Test bank for MCQs in Pediatrics Review of Nelson Textbook of
Pediatrics 20 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 fof fthe ffollowing fclinical fscenarios fincreases fthe frisk fof fvitamin fA fdeficiency?
□Vegetarian f diet
□Chronic f intestinal fdisorders
□Zinc fdeficiency
■ B fand fC
□All fof fthe fabove
description fVitamin fA fis fan fessential fmicronutrient fbecause fit fcannot fbe fbiogenerated fde fnovo fby fanimals. fIt
fmust fbe f obtained ffrom fplants fin fthe fform fof fprovitamin-A fcarotenoids. fIn fthe fUSA, fgrains fand fvegetables
fsupply fapproximately f 55% fand fdairy fand fmeat fproducts fsupply fapproximately f30% fof fvitamin fA fintake
ffrom ffood. fVitamin fA fand fthe f provitamins-A fare ffat fsoluble, fand ftheir fabsorption fdepends fon fthe fpresence fof
fadequate flipid fand fprotein fwithin fthe fmeal.
Chronic fintestinal fdisorders for flipid fmalabsorption fsyndromes fcan fresult fin fvitamin fA fdeficiency. fIn fdeveloping fcountries,
f subclinical for fclinical fzinc fdeficiency fcan fincrease fthe frisk fof fvitamin fA fdeficiency. fThere fis falso fsome fevidence fof
fmarginal f zinc fintakes f in fchildren fin fthe fUSA. f(See fChapter f45, fpage f188.)
7. Which fstatement f about f vitamin f A f toxicity f is f NOT f true?
Pediatrics 20 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 fof fthe ffollowing fclinical fscenarios fincreases fthe frisk fof fvitamin fA fdeficiency?
□Vegetarian f diet
□Chronic f intestinal fdisorders
□Zinc fdeficiency
■ B fand fC
□All fof fthe fabove
description fVitamin fA fis fan fessential fmicronutrient fbecause fit fcannot fbe fbiogenerated fde fnovo fby fanimals. fIt
fmust fbe f obtained ffrom fplants fin fthe fform fof fprovitamin-A fcarotenoids. fIn fthe fUSA, fgrains fand fvegetables
fsupply fapproximately f 55% fand fdairy fand fmeat fproducts fsupply fapproximately f30% fof fvitamin fA fintake
ffrom ffood. fVitamin fA fand fthe f provitamins-A fare ffat fsoluble, fand ftheir fabsorption fdepends fon fthe fpresence fof
fadequate flipid fand fprotein fwithin fthe fmeal.
Chronic fintestinal fdisorders for flipid fmalabsorption fsyndromes fcan fresult fin fvitamin fA fdeficiency. fIn fdeveloping fcountries,
f subclinical for fclinical fzinc fdeficiency fcan fincrease fthe frisk fof fvitamin fA fdeficiency. fThere fis falso fsome fevidence fof
fmarginal f zinc fintakes f in fchildren fin fthe fUSA. f(See fChapter f45, fpage f188.)
7. Which fstatement f about f vitamin f A f toxicity f is f NOT f true?
