Test bank for MCQs in Pediatrics Review of Nelson
b7 b7 b7 b7 b7 b7 b7 b7
b7 Textbook of Pediatrics 20 Edition
b7 b7 b7 b7 b7
, Nelson Pediatrics Review(MCQs) 19 Edition b7 b7 b7 b7
1. Which of the following statements regarding foster care is true?
b7 b7 b7 b7 b7 b7 b7 b7 b7
□A permanency plan must
b7 b7 b7 b7 be made for a child in foster care no later than 12 mo from the child's entry into care
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□A minority of children in foster care have a history of abuse or neglect
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□The mission of foster care is to safely care for children while providing services to families to promote reunification
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Most (>70%) of children in foster care are reunited with their families
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
■ A and C b7 b7
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
their families with services to promote reunification. Children entering foster care have frequently experienced early
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
terminate parental rights typically must be filed when a child has been in foster care for at least 15 of the previous
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
22 mo. (See Chapter 35, page 134, and e35-1.)
b7 b7 b7 b7 b7 b7 b7 b7 b7
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
mother noted bright red blood on the child's underwear. Previous examinations revealed
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
a normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
results were normal, as was the serum estradiol level. The hemoglobin and platelet
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
counts were normal, as were the bleeding time and coagulation studies. Findings on
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
pelvic examination conducted under anesthesia also were normal. The next step in the
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
examination is to:
b7 b7 b7
■ Determine the blood type of the blood on the underwear
b7 b7 b7 b7 b7 b7 b7 b7 b7
□Interrogate b7 the father b7
□Isolate the parents and child b7 b7 b7 b7
□Determine b7 von Willebrand factor levels
b7 b7 b7
, □Measure b7 fibronectin in the vagina b7 b7 b7
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
treatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
incompatible with any recognized disease. Preverbal children are usually involved. Bleeding is a particularly
b7 b7 b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7
common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
b7 b7 b7 b7 b7 b7 b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7 b7
child's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Mother b7 who appears devoted and wins over members of care team
b7 b7 b7 b7 b7 b7 b7 b7 b7
□Multiple b7 hospitalizations and investigations without diagnosis b7 b7 b7 b7
□Symptoms on history but not witnessed by medical team
b7 b7 b7 b7 b7 b7 b7 b7
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Use of medications or toxins
b7 b7 b7 b7
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
child. The mother may present as a devoted or even model parent who forms close relationships with members
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
of the health care team. While appearing very interested in her child's condition, she may be relatively distant
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
emotionally. (See Chapter 37, page 146.)
b7 b7 b7 b7 b7 b7
4. Which statement is false? b7 b7 b7
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Zinc b7 is important in immune function and linear growth
b7 b7 b7 b7 b7 b7 b7
□Kwashiorkor and b7 b7 marasmus are rare in developed countries b7 b7 b7 b7 b7
□The Western diet is associated with increased noncommunicable disease
b7 b7 b7 b7 b7 b7 b7 b7
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
acquired immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
age. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
functioning, and is required to support linear growth; zinc deficiency is associated with impaired immune functioning
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
important challenges because of their negative health effects, such as obesity or cardiovascular disease risk factors.
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
The nutrition transition under way in the
b7 b7 b7 b7 b7 b7 b7
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
the same families. (See e41-1.)
b7 b7 b7 b7 b7
5. Components of energy expenditure in children include: b7 b7 b7 b7 b7 b7
□Thermal b7 effect of food b7 b7
□Basal b7 metabolic rate b7
□Energy for b7 b7 physical activity b7
□Energy b7 to support growth
b7 b7
■ All of the above
b7 b7 b7
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
expenditure are required to support growth and development for children. (See e41-4.)
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Vegetarian diet b7
□Chronic b7 intestinal disorders b7
□Zinc b7 deficiency
■ B and C
b7 b7
□All of the above
b7 b7 b7
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
supply approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
food. Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
lipid and protein within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in
b7 b7 b7 b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7 b7
vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See Chapter 45,
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
page 188.)
b7 b7
7. Which statement about vitamin A toxicity is NOT true?
b7 b7 b7 b7 b7 b7 b7 b7
b7 b7 b7 b7 b7 b7 b7 b7
b7 Textbook of Pediatrics 20 Edition
b7 b7 b7 b7 b7
, Nelson Pediatrics Review(MCQs) 19 Edition b7 b7 b7 b7
1. Which of the following statements regarding foster care is true?
b7 b7 b7 b7 b7 b7 b7 b7 b7
□A permanency plan must
b7 b7 b7 b7 be made for a child in foster care no later than 12 mo from the child's entry into care
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□A minority of children in foster care have a history of abuse or neglect
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□The mission of foster care is to safely care for children while providing services to families to promote reunification
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Most (>70%) of children in foster care are reunited with their families
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
■ A and C b7 b7
description The mission of foster care is to provide for the health, safety, and well-being of children while assisting
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
their families with services to promote reunification. Children entering foster care have frequently experienced early
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
childhood trauma. More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
reunification. In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
terminate parental rights typically must be filed when a child has been in foster care for at least 15 of the previous
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
22 mo. (See Chapter 35, page 134, and e35-1.)
