Test bank for MCQs in Pediatrics Review of NelsonText
i i i i i i i i i
bookof Pediatrics 20 Edition
i i i i
, Nelson Pediatrics Review(MCQs) 19 Edition
i i i i
1. Whichiofitheifollowingistatementsiregardingifostericareiisitrue?
□A permanency planmust bemade for a childin foster care nolater than 12 mo fromthe child's entryinto care
i i i i i i i i i i i i i i i i i i
□Aminorityofchildreninfostercarehaveahistory of abuseorneglect i i
□Themissionoffostercareistosafelycareforchildren i whileprovidingservicestofamiliestopromotereunification
□Most(>70%)ofchildrenin fostercarearereunitedwiththeirfamilies
i
■ AiandiC
descriptioniTheimissioniofifostericareiisitoiprovideiforitheihealth,isafety,iandiwell-
beingiofichildreniwhileiassistingitheirifamiliesiwithiservicesitoipromoteireunification.iChildrenienteringifostericareihaveifrequentlyiex
periencediearlyichildhooditrauma.iMoreithani70%ihaveiaihistoryiofiabuse,ineglect,ioriboth.iOnlyiabouti50%iofichildreniachieveireuni
fication.iInithei USA,itheiAdoptioniandiSafeiFamiliesiActi(P.L.i105-
89)ipassediini1997irequiresithatiaipermanencyiplanibeimadeifori eachchildinoilaterithani12imoiafterientryitoifostericareandthatapetit
ionitoiterminateparentalirightsitypicallymustibeifiledi wheniaichildi hasibeeniinifostericareiforiatileasti15iofitheipreviousi22imo.i(Seei
Chapteri35,ipagei134,iandie35-1.)
2. Ai4iyrioldigirliisiadmitteditoitheihospitaliforiherithirdievaluationiforivaginalibleeding.iTheimothe
ri notedi brighti redi bloodi onithei child'si underwear.i Previousi examinationsi revealedi a
normali4iyrioldigirl,iTanneristagei1,iwithinormaliexternaligenitalia.iPelviciultrasoundiresultsi were
normal,iasiwasitheiserumiestradiolilevel.iTheihemoglobiniandiplateleticountsiwerei normal,iasiwereith
eibleedingitimeiandicoagulationistudies.iFindingsionipelviciexaminationiconductediunderianesthesi
aialsoiwereinormal.iTheinextistepiinitheiexaminationiisito:
■ Determineitheiblooditypeiofitheibloodionitheiunderwear
□Interrogate the father
i i
□Isolate the parents and child
i i i i
□DeterminevonWillebrand factorlevels
i i i i
, □Measurefibronectin inthevagina
i i i
descriptioniConsiderationiofifactitiousidisorderibyiproxyishouldibeitriggerediwhenitheireportedisymptomsiareirepeatedlyinotedbyonl
yoneparent,appropriatetestingifailstoconfirmadiagnosis,andseeminglyappropriatetreatmentisiineffective.
Attimes,thechild'ssymptoms,theircourse,iortheresponsetoitreatmentmaybeincompatiblewithianyrecognizeddisease.iPreverba
lchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes
tois
amples,iaddingibloodi(e.g.,ifromitheimother)itoitheichild'sisample,iorigivingitheichildianianticoagulanti(e.g.,iwarfarin).i (SeeiChapt
eri37,ipagei146.)
3. MunchausenisyndromeibyiproxyiisicharacterizedibyialliofitheifollowingiEXCEPT:
□Mother who appears devoted and wins over members of careteam
i i i i i i i i i i
□Multiple hospitalizations and investigations without diagnosis
i i i i i
□Symptomsonhistorybutnotwitnessedbymedicalteam
■ Symptomsoccurringiinipresenceiofdifferenticaregiversi(e.g.,iwhileimotherisoutiofitown)
□Use of medications or toxins
i i i i
descriptioniSymptomsiiniyoungichildreniareimostlyiassociatediwithiproximityiofitheioffendingicaregiveritoitheichild.iTheimothe
rimayipresentiasiaidevotediorievenimodeliparentiwhoiformsicloseirelationshipsiwithimembersiofitheihealthicareiteam.iWhilei
appearingiveryiinterestediiniherichild'sicondition,isheimayibeirelativelyidistantiemotionally.i(SeeiChapteri37,i pagei146.)
4. Whichistatementiisifalse?
■ Malnutritioniisitheisecondileadingicauseiofiacquirediimmuneideficiencyiworldwidei behindi HIViinfection
□Zinc is important in immune function and linear growth
i i i i i i i i
□Kwashiorkor and marasmus are rare in developed countries
i i i i i i i
□The Western diet is associated with increased noncommunicable disease
i i i i i i i i
descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquirediimmun
odeficiencyandthemajorunderlyingfactorformorbidityandmortalitygloballyforchildren i<5iyriofage.iZincisaimicronutrientthatsu
pportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis irequireditosupportlineargrowth;zin
cdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.Iniparalleltoitheriskfornutrientandenergydeficie
ncies,issuesrelatingtoiexcessesposeimportantchallengesbecauseoftheirinegativeihealtheffects,isuchiasiobesityioricardiovasculari
diseaseiriskifactors.iTheinutritionitransitioniunderiwayiinithe
, developingiworldifromitraditionalidietsitoitheiWesternidietihasibeeniassociatediwithiincreasesiininoncommunicableidiseases,iofteni
coexistingiwithiundernutritioniandimalnutrition,iobservedisometimesiinitheisameicommunitiesiorievenitheisameifamilies.i(Seeie41-
1.)
