomeevidenceofmarginal zinc
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intakes in children in the USA. (See Chapter 45, page 188.)
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7. Which statement about vitamin A toxicity is NOT true?
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