, Nelson .Pediatrics . Review(MCQs) .19 .Edition
1. Which . of . the . following . statements . regarding . foster . care . is . true?
□A .permanency .plan .must .be .made .for .a .child .in .foster .care .no .later .than .12 .mo .from .the .child's .entry .into .care
□A .minority .of .children .in .foster .care .have .a .history .of .abuse .or .neglect
□The .mission .of .foster .care .is .to .safely .care .for .children .while .providing .services .to .families .to .promote .reunification
□Most .(>70%) .of .children .in .foster .care .are .reunited .with .their .families
■ A .and .C
description .The .mission .of .foster .care .is .to .provide .for .the .health, .safety, .and .well-being .of .children .while .assisting
.their .families .with .services .to .promote .reunification. .Children .entering .foster .care .have .frequently .experienced .early
.childhood .trauma. .More .than .70% .have .a .history .of .abuse, .neglect, .or .both. .Only .about .50% .of .children .achieve
.reunification. .In .the .USA, .the .Adoption .and .Safe .Families .Act .(P.L. .105-89) .passed .in .1997 .requires .that .a
.permanency .plan .be .made .for .each .child .no .later .than .12 .mo .after .entry .to .foster .care .and .that .a .petition .to .terminate
.parental .rights .typically .must .be .filed .when .a .child .has .been .in .foster .care .for .at .least .15 .of .the .previous .22 .mo. .(See
.Chapter .35, .page .134, .and .e35-1.)
2. A .4 .yr .old .girl .is .admitted .to .the .hospital .for .her .third .evaluation .for .vaginal .bleeding. .The
mother .noted .bright .red .blood .on .the .child's .underwear. .Previous .examinations .revealed .a
.normal .4 .yr .old .girl, .Tanner .stage .1, .with .normal .external .genitalia. .Pelvic .ultrasound .results
.were .normal, .as .was .the .serum .estradiol .level. .The .hemoglobin .and .platelet .counts .were
.normal, .as .were .the .bleeding .time .and .coagulation .studies. .Findings .on .pelvic .examination
.conducted .under .anesthesia .also .were .normal. .The .next .step .in .the .examination .is .to:
■ Determine .the .blood .type .of .the .blood .on .the .underwear
□Interrogate . the . father
□Isolate .the .parents .and .child
□Determine . von . Willebrand . factor . levels
, □Measure . fibronectin . in .the .vagina
description .Consideration .of .factitious .disorder .by .proxy .should .be .triggered .when .the .reported .symptoms .are
.repeatedly .noted .by .only .one .parent, .appropriate .testing .fails .to .confirm .a .diagnosis, .and .seemingly .appropriate .treatment
.is .ineffective. . At .times, .the .child's .symptoms, .their .course, .or .the .response .to .treatment .may .be .incompatible .with .any
.recognized .disease. . Preverbal .children .are .usually .involved. .Bleeding .is .a .particularly .common .presentation. .This .may
.be .caused .by .adding .dyes . to .samples, .adding .blood .(e.g., .from .the .mother) .to .the .child's .sample, .or .giving .the .child .an
.anticoagulant .(e.g., .warfarin). .(See .Chapter .37, .page .146.)
3. Munchausen . syndrome . by . proxy . is . characterized . by . all . of . the . following . EXCEPT:
□Mother .who .appears .devoted .and .wins .over .members .of .care .team
□Multiple . hospitalizations . and . investigations . without . diagnosis
□Symptoms .on .history .but .not .witnessed .by .medical .team
■ Symptoms .occurring .in .presence .of .different .caregivers .(e.g., .while .mother .is .out .of .town)
□Use .of .medications .or .toxins
description .Symptoms .in .young .children .are .mostly .associated .with .proximity .of .the .offending .caregiver .to .the .child.
.The .mother .may .present .as .a .devoted .or .even .model .parent .who .forms .close .relationships .with .members .of .the
.health .care .team. .While .appearing .very .interested .in .her .child's .condition, .she .may .be .relatively .distant .emotionally.
.(See .Chapter .37, .page .146.)
4. Which . statement . is . false?
■ Malnutrition .is .the .second .leading .cause .of .acquired .immune .deficiency .worldwide .behind .HIV .infection
□Zinc .is .important .in .immune .function .and .linear .growth
□Kwashiorkor .and .marasmus .are .rare .in .developed .countries
□The .Western .diet .is .associated .with .increased .noncommunicable .disease
description .The .significant .global .burden .of .malnutrition .and .undernutrition .is .the .leading .worldwide .cause .of .acquired
.immunodeficiency .and .the .major .underlying .factor .for .morbidity .and .mortality .globally .for .children .<5 .yr .of .age. .Zinc .is
.a .micronutrient .that .supports .multiple .metabolic .functions .in .the .body, .is .essential .for .normal .immune .functioning, .and .is
.required .to .support .linear .growth; .zinc .deficiency .is .associated .with .impaired .immune .functioning .and .poor .linear .growth.
