, Nelson Pediatrics Review(MCQs) 19 Edition d d d d
1. Which of the following statements regarding foster care is true?
d d d d d d d d d
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
d d d d d d d d d d d d d d d d d d d d d d
□A minority of children in foster care have a history of abuse or neglect
d d d d d d d d d d d d d
□The mission of foster care is to safely care for children while providing services to families to promote reunification
d d d d d d d d d d d d d d d d d d
□Most (>70%) of children in foster care are reunited with their families
d d d d d d d d d d d
■ A and C d d
description The mission of foster care is to provide for the health, safety, and well-being of children while
d d d d d d d d d d d d d d d d d
dassistingtheir families with services to promote reunification. Children entering foster care have frequently
d d d d d d d d d d d d d
dexperienced early childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about
d d d d d d d d d d d d d d d d
d 50% of children achieve reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed
d d d d d d d d d d d d d d d d
din 1997 requires that a permanency plan be made for each child no later than 12 mo after entry to foster care
d d d d d d d d d d d d d d d d d d d d d
dand that a petition to terminate parental rights typically must be filedwhen a child has been in foster care for at
d d d d d d d d d d d d d d d d d d d d
dleast 15 of the previous22 mo. (See Chapter 35, page 134, and e35-1.)
d d d d d d d d d d d d d
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
d d d d d d d d d d d d d d d d d
mother noted bright red blood on the child's underwear. Previous examinations
d d d d d d d d d d
drevealed anormal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic
d d d d d d d d d d d d d d
ultrasound resultswere normal, as was the serum estradiol level. The hemoglobin and
d d d d d d d d d d d d
dplatelet counts were normal, as were the bleeding time and coagulation studies. Findings on
d d d d d d d d d d d d d
pelvic examination conducted under anesthesia also were normal. The next step in the
d d d d d dd d d dd dd d d d
examination is to:
d d d
■ Determine the blood type of the blood on the underwear
d d d d d d d d d
□Interrogate the father d d
□Isolate the parents and child
d d d d
□Determine von Willebrand factor levels d d d d
, □Measure fibronectin in the vagina d d d d
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
d d d d d d d d d d d d d d
drepeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
d d d d d d d d d d d d d d d
dtreatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
d d d d d d d d d d d d d d d d
dincompatible with any recognized disease.Preverbal children are usually involved. Bleeding is a particularly
d d d d d d d d d d d d
d common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
d d d d d d d d d d d d d d d d d d
dchild's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
d d d d d d d d d d d d d d
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:d d d d d d d d d d d
□Mother who appears devoted and wins over members of care team
d d d d d d d d d d
□Multiple hospitalizations d d and investigations without diagnosis
d d d
□Symptoms on history but not witnessed by medical team
d d d d d d d d
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
d d d d d d d d d d d d d
□Use of medications or toxins
d d d d
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
d d d d d d d d d d d d d d d
dchild.The mother may present as a devoted or even model parent who forms close relationships with members
d d d d d d d d d d d d d d d d d
dof the health care team. While appearing very interested in her child's condition, she may be relatively distant
d d d d d d d d d d d d d d d d d
demotionally. (See Chapter 37, page 146.) d d d d d
4. Which statement is false? d d d
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
d d d d d d d d d d d d d
□Zinc is important in
d d d d immune function and linear growth d d d d
□Kwashiorkor and marasmus are rare in developed countries d d d d d d d
□The d Western diet is associated with increased noncommunicable disease
d d d d d d d
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
d d d d d d d d d d d d d d
dacquiredimmunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of
d d d d d d d d d d d d d d d d
dage. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune
d d d d d d d d d d d d d d d d d
dfunctioning, and is required to support linear growth; zinc deficiency is associated with impaired immune
d d d d d d d d d d d d d d
dfunctioning and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to
d d d d d d d d d d d d d d d d d
dexcesses pose important challenges because of theirjnegative health effects, such as obesity or cardiovascular disease
d d d d d d d d d d d d d d
drisk factors. The nutrition transition under way in the
d d d d d d d d
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
d d d d d d d d d d d d d d d
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even
d d d d d d d d d d d d d d d
thesame families. (See e41-1.)
d d d d
5. Components of energy expenditure in children include: d d d d d d
□Thermal effect of food d d d
□Basal d metabolic rate d
□Energy d for physical activity
d d
□Energy to support growth d d d
■ All of the above
d d d
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect
d d d d d d d d d d d d d d d d
of food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
d d d d d d d d d d d d d d d d d
expenditure are required to support growth and development for children. (See e41-4.)
d d d d d d d d d d d d
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
d d d d d d d d d d d d
□Vegetarian d diet
□Chronic intestinal disorders d d
□Zinc deficiency d
■ B and C
d d
□All of the above
d d d
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
d d d d d d d d d d d d d d d d
must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
d d d d d d d d d d d d d d d d d
supplyapproximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
d d d d d d d d d d d d d d d d
food.
d
Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
d d d d d d d d d d d d d d d d
lipidand protein within the meal.Chronic intestinal disorders or lipid malabsorption syndromes can result in
d d d d d d d d d d d d d d d
vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of
d d d d d d d d d d d d d d d d
vitamin A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See Chapter
d d d d d d d d d d d d d d d d d d d
45, page
d d
188.)
