, Nelson Pediatrics Review(MCQs) 19 Edition
j j j j
1. Whichjofjthejfollowingjstatementsjregardingjfosterjcarejisjtrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
j j j j j j j j j j j j j j j j j j j j j j
□A minority of children in foster care have a history of abuse or neglect
j j j j j j j j j j j j j
□The mission of foster care is to safely care for children while providing services to families to promote reunification
j j j j j j j j j j j j j j j j j j
□Most (>70%) of children in foster care are reunited with their families
j j j j j j j j j j j
■ AjandjC
descriptionj Thej missionj ofj fosterj carejisj toj providej forjthej health,j safety,jandj well-
beingj ofj childrenj whilej assistingj theirjfamiliesj withj servicesjtoj promotej reunification.j Childrenj enteringj fosterjcarej havej frequently
j experiencedj earlyj childhoodjtrauma.j Morej thanj 70%j havej aj historyj ofj abuse,j neglect,j orj both.j Onlyj aboutj 50%j ofj childrenj achieve
j reunification.j Inj thejUSA,jthejAdoptionjandjSafejFamiliesjActj(P.L.j105-
89)jpassedjinj1997jrequiresjthatjajpermanencyjplanjbejmadejforjeachj childj nojlaterjthanj 12j mojafterjentryjtoj fosterjcarej andjthatj aj
petitionjtojterminatej parentalj rightsjtypicallyj mustj bej filedjwhenjajchildjhasjbeenjinjfosterjcarejforjatjleastj15jofjthejpreviousj22jmo
.j(SeejChapterj35,jpagej134,jandje35-1.)
2. Aj4jyrjoldjgirljisjadmittedjtojthejhospitaljforjherjthirdjevaluationjforjvaginaljbleeding.jThe
motherjnotedjbrightjredjbloodjonjthejchild'sjunderwear.jPreviousjexaminationsjrevealedjajnorma
lj 4j yrj oldj girl,j Tannerj stagej 1,j withj normalj externalj genitalia.j Pelvicj ultrasoundj resultsjwerejnormal,
jasjwasjthejserumjestradioljlevel. jThejhemoglobinjandjplateletjcountsjwerejnormal,jasjwerejthejble
edingjtimejandjcoagulationjstudies.jFindingsjonjpelvicjexaminationjconductedjunderjanesthesiajal
sojwerejnormal.jThejnextjstepjinjthejexaminationjisjto:
■ Determinejthejbloodjtypejofjthejbloodjonjthejunderwear
□Interrogate the father j j
□Isolate the parents and child
j j j j
□Determine von Willebrand factor levels
j j j j
, □Measure fibronectin in the vagina
j j j j
descriptionjConsiderationjofjfactitiousjdisorderjbyjproxyjshouldjbejtriggeredjwhenjthejreportedjsymptomsjarejrepeatedlyjnotedj
byj onlyj onej parent,j appropriatej testingj failsj toj confirmjaj diagnosis,j andj seeminglyj appropriatej treatmentj isj ineffective.jAtj times,j th
ej child'sj symptoms,j theirj course,j orj thej responsej toj treatmentj mayj bej incompatiblej withj anyj recognizedj disease.jPreverbalj childre
nj arej usuallyjinvolved.j Bleedingjisj aj particularlyjcommonj presentation.j Thisj mayj bej causedj byj addingj dyesjtoj samples,j addingj bloo
dj(e.g.,j fromjthej mother)jtojthejchild'sj sample,j orj givingjthejchildjanjanticoagulantj (e.g.,j warfarin).j(SeejChapterj37,jpagej146.)
3. Munchausenj syndromej byj proxyj isj characterizedj byj allj ofj thej followingj EXCEPT:
□Mother who appears devoted and wins over members of care team
j j j j j j j j j j
□Multiple hospitalizations and investigations without diagnosis
j j j j j
□Symptoms on history but not witnessed by medical team
j j j j j j j j
■ Symptomsj occurringjinj presencej ofj differentj caregiversj (e.g.,j whilej motherjisj outj ofjtown)
□Use of medications or toxins
j j j j
descriptionjSymptomsjinjyoungjchildrenjarejmostlyjassociatedjwithjproximityjofjthejoffendingjcaregiverjtojthejchild.jThejmothe
rjmayjpresentjasjajdevotedjorjevenjmodeljparentjwhojformsjclosejrelationshipsjwithjmembersjofjthejhealthjcarejteam.jWhileja
ppearingjveryjinterestedjinjherjchild'sjcondition,jshejmayjbejrelativelyjdistantjemotionally.j(SeejChapterj37,jpagej146.)