.In .parallel .to .the .risk .for .nutrient .and .energy .deficiencies, .issues .relating .to .excesses .pose .important .challenges .because .of
.their .negative .health .effects, .such .as .obesity .or .cardiovascular .disease .risk .factors. .The .nutrition .transition .under .way
.in .the
, developing .world .from .traditional .diets .to .the .Western .diet .has .been .associated .with .increases .in .noncommunicable
.diseases, .often .coexisting .with .undernutrition .and .malnutrition, .observed .sometimes .in .the .same .communities .or .even .the
.same .families. .(See .e41-1.)
5. Components . of . energy . expenditure . in . children . include:
□Thermal .effect .of .food
□Basal .metabolic .rate
□Energy .for .physical .activity
□Energy .to . support . growth
■ All .of .the .above
description .The .3 .components .of .energy .expenditure .in .adults .are .the .basal .metabolic .rate, .the .thermal .effect .of
.food .(energy .required .for .digestion .and .absorption), .and .energy .for .physical .activity. .Additional .energy .intake .and
.expenditure .are .required .to .support .growth .and .development .for .children. .(See .e41-4.)
6. Which .of .the .following .clinical .scenarios .increases .the .risk .of .vitamin .A .deficiency?
□Vegetarian .diet
□Chronic . intestinal . disorders
□Zinc . deficiency
■ B .and .C
□All .of .the .above
description .Vitamin .A .is .an .essential .micronutrient .because .it .cannot .be .biogenerated .de .novo .by .animals. .It .must
.be .obtained .from .plants .in .the .form .of .provitamin-A .carotenoids. .In .the .USA, .grains .and .vegetables .supply
.approximately .55% .and .dairy .and .meat .products .supply .approximately .30% .of .vitamin .A .intake .from .food.
.Vitamin .A .and .the .provitamins-A .are .fat .soluble, .and .their .absorption .depends .on .the .presence .of .adequate .lipid .and
.protein .within .the .meal. . Chronic .intestinal .disorders .or .lipid .malabsorption .syndromes .can .result .in .vitamin .A
.deficiency. .In .developing .countries, .subclinical .or .clinical .zinc .deficiency .can .increase .the .risk .of .vitamin .A .deficiency.
.There .is .also .some .evidence .of .marginal .zinc .intakes .in .children .in .the .USA. .(See .Chapter .45, .page .188.)
7. Which . statement . about . vitamin . A . toxicity . is . NOT . true?
1. Which . of . the . following . statements . regarding . foster . care . is . true?
□A .permanency .plan .must .be .made .for .a .child .in .foster .care .no .later .than .12 .mo .from .the .child's .entry .into .care
□A .minority .of .children .in .foster .care .have .a .history .of .abuse .or .neglect
□The .mission .of .foster .care .is .to .safely .care .for .children .while .providing .services .to .families .to .promote .reunification
□Most .(>70%) .of .children .in .foster .care .are .reunited .with .their .families
■ A .and .C
description .The .mission .of .foster .care .is .to .provide .for .the .health, .safety, .and .well-being .of .children .while .assisting
.their .families .with .services .to .promote .reunification. .Children .entering .foster .care .have .frequently .experienced .early
.childhood .trauma. .More .than .70% .have .a .history .of .abuse, .neglect, .or .both. .Only .about .50% .of .children .achieve
.reunification. .In .the .USA, .the .Adoption .and .Safe .Families .Act .(P.L. .105-89) .passed .in .1997 .requires .that .a
.permanency .plan .be .made .for .each .child .no .later .than .12 .mo .after .entry .to .foster .care .and .that .a .petition .to .terminate
.parental .rights .typically .must .be .filed .when .a .child .has .been .in .foster .care .for .at .least .15 .of .the .previous .22 .mo. .(See
.Chapter .35, .page .134, .and .e35-1.)
2. A .4 .yr .old .girl .is .admitted .to .the .hospital .for .her .third .evaluation .for .vaginal .bleeding. .The
mother .noted .bright .red .blood .on .the .child's .underwear. .Previous .examinations .revealed .a
.normal .4 .yr .old .girl, .Tanner .stage .1, .with .normal .external .genitalia. .Pelvic .ultrasound .results
.were .normal, .as .was .the .serum .estradiol .level. .The .hemoglobin .and .platelet .counts .were
.normal, .as .were .the .bleeding .time .and .coagulation .studies. .Findings .on .pelvic .examination
.conducted .under .anesthesia .also .were .normal. .The .next .step .in .the .examination .is .to:
■ Determine .the .blood .type .of .the .blood .on .the .underwear
□Interrogate . the . father
□Isolate .the .parents .and .child
□Determine . von . Willebrand . factor . levels
, □Measure . fibronectin . in .the .vagina
description .Consideration .of .factitious .disorder .by .proxy .should .be .triggered .when .the .reported .symptoms .are
.repeatedly .noted .by .only .one .parent, .appropriate .testing .fails .to .confirm .a .diagnosis, .and .seemingly .appropriate .treatment
.is .ineffective. . At .times, .the .child's .symptoms, .their .course, .or .the .response .to .treatment .may .be .incompatible .with .any
.recognized .disease. . Preverbal .children .are .usually .involved. .Bleeding .is .a .particularly .common .presentation. .This .may
.be .caused .by .adding .dyes . to .samples, .adding .blood .(e.g., .from .the .mother) .to .the .child's .sample, .or .giving .the .child .an
.anticoagulant .(e.g., .warfarin). .(See .Chapter .37, .page .146.)