d
1. Which of the following statements regarding foster care is true?
d d d d d d d d d
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
d d d d d d d d d d d d d d d d d d d d d d
□A minority of children in foster care have a history of abuse or neglect
d d d d d d d d d d d d d
□The mission of foster care is to safely care for children while providing services to families to promote reunification
d d d d d d d d d d d d d d d d d d
□Most (>70%) of children in foster care are reunited with their families
d d d d d d d d d d d
■ A and C d d
description The mission of foster care is to provide for the health, safety, and well-being of children while
d d d d d d d d d d d d d d d d d
dassistingtheir families with services to promote reunification. Children entering foster care have frequently
d d d d d d d d d d d d d
dexperienced early childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about
d d d d d d d d d d d d d d d d
d 50% of children achieve reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed
d d d d d d d d d d d d d d d d
din 1997 requires that a permanency plan be made for each child no later than 12 mo after entry to foster care
d d d d d d d d d d d d d d d d d d d d d
dand that a petition to terminate parental rights typically must be filedwhen a child has been in foster care for at
d d d d d d d d d d d d d d d d d d d d
dleast 15 of the previous22 mo. (See Chapter 35, page 134, and e35-1.)
d d d d d d d d d d d d d
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
d d d d d d d d d d d d d d d d d
mother noted bright red blood on the child's underwear. Previous examinations
d d d d d d d d d d
drevealed anormal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic
d d d d d d d d d d d d d d
ultrasound resultswere normal, as was the serum estradiol level. The hemoglobin and
d d d d d d d d d d d d
dplatelet counts were normal, as were the bleeding time and coagulation studies. Findings on
d d d d d d d d d d d d d
pelvic examination conducted under anesthesia also were normal. The next step in the
d d d d d dd d d dd dd d d d
examination is to:
d d d
■ Determine the blood type of the blood on the underwear
d d d d d d d d d
□Interrogate the father d d
□Isolate the parents and child
d d d d
□Determine von Willebrand factor levels d d d d
, □Measure fibronectin in the vagina d d d d
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
d d d d d d d d d d d d d d
drepeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
d d d d d d d d d d d d d d d
dtreatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
d d d d d d d d d d d d d d d d
dincompatible with any recognized disease.Preverbal children are usually involved. Bleeding is a particularly
d d d d d d d d d d d d
d common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
d d d d d d d d d d d d d d d d d d
dchild's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
d d d d d d d d d d d d d d
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:d d d d d d d d d d d
□Mother who appears devoted and wins over members of care team
d d d d d d d d d d
□Multiple hospitalizations d d and investigations without diagnosis
d d d
□Symptoms on history but not witnessed by medical team
d d d d d d d d
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
d d d d d d d d d d d d d
□Use of medications or toxins
d d d d
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
d d d d d d d d d d d d d d d
dchild.The mother may present as a devoted or even model parent who forms close relationships with members
d d d d d d d d d d d d d d d d d
dof the health care team. While appearing very interested in her child's condition, she may be relatively distant
d d d d d d d d d d d d d d d d d
demotionally. (See Chapter 37, page 146.) d d d d d
4. Which statement is false? d d d
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
d d d d d d d d d d d d d
□Zinc is important in
d d d d immune function and linear growth d d d d
□Kwashiorkor and marasmus are rare in developed countries d d d d d d d
□The d Western diet is associated with increased noncommunicable disease
d d d d d d d
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
d d d d d d d d d d d d d d
dacquiredimmunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of
d d d d d d d d d d d d d d d d
dage. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune
d d d d d d d d d d d d d d d d d
dfunctioning, and is required to support linear growth; zinc deficiency is associated with impaired immune
d d d d d d d d d d d d d d
dfunctioning and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to
d d d d d d d d d d d d d d d d d
dexcesses pose important challenges because of theirjnegative health effects, such as obesity or cardiovascular disease
d d d d d d d d d d d d d d
drisk factors. The nutrition transition under way in the
d d d d d d d d
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
d d d d d d d d d d d d d d d
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even
d d d d d d d d d d d d d d d
thesame families. (See e41-1.)
d d d d
5. Components of energy expenditure in children include: d d d d d d
□Thermal effect of food d d d
□Basal d metabolic rate d
□Energy d for physical activity
d d
□Energy to support growth d d d
■ All of the above
d d d
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect
d d d d d d d d d d d d d d d d
of food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
d d d d d d d d d d d d d d d d d
expenditure are required to support growth and development for children. (See e41-4.)
d d d d d d d d d d d d
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
d d d d d d d d d d d d
□Vegetarian d diet
□Chronic intestinal disorders d d
□Zinc deficiency d
■ B and C
d d
□All of the above
d d d
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
d d d d d d d d d d d d d d d d
must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
d d d d d d d d d d d d d d d d d
supplyapproximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
d d d d d d d d d d d d d d d d
food.
d
Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
d d d d d d d d d d d d d d d d
lipidand protein within the meal.Chronic intestinal disorders or lipid malabsorption syndromes can result in
d d d d d d d d d d d d d d d
vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of
d d d d d d d d d d d d d d d d
vitamin A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See Chapter
d d d d d d d d d d d d d d d d d d d
45, page
d d
188.)
d
