, Nelson Pediatrics Review(MCQs) 19 Edition
n n n n
1. Which nofnthenfollowing nstatementsnregarding nfosterncarenisntrue?
□Ape rman en cy p la n m u st be ma de fo r a ch ild in fo ste r ca re no la te r tha n 1 2 mo fro m the ch ild's e n try in to ca re
n n n n n n n n n n n n n n n n n n n n n n
□Amin ority o f child re n in fo ste r ca re ha ve a histo ry o f ab u se o r n eg le ct
n n n n n n n n n n n n n
□The missio n o f fo ste r care i s to sa fe ly c a re fo r ch ild re n while pro viding se rvice s to fa milie s to p ro mo te re un ifica tio n
n n n n n n n n n n n n n n n n n n
□Most (>70 % ) o f ch ild re n in fo ste r ca re a re reu nited with th eir fa milie s
n n n n n n n n n n n
■ AnandnC
description n The nmissio n no fnfo ste rnca re nisnto np ro vide nfo rnth e nh ea lth ,nsa fe ty,nan d nwe ll-
being nofnchild re n nwhile na ssistin g nth eirn fa milie s nwith nservice s nto np ro mo te nr eu nifica tion . nCh ildre n nen te ring nfo ster ncare nh a ve nfreq ue n tly ne xpe rie nce
d ne arly nchildh o od n tra u ma .nM ore nth an n70 % nha ve na nhisto ry no fnab use ,nne g le ct,no r nbo th .nOn lynab o u tn5 0 % no fnch ild re n na chieve nreu n ifica tion . nIn nth
e n USA,nthenAdoptionnandnSafenFamiliesnActn(P.L.n105-
89)npassedninn1997nrequiresnthatnanpermanencynplannbenmadenfornn each nchild nno nla te r ntha n n1 2 nmo na fte rne n trynto nfo ste r nca re na nd nth a tna npe titi
on nto nte rm ina te np a re n ta l nrigh ts ntypica lly nm u stnbe nfile d n whennanchildnhasnbeenninnfosterncarenfornatnleastn15nof nthenpreviousn22 nmo. n(SeenCha
ptern35,npagen134,nandne35-1.)
2. An4nyrnold ngirlnisnadmitted ntonthenhospitalnfornhernthird nevaluation nfornvaginalnbleeding.nThe
mothernnoted nbrightnrednblood nonnthenchild'snunderwear.nPreviousnexaminationsn revealed nan normaln4nyrn
old ngirl,nTannernstagen1,nwith nnormalnexternalngenitalia.nPelvicnultrasound nresultsn werennormal,nasnwasnthe
n serumn estradiol n level.n The nhemoglobin nand nplatelet ncounts nwere n normal, nas n were nthe nbleedingntime n andn
coagulation nstudies.nFindingsnonnpelvicnexamination n conducted nundernanesthesianalsonwerennormal.nTh
ennextnstep ninnthenexamination nisnto:
■ Determinenthenbloodntypenofnthenbloodnonnthenunderwear
□Interroga te the fa th er
n n
□Isolate the p aren ts and ch ild
n n n n
□Determine von W illeb ran d factor le vels
n n n n
, □Measure fib rone ctin in th e vag ina
n n n n
description n Co n side ra tio n no fnfa ctitio u sndiso rd e r nb y np ro xynsho uld nb e ntrig ge red nwhe n nthe nre p orte d nsym p to ms na re nre pe a ted lyn no te d nb y no nly no
ne np aren t,nap p rop ria te nte stin g nfa ils nto ncon firm na nd ia gn osis,nan d nsee m in gly nap p ro pria te ntre a tm e n tnis nin e ffective . n Atntime s,nth e nchild 's nsym p to m s
,ntheir nco u rse ,no r nthe nre sp on se nto ntre a tm en tnm a ynbe nin co mp a tible nwith nan y nre co gn ized nd ise a se .n Pre verba l nchild re n na re nu su ally nin vo lve d .nBle e
ding ni s na np a rticula rly nco m mo n np re sen ta tio n . nTh isnma y nbe nca used nb y nad din g ndye s n to nsa m ple s,na dd ing nb lo od n(e .g .,nfro m nthe nmo the r) nto nth e nch ild'
snsamp le ,no r ng iving nth e nch ild na n nan tico ag ulan t n(e .g .,nwa rfa rin ).n (SeenChaptern37,npagen146.)