3. Munchausen . syndrome . by . proxy . is . characterized . by . all . of . the . following . EXCEPT:
□Mother .who .appears .devoted .and .wins .over .members .of .care .team
□Multiple . hospitalizations . and . investigations . without . diagnosis
□Symptoms .on .history .but .not .witnessed .by .medical .team
■ Symptoms .occurring .in .presence .of .different .caregivers .(e.g., .while .mother .is .out .of .town)
□Use .of .medications .or .toxins
description .Symptoms .in .young .children .are .mostly .associated .with .proximity .of .the .offending .caregiver .to .the .child.
.The .mother .may .present .as .a .devoted .or .even .model .parent .who .forms .close .relationships .with .members .of .the
.health .care .team. .While .appearing .very .interested .in .her .child's .condition, .she .may .be .relatively .distant .emotionally.
.(See .Chapter .37, .page .146.)
4. Which . statement . is . false?
■ Malnutrition .is .the .second .leading .cause .of .acquired .immune .deficiency .worldwide .behind .HIV .infection
□Zinc .is .important .in .immune .function .and .linear .growth
□Kwashiorkor .and .marasmus .are .rare .in .developed .countries
□The .Western .diet .is .associated .with .increased .noncommunicable .disease
description .The .significant .global .burden .of .malnutrition .and .undernutrition .is .the .leading .worldwide .cause .of .acquired
.immunodeficiency .and .the .major .underlying .factor .for .morbidity .and .mortality .globally .for .children .<5 .yr .of .age. .Zinc .is
.a .micronutrient .that .supports .multiple .metabolic .functions .in .the .body, .is .essential .for .normal .immune .functioning, .and .is
.required .to .support .linear .growth; .zinc .deficiency .is .associated .with .impaired .immune .functioning .and .poor .linear .growth.
.In .parallel .to .the .risk .for .nutrient .and .energy .deficiencies, .issues .relating .to .excesses .pose .important .challenges .because .of
.their .negative .health .effects, .such .as .obesity .or .cardiovascular .disease .risk .factors. .The .nutrition .transition .under .way
.in .the
, developing .world .from .traditional .diets .to .the .Western .diet .has .been .associated .with .increases .in .noncommunicable
.diseases, .often .coexisting .with .undernutrition .and .malnutrition, .observed .sometimes .in .the .same .communities .or .even .the
.same .families. .(See .e41-1.)
5. Components . of . energy . expenditure . in . children . include:
□Thermal .effect .of .food
□Basal .metabolic .rate
□Energy .for .physical .activity
□Energy .to . support . growth
■ All .of .the .above
description .The .3 .components .of .energy .expenditure .in .adults .are .the .basal .metabolic .rate, .the .thermal .effect .of
.food .(energy .required .for .digestion .and .absorption), .and .energy .for .physical .activity. .Additional .energy .intake .and
.expenditure .are .required .to .support .growth .and .development .for .children. .(See .e41-4.)
6. Which .of .the .following .clinical .scenarios .increases .the .risk .of .vitamin .A .deficiency?
□Vegetarian .diet
□Chronic . intestinal . disorders
□Zinc . deficiency
■ B .and .C
□All .of .the .above
description .Vitamin .A .is .an .essential .micronutrient .because .it .cannot .be .biogenerated .de .novo .by .animals. .It .must
.be .obtained .from .plants .in .the .form .of .provitamin-A .carotenoids. .In .the .USA, .grains .and .vegetables .supply
.approximately .55% .and .dairy .and .meat .products .supply .approximately .30% .of .vitamin .A .intake .from .food.
.Vitamin .A .and .the .provitamins-A .are .fat .soluble, .and .their .absorption .depends .on .the .presence .of .adequate .lipid .and
.protein .within .the .meal. . Chronic .intestinal .disorders .or .lipid .malabsorption .syndromes .can .result .in .vitamin .A
.deficiency. .In .developing .countries, .subclinical .or .clinical .zinc .deficiency .can .increase .the .risk .of .vitamin .A .deficiency.
.There .is .also .some .evidence .of .marginal .zinc .intakes .in .children .in .the .USA. .(See .Chapter .45, .page .188.)
7. Which . statement . about . vitamin . A . toxicity . is . NOT . true?