4. Whichjstatementjisjfalse?
■ Malnutritionjisjthej secondjleadingjcausej ofjacquiredjimmunej deficiencyj worldwidej behindj HIVjinfection
□Zinc is important in immune function and linear growth
j j j j j j j j
□Kwashiorkor and marasmus are rare in developed countries
j j j j j j j
□The Western diet is associated with increased noncommunicable disease
j j j j j j j j
descriptionjThejsignificantj globalj burdenj ofj malnutritionjandjundernutritionjisjthejleadingj worldwidejcausej ofjacquiredjimmunode
ficiencyjandjthejmajorjunderlyingjfactorjforjmorbidityjandj mortalityjgloballyjforjchildrenj<5jyrjofjage.jZincjisjajmicronutrientjthatjsu
pportsjmultiplejmetabolicjfunctionsjinjthejbody,jisjessentialjforjnormaljimmunejfunctioning,jandjisjrequiredjtojsupportjlinearj growth
;j zincj deficiencyjisjassociatedj withjimpairedjimmunejfunctioningjandj poorjlinearj growth.j Injparallelj tojthej riskj forj nutrientj andj ener
gyj deficiencies,j issuesj relatingjtoj excessesj posej importantj challengesj becausej ofjtheirjnegativejhealthjeffects,jsuchjasjobesityjorjcar
diovascularjdiseasejriskjfactors.jThejnutritionjtransitionjunderjwayjinjthe
, developingj worldj fromj traditionalj dietsj tojthej Westernj dietj hasj beenj associatedj withj increasesj injnoncommunicablejdiseases,j oft
enjcoexistingj withj undernutritionjandj malnutrition,j observedj sometimesjinjthej samejcommunitiesj orj evenjthejsamejfamilies.j(Se
eje41-1.)
5. Componentsj ofj energyj expenditurej inj childrenj include:
□Thermal effect of food j j j
□Basal metabolic rate
j j
□Energy for physical activity
j j j
□Energy to support growth
j j j
■ Alljofjthejabove
descriptionjThej3jcomponentsjofjenergyjexpenditurejinjadultsjarejthejbasaljmetabolicjrate,jthejthermaljeffectjofjfoodj(energ
yjrequiredjforjdigestionjandjabsorption),jandjenergyjforjphysicaljactivity.jAdditionaljenergyjintakejandjexpenditurejarejrequiredj
tojsupportjgrowthjandjdevelopmentjforjchildren.j(Seeje41-4.)
6. WhichjofjthejfollowingjclinicaljscenariosjincreasesjthejriskjofjvitaminjAjdeficiency?
□Vegetarian diet j
□Chronic intestinal disorders
j j
□Zinc deficiency
j
■ BjandjC
□All of the above
j j j
descriptionjVitaminjAjisjanjessentialjmicronutrientjbecausejitjcannotjbejbiogeneratedjdejnovojbyjanimals.jItjmustjbejobtain
edj fromj plantsj inj thej formj ofj provitamin-
Aj carotenoids.j Inj thej USA,j grainsj andj vegetablesj supplyj approximatelyj55%jandjdairyjandjmeatjproductsjsupplyjapproximatel
yj30%jofjvitaminjAjintakejfromjfood.jVitaminjAjandjthejprovitamins-
Aj arej fatj soluble,j andj theirj absorptionj dependsj onj thej presencej ofj adequatej lipidj andj proteinj withinj thej meal.jChronicjintestinalj d
isordersj orjlipidj malabsorptionjsyndromesjcanjresultjinj vitaminj Ajdeficiency.j Injdevelopingjcountries,jsubclinicaljorjclinicaljzincj
deficiencyjcanjincreasejthejriskjofjvitaminjAjdeficiency.jTherejisjalsojsomejevidencejofjmarginaljzincjintakesjinjchildrenjinjthej
USA.j(SeejChapterj45,jpagej188.)
