Test bank for MCQs in Pediatrics Review of Nelson
Textbook of Pediatrics 20 Edition
, 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 h of h energy h expenditure h in h children h include:
□Thermal heffect hof hfood
□Basal hmetabolic hrate
□Energy hfor hphysical hactivity
□Energy hto h support h growth
■ All hof hthe habove
description hThe h3 hcomponents hof henergy hexpenditure hin hadults hare hthe hbasal hmetabolic hrate, hthe hthermal
heffect hof hfood h(energy hrequired hfor hdigestion hand habsorption), hand henergy hfor hphysical hactivity. hAdditional henergy
hintake hand hexpenditure hare hrequired hto hsupport hgrowth hand hdevelopment hfor hchildren. h(See he41-4.)
6. Which hof hthe hfollowing hclinical hscenarios hincreases hthe hrisk hof hvitamin hA hdeficiency?
□Vegetarian hdiet
□Chronic h intestinal h disorders
□Zinc h deficiency
■ B hand hC
□All hof hthe habove
description hVitamin hA his han hessential hmicronutrient hbecause hit hcannot hbe hbiogenerated hde hnovo hby hanimals.
hIt hmust hbe hobtained hfrom hplants hin hthe hform hof hprovitamin-A hcarotenoids. hIn hthe hUSA, hgrains hand hvegetables
hsupply happroximately h55% hand hdairy hand hmeat hproducts hsupply happroximately h30% hof hvitamin hA hintake
hfrom hfood. hVitamin hA hand hthe hprovitamins-A hare hfat hsoluble, hand htheir habsorption hdepends hon hthe hpresence hof
hadequate hlipid hand hprotein hwithin hthe hmeal. h Chronic hintestinal hdisorders hor hlipid hmalabsorption hsyndromes hcan
hresult hin hvitamin hA hdeficiency. hIn hdeveloping hcountries, hsubclinical hor hclinical hzinc hdeficiency hcan hincrease hthe
hrisk hof hvitamin hA hdeficiency. hThere his halso hsome hevidence hof hmarginal hzinc hintakes hin hchildren hin hthe hUSA.
h(See hChapter h45, hpage h188.)
7. Which h statement h about h vitamin h A h toxicity h is h NOT h true?
Textbook of Pediatrics 20 Edition
, 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 h of h energy h expenditure h in h children h include:
□Thermal heffect hof hfood
□Basal hmetabolic hrate
□Energy hfor hphysical hactivity
□Energy hto h support h growth
■ All hof hthe habove
description hThe h3 hcomponents hof henergy hexpenditure hin hadults hare hthe hbasal hmetabolic hrate, hthe hthermal
heffect hof hfood h(energy hrequired hfor hdigestion hand habsorption), hand henergy hfor hphysical hactivity. hAdditional henergy
hintake hand hexpenditure hare hrequired hto hsupport hgrowth hand hdevelopment hfor hchildren. h(See he41-4.)
6. Which hof hthe hfollowing hclinical hscenarios hincreases hthe hrisk hof hvitamin hA hdeficiency?
□Vegetarian hdiet
□Chronic h intestinal h disorders
□Zinc h deficiency
■ B hand hC
□All hof hthe habove
description hVitamin hA his han hessential hmicronutrient hbecause hit hcannot hbe hbiogenerated hde hnovo hby hanimals.
hIt hmust hbe hobtained hfrom hplants hin hthe hform hof hprovitamin-A hcarotenoids. hIn hthe hUSA, hgrains hand hvegetables
hsupply happroximately h55% hand hdairy hand hmeat hproducts hsupply happroximately h30% hof hvitamin hA hintake
hfrom hfood. hVitamin hA hand hthe hprovitamins-A hare hfat hsoluble, hand htheir habsorption hdepends hon hthe hpresence hof
hadequate hlipid hand hprotein hwithin hthe hmeal. h Chronic hintestinal hdisorders hor hlipid hmalabsorption hsyndromes hcan
hresult hin hvitamin hA hdeficiency. hIn hdeveloping hcountries, hsubclinical hor hclinical hzinc hdeficiency hcan hincrease hthe
hrisk hof hvitamin hA hdeficiency. hThere his halso hsome hevidence hof hmarginal hzinc hintakes hin hchildren hin hthe hUSA.
h(See hChapter h45, hpage h188.)
7. Which h statement h about h vitamin h A h toxicity h is h NOT h true?
