, Nelson Pediatrics Review(MCQs) 19 Edition
g g g g
1. Whichgofgthegfollowinggstatementsgregardinggfostergcaregisgtrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
g g g g g g g g g g g g g g g g g g g g g g
□A minority of children in foster care have a history of abuse or neglect
g g g g g g g g g g g g g
□The mission of foster care is to safelycare for children while providing services to familiesto promote reunification
g g g g g g g g g g g g g g g g g g
□Most (>70%) of children in foster care are reunited with their families
g g g g g g g g g g g
■ AgandgC
descriptiongThegmissiongofgfostergcaregisgtogprovidegforgtheghealth,gsafety,gandgwell-
beinggofgchildrengwhilegassistinggtheirg familiesgwithgservicesgtogpromotegreunification.gChildrengenteringgfostergcareghavegfrequentlygexperience
dgearlygchildhoodg trauma.gMoregthang70%ghavegaghistorygofgabuse,gneglect,gorgboth.gOnlygaboutg50%gofgchildrengachievegreunification.gIngth
eg USA,gthegAdoptiongandgSafegFamiliesgActg(P.L.g105-
89)gpassedging1997grequiresgthatgagpermanencygplangbegmadegforgg eachgchildgnoglatergthang12gmogaftergentrygtogfostergcaregandgthatgagpetiti
ongtogterminategparentalgrightsgtypicallygmustgbegfiledg whengagchildghasgbeengingfostergcaregforgatgleastg15gofgthegpreviousg22gmo.g(SeegCha
pterg35,gpageg134,gandge35-1.)
2. Ag4gyrgoldggirlgisgadmittedgtogtheghospitalgforghergthirdgevaluationgforgvaginalgbleeding.gThe
mothergnotedgbrightgredgbloodgongthegchild'sgunderwear.gPreviousgexaminationsgrevealedgag normalg4gyrg
oldggirl,gTannergstageg1,gwithgnormalgexternalggenitalia.gPelvicgultrasoundgresultsg weregnormal,gasgwasgthe
gserum gestradiolglevel. gTheghemoglobin gandgplateletgcountsgwereg normal,gasgweregthegbleedinggtimegandg
coagulationgstudies.gFindingsgongpelvicgexaminationg conductedgunderganesthesiagalsogweregnormal.gTh
egnextgstepgingthegexaminationgisgto:
■ Determinegthegbloodgtypegofgthegbloodgongthegunderwear
□Interrogate the father g g
□Isolate the parents and child
g g g g
□Determine von Willebrand factor levels
g g g g
, □Measure fibronectin in the vagina
g g g g
descriptiongConsiderationgofgfactitiousgdisordergbygproxygshouldgbegtriggeredgwhengthegreportedgsymptomsgaregrepeatedlyg notedgbygonlygo
negparent,gappropriategtestinggfailsgtogconfirmgagdiagnosis,gandgseeminglygappropriategtreatmentgisgineffective.g Atgtimes,gthegchild'sgsymptoms
,gtheirgcourse,gorgthegresponsegtogtreatmentgmaygbegincompatiblegwithganygrecognizedgdisease.g Preverbalgchildrengaregusuallyginvolved.gBlee
dinggisgagparticularlygcommongpresentation.gThisgmaygbegcausedgbygaddinggdyesg togsamples,gaddinggbloodg(e.g.,gfromgthegmother)gtogthegchild'
sgsample,gorggivinggthegchildganganticoagulantg(e.g.,gwarfarin).g (SeegChapterg37,gpageg146.)
3. MunchausengsyndromegbygproxygisgcharacterizedgbygallgofgthegfollowinggEXCEPT:
□Mother who appears devoted and wins over members of care team
g g g g g g g g g g
□Multiple hospitalizations and investigations without diagnosis
g g g g g
□Symptoms on historybut not witnessed by medicalteam
g g g g g g g g
■ Symptomsgoccurringgingpresencegofgdifferentgcaregiversg(e.g.,gwhilegmothergisgoutgofgtown)
□Use of medications or toxins
g g g g
descriptiongSymptomsgingyounggchildrengaregmostlygassociatedgwithgproximitygofgthegoffendinggcaregivergtogthegchild.gTheg mothergmaygpr
esentgasgagdevotedgorgevengmodelgparentgwhogformsgclosegrelationshipsgwithgmembersgofgtheghealthgcareg team.gWhilegappearinggverygi
nterestedginghergchild'sgcondition,gshegmaygbegrelativelygdistantgemotionally.g(SeegChapterg37,ggpageg146.)
4. Whichgstatementgisgfalse?
■ MalnutritiongisgthegsecondgleadinggcausegofgacquiredgimmunegdeficiencygworldwidegbehindgHIVginfection
□Zinc is important in immune function and linear growth
g g g g g g g g
□Kwashiorkor and marasmusare rare in developed countries
g g g g g g g
□The Western diet is associated with increased noncommunicable disease
g g g g g g g g
descriptiongThegsignificantgglobalgburdengofgmalnutritiongandgundernutritiongisgthegleadinggworldwidegcausegofgacquiredg immunodeficiencygan
dgthegmajorgunderlyinggfactorgforgmorbiditygandgmortalityggloballygforgchildreng<5gyrgofgage.gZincgisgag micronutrientgthatgsupportsgmultiplegmetaboli
cgfunctionsgingthegbody,gisgessentialgforgnormalgimmunegfunctioning,gandgisg requiredgtogsupportglinearggrowth;gzincgdeficiencygisgassociatedgwithgim
pairedgimmunegfunctioninggandgpoorglinearggrowth.gIng parallelgtogthegriskgforgnutrientgandgenergygdeficiencies,gissuesgrelatinggtogexcessesgpose
gimportantgchallengesgbecausegofgtheirg negativeghealthgeffects,gsuchgasgobesitygorgcardiovasculargdiseasegriskgfactors.gThegnutritiongtransitio
ngundergwaygingthe
, developinggworldgfromgtraditionalgdietsgtogthegWesterngdietghasgbeengassociatedgwithgincreasesgingnoncommunicableg diseases,goftengcoexisti
nggwithgundernutritiongandgmalnutrition,gobservedgsometimesgingthegsamegcommunitiesgorgevengtheg samegfamilies.g(Seege41-1.)