7. WhichjstatementjaboutjvitaminjAjtoxicityjisjNOTjtrue?
j j j j
1. Whichjofjthejfollowingjstatementsjregardingjfosterjcarejisjtrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
j j j j j j j j j j j j j j j j j j j j j j
□A minority of children in foster care have a history of abuse or neglect
j j j j j j j j j j j j j
□The mission of foster care is to safely care for children while providing services to families to promote reunification
j j j j j j j j j j j j j j j j j j
□Most (>70%) of children in foster care are reunited with their families
j j j j j j j j j j j
■ AjandjC
descriptionj Thej missionj ofj fosterj carejisj toj providej forjthej health,j safety,jandj well-
beingj ofj childrenj whilej assistingj theirjfamiliesj withj servicesjtoj promotej reunification.j Childrenj enteringj fosterjcarej havej frequently
j experiencedj earlyj childhoodjtrauma.j Morej thanj 70%j havej aj historyj ofj abuse,j neglect,j orj both.j Onlyj aboutj 50%j ofj childrenj achieve
j reunification.j Inj thejUSA,jthejAdoptionjandjSafejFamiliesjActj(P.L.j105-
89)jpassedjinj1997jrequiresjthatjajpermanencyjplanjbejmadejforjeachj childj nojlaterjthanj 12j mojafterjentryjtoj fosterjcarej andjthatj aj
petitionjtojterminatej parentalj rightsjtypicallyj mustj bej filedjwhenjajchildjhasjbeenjinjfosterjcarejforjatjleastj15jofjthejpreviousj22jmo
.j(SeejChapterj35,jpagej134,jandje35-1.)
2. Aj4jyrjoldjgirljisjadmittedjtojthejhospitaljforjherjthirdjevaluationjforjvaginaljbleeding.jThe
motherjnotedjbrightjredjbloodjonjthejchild'sjunderwear.jPreviousjexaminationsjrevealedjajnorma
lj 4j yrj oldj girl,j Tannerj stagej 1,j withj normalj externalj genitalia.j Pelvicj ultrasoundj resultsjwerejnormal,
jasjwasjthejserumjestradioljlevel. jThejhemoglobinjandjplateletjcountsjwerejnormal,jasjwerejthejble
edingjtimejandjcoagulationjstudies.jFindingsjonjpelvicjexaminationjconductedjunderjanesthesiajal
sojwerejnormal.jThejnextjstepjinjthejexaminationjisjto:
■ Determinejthejbloodjtypejofjthejbloodjonjthejunderwear
□Interrogate the father j j
□Isolate the parents and child
j j j j
□Determine von Willebrand factor levels
j j j j
, □Measure fibronectin in the vagina
j j j j
descriptionjConsiderationjofjfactitiousjdisorderjbyjproxyjshouldjbejtriggeredjwhenjthejreportedjsymptomsjarejrepeatedlyjnotedj
byj onlyj onej parent,j appropriatej testingj failsj toj confirmjaj diagnosis,j andj seeminglyj appropriatej treatmentj isj ineffective.jAtj times,j th
ej child'sj symptoms,j theirj course,j orj thej responsej toj treatmentj mayj bej incompatiblej withj anyj recognizedj disease.jPreverbalj childre
nj arej usuallyjinvolved.j Bleedingjisj aj particularlyjcommonj presentation.j Thisj mayj bej causedj byj addingj dyesjtoj samples,j addingj bloo
dj(e.g.,j fromjthej mother)jtojthejchild'sj sample,j orj givingjthejchildjanjanticoagulantj (e.g.,j warfarin).j(SeejChapterj37,jpagej146.)
3. Munchausenj syndromej byj proxyj isj characterizedj byj allj ofj thej followingj EXCEPT:
□Mother who appears devoted and wins over members of care team
j j j j j j j j j j
□Multiple hospitalizations and investigations without diagnosis
j j j j j
□Symptoms on history but not witnessed by medical team
j j j j j j j j
■ Symptomsj occurringjinj presencej ofj differentj caregiversj (e.g.,j whilej motherjisj outj ofjtown)
□Use of medications or toxins
j j j j
descriptionjSymptomsjinjyoungjchildrenjarejmostlyjassociatedjwithjproximityjofjthejoffendingjcaregiverjtojthejchild.jThejmothe
rjmayjpresentjasjajdevotedjorjevenjmodeljparentjwhojformsjclosejrelationshipsjwithjmembersjofjthejhealthjcarejteam.jWhileja
ppearingjveryjinterestedjinjherjchild'sjcondition,jshejmayjbejrelativelyjdistantjemotionally.j(SeejChapterj37,jpagej146.)
