Test bank for MCQs in Pediatrics Review of Nelson
Textbook of Pediatrics 20 Edition
, Nelson Pediatrics Review(MCQs) 19 Edition
u u u u
1. Whichu ofu theu followingu statementsu regardingu fosteru careu isu 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
u u u u u u u u u u u u u u u u u u u u u u
□A minority of children in foster care have a history of abuse or neglect
u u u u u u u u u u u u u
□The mission of foster care is to safely care for children while providing services to families to promote reunification
u u u u u u u u u u u u u u u u u u
□Most (>70%) of children in foster care are reunited with their families
u u u u u u u u u u u
■ AuanduC
descriptionuTheumissionuofufosterucareuisutouprovideuforutheuhealth,usafety,uanduwell-
beinguofuchildrenuwhileuassistingutheirufamiliesuwithuservicesutoupromoteureunification.uChildrenuenteringufosterucareuhaveufreq
uentlyuexperienceduearlyuchildhoodutrauma.uMoreuthanu70%uhaveuauhistoryuofuabuse,uneglect,uoruboth.uOnlyuaboutu50%uofuc
hildrenuachieveureunification.uInutheuUSA,utheuAdoptionuanduSafeuFamiliesuActu(P.L.u105-
89)upasseduinu1997urequiresuthatuaupermanencyuplanubeumadeuforueachuchildunoulateruthanu12umouafteruentryutoufosterucareua
nduthatuaupetitionutouterminateuparentalurightsutypicallyumustubeufileduwhenuauchilduhasubeenuinufosterucareuforuatuleastu15uofut
heupreviousu22umo.u(SeeuChapteru35,upageu134,uandue35-1.)
2. Au4uyruoldugirluisuadmittedutoutheuhospitaluforuheruthirduevaluationuforuvaginalubleeding.uThe
motherunotedubrighturedublooduonutheuchild'suunderwear.uPreviousuexaminationsurevealeduaun
ormalu4uyruoldugirl,uTannerustageu1,uwithunormaluexternalugenitalia.uPelvicuultrasounduresultsuwe
reunormal,uasuwasutheuserumuestradiolulevel.uTheuhemoglobinuanduplateletucountsuwereunormal,
uasuwereutheubleedingutimeuanducoagulationustudies.uFindingsuonupelvicuexaminationuconducted
uunderuanesthesiaualsouwereunormal.uTheunextustepuinutheuexaminationuisuto:
■ Determineutheubloodutypeuofutheublooduonutheuunderwear
□Interrogate the father
u u
□Isolate the parents and child
u u u u
□Determine von Willebrand factor levels
u u u u
, □Measure fibronectin in the vagina
u u u u
descriptionuConsiderationuofufactitiousudisorderubyuproxyushouldubeutriggereduwhenutheureportedusymptomsuareurepeatedl
yunotedubyuonlyuoneuparent,uappropriateutestingufailsutouconfirmuaudiagnosis,uanduseeminglyuappropriateutreatmentuisuineffective.
u Atutimes,utheuchild'susymptoms,utheirucourse,uorutheuresponseutoutreatmentumayubeuincompatibleuwithuanyurecognizedudisease.u
Preverbaluchildrenuareuusuallyuinvolved.uBleedinguisuauparticularlyucommonupresentation.uThisumayubeucausedubyuaddingudyesu t
ousamples,uaddingubloodu(e.g.,ufromutheumother)utoutheuchild'susample,uorugivingutheuchilduanuanticoagulantu(e.g.,uwarfarin).u
(SeeuChapteru37,upageu146.)
3. Munchausenu syndromeu byu proxyu isu characterizedu byu allu ofu theu followingu EXCEPT:
□Mother who appears devoted and wins over members of care team
u u u u u u u u u u
□Multiple hospitalizations and investigations without diagnosis
u u u u u
□Symptoms on history but not witnessed by medical team
u u u u u u u u
■ Symptomsuoccurringuinupresenceuofudifferentucaregiversu(e.g.,uwhileumotheruisuoutuofutown)
□Use of medications or toxins
u u u u
descriptionuSymptomsuinuyounguchildrenuareumostlyuassociateduwithuproximityuofutheuoffendingucaregiverutoutheuchild.uTheu
motherumayupresentuasuaudevoteduoruevenumodeluparentuwhouformsucloseurelationshipsuwithumembersuofutheuhealthucare
uteam.uWhileuappearinguveryuinteresteduinuheruchild'sucondition,usheumayubeurelativelyudistantuemotionally.u(SeeuChapteru37,u
pageu146.)
