, Nelson Pediatrics Review(MCQs) 19 Edition
p p p p
1. Whichpofpthepfollowingpstatementspregardingpfosterpcarepisptrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
p p p p p p p p p p p p p p p p p p p p p p
□A minority of children in foster care have a history of abuse or neglect
p p p p p p p p p p p p p
□The mission of foster care is to safely care for children while providing services to families to promote reunification
p p p p p p p p p p p p p p p p p p
□Most (>70%) of children in foster care are reunited with their families
p p p p p p p p p p p
■ ApandpC
descriptionp Thep missionp ofp fosterp carep isp top providep forp thep health,p safety,p andp well-
beingp ofp childrenp whilep assistingp theirpfamiliesp withp servicesptop promotep reunification.p Childrenp enteringp fosterpcarep havep freque
ntlyp experiencedp earlyp childhoodptrauma.p Morep thanp 70%p havep ap historyp ofp abuse,p neglect,p orp both.p Onlyp aboutp 50%p ofp childre
np achievep reunification.p Inp thepUSA,pthepAdoptionpandpSafepFamiliespActp(P.L.p105-
89)ppassedpinp1997prequirespthatpappermanencypplanpbepmadepforpeachp childp nop laterp thanp 12p mop afterp entryptop fosterp carep andp
thatp ap petitionp top terminatep parentalp rightsp typicallyp mustp bep filedpwhenpapchildphaspbeenpinpfosterpcarepforpatpleastp15pofptheppre
viousp22pmo.p(SeepChapterp35,ppagep134,pandpe35-1.)
2. Ap4pyrpoldpgirlpispadmittedptopthephospitalpforpherpthirdpevaluationpforpvaginalpbleeding.pThe
motherpnotedpbrightpredpbloodponpthepchild'spunderwear.pPreviouspexaminationsprevealedpapnor
malp 4p yrp oldp girl,p Tannerp stagep 1,p withp normalp externalp genitalia.p Pelvicp ultrasoundp resultspwerepn
ormal,paspwaspthepserumpestradiolplevel.pThephemoglobinpandpplateletpcountspwerepnormal,paspw
erepthepbleedingptimepandpcoagulationpstudies.pFindingsponppelvicpexaminationpconductedpunder
panesthesia palsopwerepnormal.pThepnextpsteppinpthepexaminationpispto:
■ Determinepthepbloodptypepofpthepbloodponpthepunderwear
□Interrogate the father p p
□Isolate the parents and child
p p p p
□Determine von Willebrand factor levels
p p p p
, □Measure fibronectin in the vagina
p p p p
descriptionpConsiderationpofpfactitiouspdisorderpbypproxypshouldpbeptriggeredpwhenpthepreportedpsymptomspareprepeatedlypn
otedp byp onlyp onep parent,p appropriatep testingp failsp top confirmp ap diagnosis,p andp seeminglyp appropriatep treatmentp isp ineffective.pAt
p times,p thep child'sp symptoms,p theirp course,p orp thep responsep top treatmentp mayp bep incompatiblep withp anyp recognizedp disease.pPrev
erbalp childrenp arep usuallyp involved.p Bleedingp isp ap particularlyp commonp presentation.p Thisp mayp bep causedp byp addingp dyesptop sa
mples,p addingp bloodp (e.g.,p fromp thep mother)p top thep child'sp sample,p orp givingp thep childp anp anticoagulantp (e.g.,p warfarin).p(SeepCh
apterp37,ppagep146.)
3. Munchausenp syndromep byp proxyp isp characterizedp byp allp ofp thep followingp EXCEPT:
□Mother who appears devoted and wins over members of care team
p p p p p p p p p p
□Multiple hospitalizations and investigations without diagnosis
p p p p p
□Symptoms on history but not witnessed by medical team
p p p p p p p p
■ Symptomsp occurringp inp presencep ofp differentp caregiversp (e.g.,p whilep motherp isp outp ofp town)
□Use of medications or toxins
p p p p
descriptionpSymptomspinpyoungpchildrenparepmostlypassociatedpwithpproximitypofpthepoffendingpcaregiverptopthepchild.pThepm
otherpmayppresentpaspapdevotedporpevenpmodelpparentpwhopformspcloseprelationshipspwithpmemberspofpthephealthpcareptea
m.pWhilepappearingpverypinterestedpinpherpchild'spcondition,pshepmaypbeprelativelypdistantpemotionally.p(SeepChapterp37,ppagep
146.)