3. Munchausen nsyndromenbynproxynisncharacterized nbynallnofnthenfollowing nEXCEPT:
□Mothe r wh o a pp ea rs de vo ted an d wins o ve r m e mb e rs o f ca re tea m
n n n n n n n n n n
□Multiple hospitaliza tions and in vestiga tions withou t d iagnosis
n n n n n
□Symp to m s o n histo ry bu t n o t witn e sse d b y me dical tea m
n n n n n n n n
■ Symp to m s no ccu rrin g nin np re sen ce no fnd iffe ren tnca reg ive rsn(e .g .,nwh ile nmo th e rnisnou tno fnto w n )
□Use of me dica tions o r to xin s
n n n n
description nSymptomsnin nyoung nchildren nare nmostlynassociated nwith nproximitynofnthe noffending ncaregivernto nthe nchild.nThe n mothernmaynpr
esentnasnandevotednornevennmodelnparentnwhonformsnclosenrelationshipsnwithnmembersnofnthenhealthncaren team.nWhile nappearing nveryni
ntereste d nin nhe r nch ild'sncon dition ,nshe nm a ynbe nre la tive ly nd ista n tne m o tio n ally. n(Se e nCh a p te rn3 7 ,nnpagen146.)
4. Which nstatement nisnfalse?
■ Malnutrition nisnth e nse co nd nle a ding nca u se no fna cqu ire d nim mu ne nde ficie n cy nwo rld wid e nb eh in d nHIV nin fe ctio n
□Zinc is impo rtan t in immune fun ction an d linea r gro wth
n n n n n n n n
□Kwa shio rko r a nd m ara smu s a re r a re in de velop ed cou n trie s
n n n n n n n
□The Weste rn die t is a ssocia ted with in crea sed n onco mmu nicab le d ise ase
n n n n n n n n
description nTh e nsig nifica n tng lo ba l nb u rd en no fnmalnu tritio n na nd nun de rn u trition nisnth e nl ea d in g nwo rld wid e nc au se no fnacqu ire d n im mu n od e ficie n cy na n
d nthe nma jo r nu n de rlyin g nfa cto r nfo r nmo rb id ity na n d nmo rtality ng lo ba lly nfo r nch ild re n n<5 nyr no f na ge . nZin c nis na n micro nu trie n t ntha t ns u pp o rts nmu ltip le nme tab oli
cnfunction s nin nthe nbo dy,nis ne sse n tia l nfo r nn o rma lnim mu ne nfun ctio ning , nan d ni s n re qu ire d nto nsu pp o rtnl ine a r ngro wth ;nzin c nde ficien cy nis na sso cia te d nwith nim
paired nim mu n e nfu n ction in g na n d np o o r nl ine a r ng ro wth .nIn n p aralle lnto nthe nrisknfo r nn u trien tnan d ne ne rg y nd e ficie n cie s,nissu es nrela tin g nto nexce sse snpo se
nimporta n t ncha lle ng es nb e ca u se no f nthe ir n ne g a tive nh ea lth ne ffe cts, nsu ch na s nob e sity no r nca rd io va scu la r ndisea se nrisknfa cto rs. nThe nn u tritio n ntra nsitio
n nundernwa y nin nth e
, developing nwo rld nfro m ntrad ition a lndie tsnto nthe nWe ste rn nd ie tnha s nb ee n na sso cia te d nwith nin cre ase s nin nno n co m mu nicab le n d ise a se s,no fte n ncoe xisti
ng nwith nu n de rnu tritio n na nd nm alnu tritio n , no b se rve d nso me time s nin nth e nsa me nco m mun itie s no r ne ven nthe n samenfamilies.n(Seene41-1.)