5. Componentsiofienergyiexpenditureiinichildreniinclude:
□Thermal effect offood i i
□Basal metabolic rate
i i
□Energy for physical activity
i i i
□Energyto support growth
i i i
■ Alliofitheiabove
descriptioniThei3icomponentsiofienergyiexpenditureiiniadultsiareitheibasalimetabolicirate,itheithermalieffectiofifoodi(ener
gyirequirediforidigestioniandiabsorption),iandienergyiforiphysicaliactivity.iAdditionalienergyiintakeiandiexpenditureiiareirequiredit
oisupportigrowthiandidevelopmentiforichildren.i(Seeie41-4.)
6. Whichiofitheifollowingiclinicaliscenariosi increasesitheiriskiofivitaminiAideficiency?
□Vegetarian diet i
□Chronic intestinal disorders
i i
□Zinc deficiency
i
■ BiandiC
□Allof theabove
i i i
descriptioniVitaminiAiisianiessentialimicronutrientibecauseiiticannotibeibiogeneratedideinovoibyianimals.iItimustibeiobtainedi
fromiplantsiinitheiformiofiprovitamin-
Aicarotenoids.iInitheiUSA,igrainsiandivegetablesisupplyiapproximatelyi55%iandidairyiandimeatiproductsisupplyiapproximatelyi
30%iofivitaminiAiintakeifromifood.iVitaminiAiandithei provitamins-
Aiarefatsoluble,iandtheirabsorptiondependsionthepresenceofiadequatelipidandproteinwithinthemeal.
ChroniciintestinalidisordersiorilipidimalabsorptionisyndromesicaniresultiinivitaminiAideficiency.iInidevelopingicountries,isubclinicalior
clinicalizincdeficiencycanincreasetheriskiofvitaminiAdeficiency.iThereisialsoisomeevidenceofimarginali zinciintakesiinichildreni
initheiUSA.i(SeeiChapteri45,ipagei188.)
7. WhichistatementiaboutivitaminiAitoxicityiisiNOTitrue?
i i i i i i i i i
bookof Pediatrics 20 Edition
i i i i
, Nelson Pediatrics Review(MCQs) 19 Edition
i i i i
1. Whichiofitheifollowingistatementsiregardingifostericareiisitrue?
□A permanency planmust bemade for a childin foster care nolater than 12 mo fromthe child's entryinto care
i i i i i i i i i i i i i i i i i i
□Aminorityofchildreninfostercarehaveahistory of abuseorneglect i i
□Themissionoffostercareistosafelycareforchildren i whileprovidingservicestofamiliestopromotereunification
□Most(>70%)ofchildrenin fostercarearereunitedwiththeirfamilies
i
■ AiandiC
descriptioniTheimissioniofifostericareiisitoiprovideiforitheihealth,isafety,iandiwell-
beingiofichildreniwhileiassistingitheirifamiliesiwithiservicesitoipromoteireunification.iChildrenienteringifostericareihaveifrequentlyiex
periencediearlyichildhooditrauma.iMoreithani70%ihaveiaihistoryiofiabuse,ineglect,ioriboth.iOnlyiabouti50%iofichildreniachieveireuni
fication.iInithei USA,itheiAdoptioniandiSafeiFamiliesiActi(P.L.i105-
89)ipassediini1997irequiresithatiaipermanencyiplanibeimadeifori eachchildinoilaterithani12imoiafterientryitoifostericareandthatapetit
ionitoiterminateparentalirightsitypicallymustibeifiledi wheniaichildi hasibeeniinifostericareiforiatileasti15iofitheipreviousi22imo.i(Seei
Chapteri35,ipagei134,iandie35-1.)
2. Ai4iyrioldigirliisiadmitteditoitheihospitaliforiherithirdievaluationiforivaginalibleeding.iTheimothe
ri notedi brighti redi bloodi onithei child'si underwear.i Previousi examinationsi revealedi a
normali4iyrioldigirl,iTanneristagei1,iwithinormaliexternaligenitalia.iPelviciultrasoundiresultsi were
normal,iasiwasitheiserumiestradiolilevel.iTheihemoglobiniandiplateleticountsiwerei normal,iasiwereith
eibleedingitimeiandicoagulationistudies.iFindingsionipelviciexaminationiconductediunderianesthesi
aialsoiwereinormal.iTheinextistepiinitheiexaminationiisito:
■ Determineitheiblooditypeiofitheibloodionitheiunderwear
□Interrogate the father
i i
□Isolate the parents and child
i i i i
□DeterminevonWillebrand factorlevels
i i i i
, □Measurefibronectin inthevagina
i i i
descriptioniConsiderationiofifactitiousidisorderibyiproxyishouldibeitriggerediwhenitheireportedisymptomsiareirepeatedlyinotedbyonl
yoneparent,appropriatetestingifailstoconfirmadiagnosis,andseeminglyappropriatetreatmentisiineffective.