4. Whichpstatementpispfalse?
■ Malnutritionpisp thep secondp leadingp causep ofp acquiredp immunep deficiencyp worldwidep behindp HIVpinfection
□Zinc is important in immune function and linear growth
p p p p p p p p
□Kwashiorkor and marasmus are rare in developed countries
p p p p p p p
□The Western diet is associated with increased noncommunicable disease
p p p p p p p p
descriptionp Thepsignificantp globalp burdenp ofp malnutritionp andp undernutritionpispthepleadingp worldwidep causep ofpacquiredpimmu
nodeficiencypandpthepmajorpunderlyingpfactorpforpmorbiditypandp mortalitypgloballypforpchildrenp<5p yrpofpage.pZincpispapmicronutri
entpthatpsupportspmultiplep metabolicpfunctionspinpthep body,pispessentialpforpnormalpimmunepfunctioning,pandpisprequiredptopsuppor
tp linearp growth;p zincp deficiencypisp associatedp withp impairedpimmunep functioningp andp poorplinearp growth.p Inpparallelp top thep riskp f
orp nutrientp andp energyp deficiencies,p issuesp relatingp top excessesp posep importantp challengesp becausep ofp theirpnegativephealthpeffec
ts,psuchpaspobesityporpcardiovascularpdiseasepriskpfactors.pThepnutritionptransitionpunderpwaypinpthe
, developingp worldp fromp traditionalp dietsp top thep Westernp dietp hasp beenp associatedp withp increasesp inp noncommunicablepdiseases
,p oftenp coexistingp withp undernutritionpandp malnutrition,p observedp sometimesp inp thep samep communitiesp orp evenpthepsamepfamil
ies.p(Seepe41-1.)
5. Componentsp ofp energyp expenditurep inp childrenp include:
□Thermal effect of food
p p p
□Basal metabolic rate
p p
□Energy for physical activity
p p p
□Energy to support growth
p p p
■ Allpofpthepabove
descriptionpThep3pcomponentspofpenergypexpenditurepinpadultsparepthepbasalpmetabolicprate,pthepthermalpeffectpofpfoodp(e
nergyprequiredpforpdigestionpandpabsorption),pandpenergypforpphysicalpactivity.pAdditionalpenergypintakepandpexpenditureparepr
equiredptopsupportpgrowthpandpdevelopmentpforpchildren.p(Seepe41-4.)
6. WhichpofpthepfollowingpclinicalpscenariospincreasespthepriskpofpvitaminpApdeficiency?
□Vegetarian diet p
□Chronic intestinal disorders
p p
□Zinc deficiency
p
■ BpandpC
□All of the above
p p p
descriptionpVitaminpApispanpessentialpmicronutrientpbecausepitpcannotpbepbiogeneratedpdepnovopbypanimals.pItpmustpbepo
btainedp fromp plantsp inp thep formp ofp provitamin-
Ap carotenoids.p Inp thep USA,p grainsp andp vegetablesp supplyp approximatelyp55%pandpdairypandpmeatpproductspsupplypapproxi
matelyp30%pofpvitaminpApintakepfrompfood.pVitaminpApandpthepprovitamins-
Ap arep fatp soluble,p andp theirp absorptionp dependsp onp thep presencep ofp adequatep lipidp andp proteinp withinp thep meal.pChronicp intesti
nalp disordersp orplipidp malabsorptionp syndromespcanp resultpinp vitaminp Ap deficiency.p Inp developingp countries,psubclinicalporpclin
icalpzincpdeficiencypcanpincreasepthepriskpofpvitaminpApdeficiency.pTherepispalsopsomepevidencepofpmarginalpzincpintakespinpchi
ldrenpinpthepUSA.p(SeepChapterp45,ppagep188.)