b7 b7 b7 b7 b7 b7 b7 b7 b7
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
mother noted bright red blood on the child's underwear. Previous examinations revealed
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
a normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
results were normal, as was the serum estradiol level. The hemoglobin and platelet
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
counts were normal, as were the bleeding time and coagulation studies. Findings on
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
pelvic examination conducted under anesthesia also were normal. The next step in the
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
examination is to:
b7 b7 b7
■ Determine the blood type of the blood on the underwear
b7 b7 b7 b7 b7 b7 b7 b7 b7
□Interrogate b7 the father b7
□Isolate the parents and child b7 b7 b7 b7
□Determine b7 von Willebrand factor levels
b7 b7 b7
, □Measure b7 fibronectin in the vagina b7 b7 b7
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
repeatedly noted by only one parent, appropriate testing fails to confirm a diagnosis, and seemingly appropriate
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
treatment is ineffective. At times, the child's symptoms, their course, or the response to treatment may be
b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
incompatible with any recognized disease. Preverbal children are usually involved. Bleeding is a particularly
b7 b7 b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7
common presentation. This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the
b7 b7 b7 b7 b7 b7 b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7 b7
child's sample, or giving the child an anticoagulant (e.g., warfarin). (See Chapter 37, page 146.)
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Mother b7 who appears devoted and wins over members of care team
b7 b7 b7 b7 b7 b7 b7 b7 b7
□Multiple b7 hospitalizations and investigations without diagnosis b7 b7 b7 b7
□Symptoms on history but not witnessed by medical team
b7 b7 b7 b7 b7 b7 b7 b7
■ Symptoms occurring in presence of different caregivers (e.g., while mother is out of town)
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Use of medications or toxins
b7 b7 b7 b7
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
child. The mother may present as a devoted or even model parent who forms close relationships with members
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
of the health care team. While appearing very interested in her child's condition, she may be relatively distant
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
emotionally. (See Chapter 37, page 146.)
b7 b7 b7 b7 b7 b7
4. Which statement is false? b7 b7 b7
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Zinc b7 is important in immune function and linear growth
b7 b7 b7 b7 b7 b7 b7
□Kwashiorkor and b7 b7 marasmus are rare in developed countries b7 b7 b7 b7 b7
□The Western diet is associated with increased noncommunicable disease
b7 b7 b7 b7 b7 b7 b7 b7
description The significant global burden of malnutrition and undernutrition is the leading worldwide cause of
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
acquired immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
age. Zinc is a micronutrient that supports multiple metabolic functions in the body, is essential for normal immune
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
functioning, and is required to support linear growth; zinc deficiency is associated with impaired immune functioning
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
and poor linear growth. In parallel to the risk for nutrient and energy deficiencies, issues relating to excesses pose
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
important challenges because of their negative health effects, such as obesity or cardiovascular disease risk factors.
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
The nutrition transition under way in the
b7 b7 b7 b7 b7 b7 b7
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
diseases, often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
the same families. (See e41-1.)
b7 b7 b7 b7 b7
5. Components of energy expenditure in children include: b7 b7 b7 b7 b7 b7
□Thermal b7 effect of food b7 b7
□Basal b7 metabolic rate b7
□Energy for b7 b7 physical activity b7
□Energy b7 to support growth
b7 b7
■ All of the above
b7 b7 b7
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
food (energy required for digestion and absorption), and energy for physical activity. Additional energy intake and
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
expenditure are required to support growth and development for children. (See e41-4.)
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
□Vegetarian diet b7
□Chronic b7 intestinal disorders b7
□Zinc b7 deficiency
■ B and C
b7 b7
□All of the above
b7 b7 b7
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
must be obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
supply approximately 55% and dairy and meat products supply approximately 30% of vitamin A intake from
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
food. Vitamin A and the provitamins-A are fat soluble, and their absorption depends on the presence of adequate
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
lipid and protein within the meal. Chronic intestinal disorders or lipid malabsorption syndromes can result in
b7 b7 b7 b7 b7 b7 b 7 b7 b7 b7 b7 b7 b7 b7 b7 b7
vitamin A deficiency. In developing countries, subclinical or clinical zinc deficiency can increase the risk of vitamin
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
A deficiency. There is also some evidence of marginal zinc intakes in children in the USA. (See Chapter 45,
b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7 b7
page 188.)
b7 b7
7. Which statement about vitamin A toxicity is NOT true?
b7 b7 b7 b7 b7 b7 b7 b7