4. Whichu statementu isu false?
■ MalnutritionuisutheuseconduleadingucauseuofuacquireduimmuneudeficiencyuworldwideubehinduHIVuinfection
□Zinc is important in immune function and linear growth
u u u u u u u u
□Kwashiorkor and marasmus are rare in developed countries
u u u u u u u
□The Western diet is associated with increased noncommunicable disease
u u u u u u u u
descriptionuTheusignificantuglobaluburdenuofumalnutritionuanduundernutritionuisutheuleadinguworldwideucauseuofuacquireduimm
unodeficiencyuandutheumajoruunderlyingufactoruforumorbidityuandumortalityugloballyuforuchildrenu<5uyruofuage.uZincuisuaumicron
utrientuthatusupportsumultipleumetabolicufunctionsuinutheubody,uisuessentialuforunormaluimmuneufunctioning,uanduisurequiredutous
upportulinearugrowth;uzincudeficiencyuisuassociateduwithuimpaireduimmuneufunctioninguandupoorulinearugrowth.uInuparallelutouth
euriskuforunutrientuanduenergyudeficiencies,uissuesurelatingutouexcessesuposeuimportantuchallengesubecauseuofutheirunegativeuhea
lthueffects,usuchuasuobesityuorucardiovascularudiseaseuriskufactors.uTheunutritionutransitionuunderuwayuinuthe
, developinguworldufromutraditionaludietsutoutheuWesternudietuhasubeenuassociateduwithuincreasesuinunoncommunicableudiseas
es,uoftenucoexistinguwithuundernutritionuandumalnutrition,uobservedusometimesuinutheusameucommunitiesuoruevenutheusameufa
milies.u(Seeue41-1.)
5. Componentsu ofu energyu expenditureu inu childrenu include:
□Thermal effect of food
u u u
□Basal metabolic rate
u u
□Energy for physical activity
u u u
□Energy to support growth
u u u
■ Alluofutheuabove
descriptionuTheu3ucomponentsuofuenergyuexpenditureuinuadultsuareutheubasalumetabolicurate,utheuthermalueffectuofufoo
du(energyurequireduforudigestionuanduabsorption),uanduenergyuforuphysicaluactivity.uAdditionaluenergyuintakeuanduexpenditure
uareurequiredutousupportugrowthuandudevelopmentuforuchildren.u(Seeue41-4.)
6. WhichuofutheufollowinguclinicaluscenariosuincreasesutheuriskuofuvitaminuAudeficiency?
□Vegetarian diet u
□Chronic intestinal disorders
u u
□Zinc deficiency
u
■ BuanduC
□All of the above
u u u
descriptionuVitaminuAuisuanuessentialumicronutrientubecauseuitucannotubeubiogeneratedudeunovoubyuanimals.uItumustube
uobtainedufromuplantsuinutheuformuofuprovitamin-
Aucarotenoids.uInutheuUSA,ugrainsuanduvegetablesusupplyuapproximatelyu55%uandudairyuandumeatuproductsusupplyuappro
ximatelyu30%uofuvitaminuAuintakeufromufood.uVitaminuAuandutheuprovitamins-
Auareufatusoluble,uandutheiruabsorptionudependsuonutheupresenceuofuadequateulipiduanduproteinuwithinutheumeal.u Chronicuintest
inaludisordersuorulipidumalabsorptionusyndromesucanuresultuinuvitaminuAudeficiency.uInudevelopingucountries,usubclinicaluorucli
nicaluzincudeficiencyucanuincreaseutheuriskuofuvitaminuAudeficiency.uThereuisualsousomeuevidenceuofumarginaluzincuintakesuinu
childrenuinutheuUSA.u(SeeuChapteru45,upageu188.)