7. WhichpstatementpaboutpvitaminpAptoxicitypispNOTptrue?
p p p p
1. Whichpofpthepfollowingpstatementspregardingpfosterpcarepisptrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
p p p p p p p p p p p p p p p p p p p p p p
□A minority of children in foster care have a history of abuse or neglect
p p p p p p p p p p p p p
□The mission of foster care is to safely care for children while providing services to families to promote reunification
p p p p p p p p p p p p p p p p p p
□Most (>70%) of children in foster care are reunited with their families
p p p p p p p p p p p
■ ApandpC
descriptionp Thep missionp ofp fosterp carep isp top providep forp thep health,p safety,p andp well-
beingp ofp childrenp whilep assistingp theirpfamiliesp withp servicesptop promotep reunification.p Childrenp enteringp fosterpcarep havep freque
ntlyp experiencedp earlyp childhoodptrauma.p Morep thanp 70%p havep ap historyp ofp abuse,p neglect,p orp both.p Onlyp aboutp 50%p ofp childre
np achievep reunification.p Inp thepUSA,pthepAdoptionpandpSafepFamiliespActp(P.L.p105-
89)ppassedpinp1997prequirespthatpappermanencypplanpbepmadepforpeachp childp nop laterp thanp 12p mop afterp entryptop fosterp carep andp
thatp ap petitionp top terminatep parentalp rightsp typicallyp mustp bep filedpwhenpapchildphaspbeenpinpfosterpcarepforpatpleastp15pofptheppre
viousp22pmo.p(SeepChapterp35,ppagep134,pandpe35-1.)
2. Ap4pyrpoldpgirlpispadmittedptopthephospitalpforpherpthirdpevaluationpforpvaginalpbleeding.pThe
motherpnotedpbrightpredpbloodponpthepchild'spunderwear.pPreviouspexaminationsprevealedpapnor
malp 4p yrp oldp girl,p Tannerp stagep 1,p withp normalp externalp genitalia.p Pelvicp ultrasoundp resultspwerepn
ormal,paspwaspthepserumpestradiolplevel.pThephemoglobinpandpplateletpcountspwerepnormal,paspw
erepthepbleedingptimepandpcoagulationpstudies.pFindingsponppelvicpexaminationpconductedpunder
panesthesia palsopwerepnormal.pThepnextpsteppinpthepexaminationpispto:
■ Determinepthepbloodptypepofpthepbloodponpthepunderwear
□Interrogate the father p p
□Isolate the parents and child
p p p p
□Determine von Willebrand factor levels
p p p p
, □Measure fibronectin in the vagina
p p p p
descriptionpConsiderationpofpfactitiouspdisorderpbypproxypshouldpbeptriggeredpwhenpthepreportedpsymptomspareprepeatedlypn
otedp byp onlyp onep parent,p appropriatep testingp failsp top confirmp ap diagnosis,p andp seeminglyp appropriatep treatmentp isp ineffective.pAt
p times,p thep child'sp symptoms,p theirp course,p orp thep responsep top treatmentp mayp bep incompatiblep withp anyp recognizedp disease.pPrev
erbalp childrenp arep usuallyp involved.p Bleedingp isp ap particularlyp commonp presentation.p Thisp mayp bep causedp byp addingp dyesptop sa
mples,p addingp bloodp (e.g.,p fromp thep mother)p top thep child'sp sample,p orp givingp thep childp anp anticoagulantp (e.g.,p warfarin).p(SeepCh
apterp37,ppagep146.)
3. Munchausenp syndromep byp proxyp isp characterizedp byp allp ofp thep followingp EXCEPT:
□Mother who appears devoted and wins over members of care team
p p p p p p p p p p
□Multiple hospitalizations and investigations without diagnosis
p p p p p
□Symptoms on history but not witnessed by medical team
p p p p p p p p
■ Symptomsp occurringp inp presencep ofp differentp caregiversp (e.g.,p whilep motherp isp outp ofp town)
□Use of medications or toxins
p p p p
descriptionpSymptomspinpyoungpchildrenparepmostlypassociatedpwithpproximitypofpthepoffendingpcaregiverptopthepchild.pThepm
otherpmayppresentpaspapdevotedporpevenpmodelpparentpwhopformspcloseprelationshipspwithpmemberspofpthephealthpcareptea
m.pWhilepappearingpverypinterestedpinpherpchild'spcondition,pshepmaypbeprelativelypdistantpemotionally.p(SeepChapterp37,ppagep
146.)