5. Componentsnofnenergynexpenditureninnchildren ninclude:
□Thermal e ffe cto f foo d
n n n
□Basal metabolic ra te
n n
□Energy for physical activity
n n n
□Energy to supp ort gro wth
n n n
■ Allnofnth e na bo ve
description nThen3ncomponentsnofnenergynexpenditureninnadultsnarenthenbasalnmetabolicnrate,nthenthermalneffectnofnfoodn (energynrequir
ed nforndigestion nand nabsorption),nand nenergynfornphysicalnactivity.nAdditionalnenergynintake nand nexpenditure n arenrequiredntonsupportngro
wthnandndevelopmentnfornchildren.n(Seene41-4.)
6. Which nofnthenfollowing nclinicalnscenariosnincreasesnthenrisknofnvitamin nAndeficiency?
□Vegetarian diet n
□Chronic intestinal d iso rders
n n
□Zinc deficiency
n
■ BnandnC
□Allof the a bo ve
n n n
description nVitaminnAnisnannessentialnmicronutrientnbecausenitncannotnbenbiogeneratedndennovonbynanimals.nItnmustnben obtained nfro m npl
antsni n nthe nfo rm no f np ro vita min-
Ancaro te no ids. nIn nth e nU SA,ng ra in s nan d nve ge ta ble s nsu p ply na pp ro xima te ly n 55% nandndairynandnmeatnproductsnsupplynapproximatelyn30% nofn
vitaminnAnintakenfromnfood.nVitaminnAnandnthen pro vita m in s-
Anare nfa tnsolub le ,na nd nth eir nab so rp tion nde pe nd s no n nth e np re sen ce no fna de qu a te nlip id nan d np ro te in nwith in nthe nm ea l.n Ch ro nic ni n testina l nd iso rd e rs n
ornlipid nma la bso rp tio n nsyn d ro me s nca n nre su ltni n nvita m in nA nd e ficie n cy.nIn nd evelop in g nco un trie s,n sub clinical no r nclinica l nz inc nd e ficie ncy nca n ni n crea
se nthe nrisk no fnvita min nA nde ficien cy.nThe re ni s na lso nso me nevid e nce no fnma rgina ln zincnintakesninnchildrenninnthenUSA.n(SeenChaptern45,npagen
188.)
7. Which nstatement nabout nvitamin nAntoxicitynisnNOT ntrue?
n n n n
1. Which nofnthenfollowing nstatementsnregarding nfosterncarenisntrue?
□Ape rman en cy p la n m u st be ma de fo r a ch ild in fo ste r ca re no la te r tha n 1 2 mo fro m the ch ild's e n try in to ca re
n n n n n n n n n n n n n n n n n n n n n n
□Amin ority o f child re n in fo ste r ca re ha ve a histo ry o f ab u se o r n eg le ct
n n n n n n n n n n n n n
□The missio n o f fo ste r care i s to sa fe ly c a re fo r ch ild re n while pro viding se rvice s to fa milie s to p ro mo te re un ifica tio n
n n n n n n n n n n n n n n n n n n
□Most (>70 % ) o f ch ild re n in fo ste r ca re a re reu nited with th eir fa milie s
n n n n n n n n n n n
■ AnandnC
description n The nmissio n no fnfo ste rnca re nisnto np ro vide nfo rnth e nh ea lth ,nsa fe ty,nan d nwe ll-
being nofnchild re n nwhile na ssistin g nth eirn fa milie s nwith nservice s nto np ro mo te nr eu nifica tion . nCh ildre n nen te ring nfo ster ncare nh a ve nfreq ue n tly ne xpe rie nce
d ne arly nchildh o od n tra u ma .nM ore nth an n70 % nha ve na nhisto ry no fnab use ,nne g le ct,no r nbo th .nOn lynab o u tn5 0 % no fnch ild re n na chieve nreu n ifica tion . nIn nth
e n USA,nthenAdoptionnandnSafenFamiliesnActn(P.L.n105-
89)npassedninn1997nrequiresnthatnanpermanencynplannbenmadenfornn each nchild nno nla te r ntha n n1 2 nmo na fte rne n trynto nfo ste r nca re na nd nth a tna npe titi
on nto nte rm ina te np a re n ta l nrigh ts ntypica lly nm u stnbe nfile d n whennanchildnhasnbeenninnfosterncarenfornatnleastn15nof nthenpreviousn22 nmo. n(SeenCha
ptern35,npagen134,nandne35-1.)