7. Whichu statementu aboutu vitaminu Au toxicityu isu NOTu true?
Textbook of Pediatrics 20 Edition
, Nelson Pediatrics Review(MCQs) 19 Edition
u u u u
1. Whichu ofu theu followingu statementsu regardingu fosteru careu isu 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
u u u u u u u u u u u u u u u u u u u u u u
□A minority of children in foster care have a history of abuse or neglect
u u u u u u u u u u u u u
□The mission of foster care is to safely care for children while providing services to families to promote reunification
u u u u u u u u u u u u u u u u u u
□Most (>70%) of children in foster care are reunited with their families
u u u u u u u u u u u
■ AuanduC
descriptionuTheumissionuofufosterucareuisutouprovideuforutheuhealth,usafety,uanduwell-
beinguofuchildrenuwhileuassistingutheirufamiliesuwithuservicesutoupromoteureunification.uChildrenuenteringufosterucareuhaveufreq
uentlyuexperienceduearlyuchildhoodutrauma.uMoreuthanu70%uhaveuauhistoryuofuabuse,uneglect,uoruboth.uOnlyuaboutu50%uofuc
hildrenuachieveureunification.uInutheuUSA,utheuAdoptionuanduSafeuFamiliesuActu(P.L.u105-
89)upasseduinu1997urequiresuthatuaupermanencyuplanubeumadeuforueachuchildunoulateruthanu12umouafteruentryutoufosterucareua
nduthatuaupetitionutouterminateuparentalurightsutypicallyumustubeufileduwhenuauchilduhasubeenuinufosterucareuforuatuleastu15uofut
heupreviousu22umo.u(SeeuChapteru35,upageu134,uandue35-1.)
2. Au4uyruoldugirluisuadmittedutoutheuhospitaluforuheruthirduevaluationuforuvaginalubleeding.uThe
motherunotedubrighturedublooduonutheuchild'suunderwear.uPreviousuexaminationsurevealeduaun
ormalu4uyruoldugirl,uTannerustageu1,uwithunormaluexternalugenitalia.uPelvicuultrasounduresultsuwe
reunormal,uasuwasutheuserumuestradiolulevel.uTheuhemoglobinuanduplateletucountsuwereunormal,
uasuwereutheubleedingutimeuanducoagulationustudies.uFindingsuonupelvicuexaminationuconducted
uunderuanesthesiaualsouwereunormal.uTheunextustepuinutheuexaminationuisuto:
■ Determineutheubloodutypeuofutheublooduonutheuunderwear
□Interrogate the father
u u
□Isolate the parents and child
u u u u
□Determine von Willebrand factor levels
u u u u
, □Measure fibronectin in the vagina
u u u u
descriptionuConsiderationuofufactitiousudisorderubyuproxyushouldubeutriggereduwhenutheureportedusymptomsuareurepeatedl
yunotedubyuonlyuoneuparent,uappropriateutestingufailsutouconfirmuaudiagnosis,uanduseeminglyuappropriateutreatmentuisuineffective.
u Atutimes,utheuchild'susymptoms,utheirucourse,uorutheuresponseutoutreatmentumayubeuincompatibleuwithuanyurecognizedudisease.u
Preverbaluchildrenuareuusuallyuinvolved.uBleedinguisuauparticularlyucommonupresentation.uThisumayubeucausedubyuaddingudyesu t
ousamples,uaddingubloodu(e.g.,ufromutheumother)utoutheuchild'susample,uorugivingutheuchilduanuanticoagulantu(e.g.,uwarfarin).u
(SeeuChapteru37,upageu146.)
3. Munchausenu syndromeu byu proxyu isu characterizedu byu allu ofu theu followingu EXCEPT:
□Mother who appears devoted and wins over members of care team
u u u u u u u u u u
□Multiple hospitalizations and investigations without diagnosis
u u u u u
□Symptoms on history but not witnessed by medical team
u u u u u u u u
■ Symptomsuoccurringuinupresenceuofudifferentucaregiversu(e.g.,uwhileumotheruisuoutuofutown)
□Use of medications or toxins
u u u u
descriptionuSymptomsuinuyounguchildrenuareumostlyuassociateduwithuproximityuofutheuoffendingucaregiverutoutheuchild.uTheu
motherumayupresentuasuaudevoteduoruevenumodeluparentuwhouformsucloseurelationshipsuwithumembersuofutheuhealthucare
uteam.uWhileuappearinguveryuinteresteduinuheruchild'sucondition,usheumayubeurelativelyudistantuemotionally.u(SeeuChapteru37,u
pageu146.)