4. Whichpstatementpispfalse?
■ Malnutritionpisp thep secondp leadingp causep ofp acquiredp immunep deficiencyp worldwidep behindp HIVpinfection
□Zinc is important in immune function and linear growth
p p p p p p p p
□Kwashiorkor and marasmus are rare in developed countries
p p p p p p p
□The Western diet is associated with increased noncommunicable disease
p p p p p p p p
descriptionp Thepsignificantp globalp burdenp ofp malnutritionp andp undernutritionpispthepleadingp worldwidep causep ofpacquiredpimmu
nodeficiencypandpthepmajorpunderlyingpfactorpforpmorbiditypandp mortalitypgloballypforpchildrenp<5p yrpofpage.pZincpispapmicronutri
entpthatpsupportspmultiplep metabolicpfunctionspinpthep body,pispessentialpforpnormalpimmunepfunctioning,pandpisprequiredptopsuppor
tp linearp growth;p zincp deficiencypisp associatedp withp impairedpimmunep functioningp andp poorplinearp growth.p Inpparallelp top thep riskp f
orp nutrientp andp energyp deficiencies,p issuesp relatingp top excessesp posep importantp challengesp becausep ofp theirpnegativephealthpeffec
ts,psuchpaspobesityporpcardiovascularpdiseasepriskpfactors.pThepnutritionptransitionpunderpwaypinpthe
, developingp worldp fromp traditionalp dietsp top thep Westernp dietp hasp beenp associatedp withp increasesp inp noncommunicablepdiseases
,p oftenp coexistingp withp undernutritionpandp malnutrition,p observedp sometimesp inp thep samep communitiesp orp evenpthepsamepfamil
ies.p(Seepe41-1.)
5. Componentsp ofp energyp expenditurep inp childrenp include:
□Thermal effect of food
p p p
□Basal metabolic rate
p p
□Energy for physical activity
p p p
□Energy to support growth
p p p
■ Allpofpthepabove
descriptionpThep3pcomponentspofpenergypexpenditurepinpadultsparepthepbasalpmetabolicprate,pthepthermalpeffectpofpfoodp(e
nergyprequiredpforpdigestionpandpabsorption),pandpenergypforpphysicalpactivity.pAdditionalpenergypintakepandpexpenditureparepr
equiredptopsupportpgrowthpandpdevelopmentpforpchildren.p(Seepe41-4.)
6. WhichpofpthepfollowingpclinicalpscenariospincreasespthepriskpofpvitaminpApdeficiency?
□Vegetarian diet p
□Chronic intestinal disorders
p p
□Zinc deficiency
p
■ BpandpC
□All of the above
p p p
descriptionpVitaminpApispanpessentialpmicronutrientpbecausepitpcannotpbepbiogeneratedpdepnovopbypanimals.pItpmustpbepo
btainedp fromp plantsp inp thep formp ofp provitamin-
Ap carotenoids.p Inp thep USA,p grainsp andp vegetablesp supplyp approximatelyp55%pandpdairypandpmeatpproductspsupplypapproxi
matelyp30%pofpvitaminpApintakepfrompfood.pVitaminpApandpthepprovitamins-
Ap arep fatp soluble,p andp theirp absorptionp dependsp onp thep presencep ofp adequatep lipidp andp proteinp withinp thep meal.pChronicp intesti
nalp disordersp orplipidp malabsorptionp syndromespcanp resultpinp vitaminp Ap deficiency.p Inp developingp countries,psubclinicalporpclin
icalpzincpdeficiencypcanpincreasepthepriskpofpvitaminpApdeficiency.pTherepispalsopsomepevidencepofpmarginalpzincpintakespinpchi
ldrenpinpthepUSA.p(SeepChapterp45,ppagep188.)
7. WhichpstatementpaboutpvitaminpAptoxicitypispNOTptrue?