2. An4nyrnold ngirlnisnadmitted ntonthenhospitalnfornhernthird nevaluation nfornvaginalnbleeding.nThe
mothernnoted nbrightnrednblood nonnthenchild'snunderwear.nPreviousnexaminationsn revealed nan normaln4nyrn
old ngirl,nTannernstagen1,nwith nnormalnexternalngenitalia.nPelvicnultrasound nresultsn werennormal,nasnwasnthe
n serumn estradiol n level.n The nhemoglobin nand nplatelet ncounts nwere n normal, nas n were nthe nbleedingntime n andn
coagulation nstudies.nFindingsnonnpelvicnexamination n conducted nundernanesthesianalsonwerennormal.nTh
ennextnstep ninnthenexamination nisnto:
■ Determinenthenbloodntypenofnthenbloodnonnthenunderwear
□Interroga te the fa th er
n n
□Isolate the p aren ts and ch ild
n n n n
□Determine von W illeb ran d factor le vels
n n n n
, □Measure fib rone ctin in th e vag ina
n n n n
description n Co n side ra tio n no fnfa ctitio u sndiso rd e r nb y np ro xynsho uld nb e ntrig ge red nwhe n nthe nre p orte d nsym p to ms na re nre pe a ted lyn no te d nb y no nly no
ne np aren t,nap p rop ria te nte stin g nfa ils nto ncon firm na nd ia gn osis,nan d nsee m in gly nap p ro pria te ntre a tm e n tnis nin e ffective . n Atntime s,nth e nchild 's nsym p to m s
,ntheir nco u rse ,no r nthe nre sp on se nto ntre a tm en tnm a ynbe nin co mp a tible nwith nan y nre co gn ized nd ise a se .n Pre verba l nchild re n na re nu su ally nin vo lve d .nBle e
ding ni s na np a rticula rly nco m mo n np re sen ta tio n . nTh isnma y nbe nca used nb y nad din g ndye s n to nsa m ple s,na dd ing nb lo od n(e .g .,nfro m nthe nmo the r) nto nth e nch ild'
snsamp le ,no r ng iving nth e nch ild na n nan tico ag ulan t n(e .g .,nwa rfa rin ).n (SeenChaptern37,npagen146.)
3. Munchausen nsyndromenbynproxynisncharacterized nbynallnofnthenfollowing nEXCEPT:
□Mothe r wh o a pp ea rs de vo ted an d wins o ve r m e mb e rs o f ca re tea m
n n n n n n n n n n
□Multiple hospitaliza tions and in vestiga tions withou t d iagnosis
n n n n n
□Symp to m s o n histo ry bu t n o t witn e sse d b y me dical tea m
n n n n n n n n
■ Symp to m s no ccu rrin g nin np re sen ce no fnd iffe ren tnca reg ive rsn(e .g .,nwh ile nmo th e rnisnou tno fnto w n )
□Use of me dica tions o r to xin s
n n n n
description nSymptomsnin nyoung nchildren nare nmostlynassociated nwith nproximitynofnthe noffending ncaregivernto nthe nchild.nThe n mothernmaynpr
esentnasnandevotednornevennmodelnparentnwhonformsnclosenrelationshipsnwithnmembersnofnthenhealthncaren team.nWhile nappearing nveryni
ntereste d nin nhe r nch ild'sncon dition ,nshe nm a ynbe nre la tive ly nd ista n tne m o tio n ally. n(Se e nCh a p te rn3 7 ,nnpagen146.)