Attimes,thechild'ssymptoms,theircourse,iortheresponsetoitreatmentmaybeincompatiblewithianyrecognizeddisease.iPreverba
lchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes
tois
amples,iaddingibloodi(e.g.,ifromitheimother)itoitheichild'sisample,iorigivingitheichildianianticoagulanti(e.g.,iwarfarin).i (SeeiChapt
eri37,ipagei146.)
3. MunchausenisyndromeibyiproxyiisicharacterizedibyialliofitheifollowingiEXCEPT:
□Mother who appears devoted and wins over members of careteam
i i i i i i i i i i
□Multiple hospitalizations and investigations without diagnosis
i i i i i
□Symptomsonhistorybutnotwitnessedbymedicalteam
■ Symptomsoccurringiinipresenceiofdifferenticaregiversi(e.g.,iwhileimotherisoutiofitown)
□Use of medications or toxins
i i i i
descriptioniSymptomsiiniyoungichildreniareimostlyiassociatediwithiproximityiofitheioffendingicaregiveritoitheichild.iTheimothe
rimayipresentiasiaidevotediorievenimodeliparentiwhoiformsicloseirelationshipsiwithimembersiofitheihealthicareiteam.iWhilei
appearingiveryiinterestediiniherichild'sicondition,isheimayibeirelativelyidistantiemotionally.i(SeeiChapteri37,i pagei146.)
4. Whichistatementiisifalse?
■ Malnutritioniisitheisecondileadingicauseiofiacquirediimmuneideficiencyiworldwidei behindi HIViinfection
□Zinc is important in immune function and linear growth
i i i i i i i i
□Kwashiorkor and marasmus are rare in developed countries
i i i i i i i
□The Western diet is associated with increased noncommunicable disease
i i i i i i i i
descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquirediimmun
odeficiencyandthemajorunderlyingfactorformorbidityandmortalitygloballyforchildren i<5iyriofage.iZincisaimicronutrientthatsu
pportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis irequireditosupportlineargrowth;zin
cdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.Iniparalleltoitheriskfornutrientandenergydeficie
ncies,issuesrelatingtoiexcessesposeimportantchallengesbecauseoftheirinegativeihealtheffects,isuchiasiobesityioricardiovasculari
diseaseiriskifactors.iTheinutritionitransitioniunderiwayiinithe
, developingiworldifromitraditionalidietsitoitheiWesternidietihasibeeniassociatediwithiincreasesiininoncommunicableidiseases,iofteni
coexistingiwithiundernutritioniandimalnutrition,iobservedisometimesiinitheisameicommunitiesiorievenitheisameifamilies.i(Seeie41-
1.)
5. Componentsiofienergyiexpenditureiinichildreniinclude:
□Thermal effect offood i i
□Basal metabolic rate
i i
□Energy for physical activity
i i i
□Energyto support growth
i i i
■ Alliofitheiabove
descriptioniThei3icomponentsiofienergyiexpenditureiiniadultsiareitheibasalimetabolicirate,itheithermalieffectiofifoodi(ener
gyirequirediforidigestioniandiabsorption),iandienergyiforiphysicaliactivity.iAdditionalienergyiintakeiandiexpenditureiiareirequiredit
oisupportigrowthiandidevelopmentiforichildren.i(Seeie41-4.)
6. Whichiofitheifollowingiclinicaliscenariosi increasesitheiriskiofivitaminiAideficiency?
□Vegetarian diet i
□Chronic intestinal disorders
i i
□Zinc deficiency
i
■ BiandiC
□Allof theabove
i i i
descriptioniVitaminiAiisianiessentialimicronutrientibecauseiiticannotibeibiogeneratedideinovoibyianimals.iItimustibeiobtainedi
fromiplantsiinitheiformiofiprovitamin-
Aicarotenoids.iInitheiUSA,igrainsiandivegetablesisupplyiapproximatelyi55%iandidairyiandimeatiproductsisupplyiapproximatelyi
30%iofivitaminiAiintakeifromifood.iVitaminiAiandithei provitamins-
Aiarefatsoluble,iandtheirabsorptiondependsionthepresenceofiadequatelipidandproteinwithinthemeal.
ChroniciintestinalidisordersiorilipidimalabsorptionisyndromesicaniresultiinivitaminiAideficiency.iInidevelopingicountries,isubclinicalior
clinicalizincdeficiencycanincreasetheriskiofvitaminiAdeficiency.iThereisialsoisomeevidenceofimarginali zinciintakesiinichildreni
initheiUSA.i(SeeiChapteri45,ipagei188.)
7. WhichistatementiaboutivitaminiAitoxicityiisiNOTitrue?