4. Whichjstatementjisjfalse?
■ Malnutritionjisjthej secondjleadingjcausej ofjacquiredjimmunej deficiencyj worldwidej behindj HIVjinfection
□Zinc is important in immune function and linear growth
j j j j j j j j
□Kwashiorkor and marasmus are rare in developed countries
j j j j j j j
□The Western diet is associated with increased noncommunicable disease
j j j j j j j j
descriptionjThejsignificantj globalj burdenj ofj malnutritionjandjundernutritionjisjthejleadingj worldwidejcausej ofjacquiredjimmunode
ficiencyjandjthejmajorjunderlyingjfactorjforjmorbidityjandj mortalityjgloballyjforjchildrenj<5jyrjofjage.jZincjisjajmicronutrientjthatjsu
pportsjmultiplejmetabolicjfunctionsjinjthejbody,jisjessentialjforjnormaljimmunejfunctioning,jandjisjrequiredjtojsupportjlinearj growth
;j zincj deficiencyjisjassociatedj withjimpairedjimmunejfunctioningjandj poorjlinearj growth.j Injparallelj tojthej riskj forj nutrientj andj ener
gyj deficiencies,j issuesj relatingjtoj excessesj posej importantj challengesj becausej ofjtheirjnegativejhealthjeffects,jsuchjasjobesityjorjcar
diovascularjdiseasejriskjfactors.jThejnutritionjtransitionjunderjwayjinjthe
, developingj worldj fromj traditionalj dietsj tojthej Westernj dietj hasj beenj associatedj withj increasesj injnoncommunicablejdiseases,j oft
enjcoexistingj withj undernutritionjandj malnutrition,j observedj sometimesjinjthej samejcommunitiesj orj evenjthejsamejfamilies.j(Se
eje41-1.)
5. Componentsj ofj energyj expenditurej inj childrenj include:
□Thermal effect of food j j j
□Basal metabolic rate
j j
□Energy for physical activity
j j j
□Energy to support growth
j j j
■ Alljofjthejabove
descriptionjThej3jcomponentsjofjenergyjexpenditurejinjadultsjarejthejbasaljmetabolicjrate,jthejthermaljeffectjofjfoodj(energ
yjrequiredjforjdigestionjandjabsorption),jandjenergyjforjphysicaljactivity.jAdditionaljenergyjintakejandjexpenditurejarejrequiredj
tojsupportjgrowthjandjdevelopmentjforjchildren.j(Seeje41-4.)
6. WhichjofjthejfollowingjclinicaljscenariosjincreasesjthejriskjofjvitaminjAjdeficiency?
□Vegetarian diet j
□Chronic intestinal disorders
j j
□Zinc deficiency
j
■ BjandjC
□All of the above
j j j
descriptionjVitaminjAjisjanjessentialjmicronutrientjbecausejitjcannotjbejbiogeneratedjdejnovojbyjanimals.jItjmustjbejobtain
edj fromj plantsj inj thej formj ofj provitamin-
Aj carotenoids.j Inj thej USA,j grainsj andj vegetablesj supplyj approximatelyj55%jandjdairyjandjmeatjproductsjsupplyjapproximatel
yj30%jofjvitaminjAjintakejfromjfood.jVitaminjAjandjthejprovitamins-
Aj arej fatj soluble,j andj theirj absorptionj dependsj onj thej presencej ofj adequatej lipidj andj proteinj withinj thej meal.jChronicjintestinalj d
isordersj orjlipidj malabsorptionjsyndromesjcanjresultjinj vitaminj Ajdeficiency.j Injdevelopingjcountries,jsubclinicaljorjclinicaljzincj
deficiencyjcanjincreasejthejriskjofjvitaminjAjdeficiency.jTherejisjalsojsomejevidencejofjmarginaljzincjintakesjinjchildrenjinjthej
USA.j(SeejChapterj45,jpagej188.)
7. WhichjstatementjaboutjvitaminjAjtoxicityjisjNOTjtrue?