4. Whichu statementu isu false?
■ MalnutritionuisutheuseconduleadingucauseuofuacquireduimmuneudeficiencyuworldwideubehinduHIVuinfection
□Zinc is important in immune function and linear growth
u u u u u u u u
□Kwashiorkor and marasmus are rare in developed countries
u u u u u u u
□The Western diet is associated with increased noncommunicable disease
u u u u u u u u
descriptionuTheusignificantuglobaluburdenuofumalnutritionuanduundernutritionuisutheuleadinguworldwideucauseuofuacquireduimm
unodeficiencyuandutheumajoruunderlyingufactoruforumorbidityuandumortalityugloballyuforuchildrenu<5uyruofuage.uZincuisuaumicron
utrientuthatusupportsumultipleumetabolicufunctionsuinutheubody,uisuessentialuforunormaluimmuneufunctioning,uanduisurequiredutous
upportulinearugrowth;uzincudeficiencyuisuassociateduwithuimpaireduimmuneufunctioninguandupoorulinearugrowth.uInuparallelutouth
euriskuforunutrientuanduenergyudeficiencies,uissuesurelatingutouexcessesuposeuimportantuchallengesubecauseuofutheirunegativeuhea
lthueffects,usuchuasuobesityuorucardiovascularudiseaseuriskufactors.uTheunutritionutransitionuunderuwayuinuthe
, developinguworldufromutraditionaludietsutoutheuWesternudietuhasubeenuassociateduwithuincreasesuinunoncommunicableudiseas
es,uoftenucoexistinguwithuundernutritionuandumalnutrition,uobservedusometimesuinutheusameucommunitiesuoruevenutheusameufa
milies.u(Seeue41-1.)
5. Componentsu ofu energyu expenditureu inu childrenu include:
□Thermal effect of food
u u u
□Basal metabolic rate
u u
□Energy for physical activity
u u u
□Energy to support growth
u u u
■ Alluofutheuabove
descriptionuTheu3ucomponentsuofuenergyuexpenditureuinuadultsuareutheubasalumetabolicurate,utheuthermalueffectuofufoo
du(energyurequireduforudigestionuanduabsorption),uanduenergyuforuphysicaluactivity.uAdditionaluenergyuintakeuanduexpenditure
uareurequiredutousupportugrowthuandudevelopmentuforuchildren.u(Seeue41-4.)
6. WhichuofutheufollowinguclinicaluscenariosuincreasesutheuriskuofuvitaminuAudeficiency?
□Vegetarian diet u
□Chronic intestinal disorders
u u
□Zinc deficiency
u
■ BuanduC
□All of the above
u u u
descriptionuVitaminuAuisuanuessentialumicronutrientubecauseuitucannotubeubiogeneratedudeunovoubyuanimals.uItumustube
uobtainedufromuplantsuinutheuformuofuprovitamin-
Aucarotenoids.uInutheuUSA,ugrainsuanduvegetablesusupplyuapproximatelyu55%uandudairyuandumeatuproductsusupplyuappro
ximatelyu30%uofuvitaminuAuintakeufromufood.uVitaminuAuandutheuprovitamins-
Auareufatusoluble,uandutheiruabsorptionudependsuonutheupresenceuofuadequateulipiduanduproteinuwithinutheumeal.u Chronicuintest
inaludisordersuorulipidumalabsorptionusyndromesucanuresultuinuvitaminuAudeficiency.uInudevelopingucountries,usubclinicaluorucli
nicaluzincudeficiencyucanuincreaseutheuriskuofuvitaminuAudeficiency.uThereuisualsousomeuevidenceuofumarginaluzincuintakesuinu
childrenuinutheuUSA.u(SeeuChapteru45,upageu188.)
7. Whichu statementu aboutu vitaminu Au toxicityu isu NOTu true?