4. Which nstatement nisnfalse?
■ Malnutrition nisnth e nse co nd nle a ding nca u se no fna cqu ire d nim mu ne nde ficie n cy nwo rld wid e nb eh in d nHIV nin fe ctio n
□Zinc is impo rtan t in immune fun ction an d linea r gro wth
n n n n n n n n
□Kwa shio rko r a nd m ara smu s a re r a re in de velop ed cou n trie s
n n n n n n n
□The Weste rn die t is a ssocia ted with in crea sed n onco mmu nicab le d ise ase
n n n n n n n n
description nTh e nsig nifica n tng lo ba l nb u rd en no fnmalnu tritio n na nd nun de rn u trition nisnth e nl ea d in g nwo rld wid e nc au se no fnacqu ire d n im mu n od e ficie n cy na n
d nthe nma jo r nu n de rlyin g nfa cto r nfo r nmo rb id ity na n d nmo rtality ng lo ba lly nfo r nch ild re n n<5 nyr no f na ge . nZin c nis na n micro nu trie n t ntha t ns u pp o rts nmu ltip le nme tab oli
cnfunction s nin nthe nbo dy,nis ne sse n tia l nfo r nn o rma lnim mu ne nfun ctio ning , nan d ni s n re qu ire d nto nsu pp o rtnl ine a r ngro wth ;nzin c nde ficien cy nis na sso cia te d nwith nim
paired nim mu n e nfu n ction in g na n d np o o r nl ine a r ng ro wth .nIn n p aralle lnto nthe nrisknfo r nn u trien tnan d ne ne rg y nd e ficie n cie s,nissu es nrela tin g nto nexce sse snpo se
nimporta n t ncha lle ng es nb e ca u se no f nthe ir n ne g a tive nh ea lth ne ffe cts, nsu ch na s nob e sity no r nca rd io va scu la r ndisea se nrisknfa cto rs. nThe nn u tritio n ntra nsitio
n nundernwa y nin nth e
, developing nwo rld nfro m ntrad ition a lndie tsnto nthe nWe ste rn nd ie tnha s nb ee n na sso cia te d nwith nin cre ase s nin nno n co m mu nicab le n d ise a se s,no fte n ncoe xisti
ng nwith nu n de rnu tritio n na nd nm alnu tritio n , no b se rve d nso me time s nin nth e nsa me nco m mun itie s no r ne ven nthe n samenfamilies.n(Seene41-1.)
5. Componentsnofnenergynexpenditureninnchildren ninclude:
□Thermal e ffe cto f foo d
n n n
□Basal metabolic ra te
n n
□Energy for physical activity
n n n
□Energy to supp ort gro wth
n n n
■ Allnofnth e na bo ve
description nThen3ncomponentsnofnenergynexpenditureninnadultsnarenthenbasalnmetabolicnrate,nthenthermalneffectnofnfoodn (energynrequir
ed nforndigestion nand nabsorption),nand nenergynfornphysicalnactivity.nAdditionalnenergynintake nand nexpenditure n arenrequiredntonsupportngro
wthnandndevelopmentnfornchildren.n(Seene41-4.)
6. Which nofnthenfollowing nclinicalnscenariosnincreasesnthenrisknofnvitamin nAndeficiency?
□Vegetarian diet n
□Chronic intestinal d iso rders
n n
□Zinc deficiency
n
■ BnandnC
□Allof the a bo ve
n n n
description nVitaminnAnisnannessentialnmicronutrientnbecausenitncannotnbenbiogeneratedndennovonbynanimals.nItnmustnben obtained nfro m npl
antsni n nthe nfo rm no f np ro vita min-
Ancaro te no ids. nIn nth e nU SA,ng ra in s nan d nve ge ta ble s nsu p ply na pp ro xima te ly n 55% nandndairynandnmeatnproductsnsupplynapproximatelyn30% nofn
vitaminnAnintakenfromnfood.nVitaminnAnandnthen pro vita m in s-
Anare nfa tnsolub le ,na nd nth eir nab so rp tion nde pe nd s no n nth e np re sen ce no fna de qu a te nlip id nan d np ro te in nwith in nthe nm ea l.n Ch ro nic ni n testina l nd iso rd e rs n
ornlipid nma la bso rp tio n nsyn d ro me s nca n nre su ltni n nvita m in nA nd e ficie n cy.nIn nd evelop in g nco un trie s,n sub clinical no r nclinica l nz inc nd e ficie ncy nca n ni n crea
se nthe nrisk no fnvita min nA nde ficien cy.nThe re ni s na lso nso me nevid e nce no fnma rgina ln zincnintakesninnchildrenninnthenUSA.n(SeenChaptern45,npagen
188.)
7. Which nstatement nabout nvitamin nAntoxicitynisnNOT ntrue?