5. Componentsgofgenergygexpendituregingchildrenginclude:
□Thermal effect of food g g g
□Basal metabolic rate
g g
□Energy for physical activity
g g g
□Energy to support growth g g g
■ Allgofgthegabove
descriptiongTheg3gcomponentsgofgenergygexpendituregingadultsgaregthegbasalgmetabolicgrate,gthegthermalgeffectgofgfoodg (energygrequir
edgforgdigestiongandgabsorption),gandgenergygforgphysicalgactivity.gAdditionalgenergygintakegandgexpenditureg aregrequiredgtogsupportggro
wthgandgdevelopmentgforgchildren.g(Seege41-4.)
6. WhichgofgthegfollowinggclinicalgscenariosgincreasesgthegriskgofgvitamingAgdeficiency?
□Vegetarian diet g
□Chronic intestinal disorders
g g
□Zinc deficiency
g
■ BgandgC
□All of the above
g g g
descriptiongVitamingAgisgangessentialgmicronutrientgbecausegitgcannotgbegbiogeneratedgdegnovogbyganimals.gItgmustgbeg obtainedgfromgpl
antsgingthegformgofgprovitamin-
Agcarotenoids.gIngthegUSA,ggrainsgandgvegetablesgsupplygapproximatelyg 55%gandgdairygandgmeatgproductsgsupplygapproximatelyg30%gofg
vitamingAgintakegfromgfood.gVitamingAgandgtheg provitamins-
Agaregfatgsoluble,gandgtheirgabsorptiongdependsgongthegpresencegofgadequateglipidgandgproteingwithingthegmeal.g Chronicgintestinalgdisordersg
orglipidgmalabsorptiongsyndromesgcangresultgingvitamingAgdeficiency.gIngdevelopinggcountries,g subclinicalgorgclinicalgzincgdeficiencygcangincrea
segthegriskgofgvitamingAgdeficiency.gTheregisgalsogsomegevidencegofgmarginalg zincgintakesgingchildrengingthegUSA.g(SeegChapterg45,gpageg
188.)
7. WhichgstatementgaboutgvitamingAgtoxicitygisgNOTgtrue?
g g g g
1. Whichgofgthegfollowinggstatementsgregardinggfostergcaregisgtrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
g g g g g g g g g g g g g g g g g g g g g g
□A minority of children in foster care have a history of abuse or neglect
g g g g g g g g g g g g g
□The mission of foster care is to safelycare for children while providing services to familiesto promote reunification
g g g g g g g g g g g g g g g g g g
□Most (>70%) of children in foster care are reunited with their families
g g g g g g g g g g g
■ AgandgC
descriptiongThegmissiongofgfostergcaregisgtogprovidegforgtheghealth,gsafety,gandgwell-
beinggofgchildrengwhilegassistinggtheirg familiesgwithgservicesgtogpromotegreunification.gChildrengenteringgfostergcareghavegfrequentlygexperience
dgearlygchildhoodg trauma.gMoregthang70%ghavegaghistorygofgabuse,gneglect,gorgboth.gOnlygaboutg50%gofgchildrengachievegreunification.gIngth
eg USA,gthegAdoptiongandgSafegFamiliesgActg(P.L.g105-
89)gpassedging1997grequiresgthatgagpermanencygplangbegmadegforgg eachgchildgnoglatergthang12gmogaftergentrygtogfostergcaregandgthatgagpetiti
ongtogterminategparentalgrightsgtypicallygmustgbegfiledg whengagchildghasgbeengingfostergcaregforgatgleastg15gofgthegpreviousg22gmo.g(SeegCha
pterg35,gpageg134,gandge35-1.)
2. Ag4gyrgoldggirlgisgadmittedgtogtheghospitalgforghergthirdgevaluationgforgvaginalgbleeding.gThe
mothergnotedgbrightgredgbloodgongthegchild'sgunderwear.gPreviousgexaminationsgrevealedgag normalg4gyrg
oldggirl,gTannergstageg1,gwithgnormalgexternalggenitalia.gPelvicgultrasoundgresultsg weregnormal,gasgwasgthe
gserum gestradiolglevel. gTheghemoglobin gandgplateletgcountsgwereg normal,gasgweregthegbleedinggtimegandg
coagulationgstudies.gFindingsgongpelvicgexaminationg conductedgunderganesthesiagalsogweregnormal.gTh
egnextgstepgingthegexaminationgisgto:
■ Determinegthegbloodgtypegofgthegbloodgongthegunderwear
□Interrogate the father g g
□Isolate the parents and child
g g g g
□Determine von Willebrand factor levels
g g g g
, □Measure fibronectin in the vagina
g g g g
descriptiongConsiderationgofgfactitiousgdisordergbygproxygshouldgbegtriggeredgwhengthegreportedgsymptomsgaregrepeatedlyg notedgbygonlygo
negparent,gappropriategtestinggfailsgtogconfirmgagdiagnosis,gandgseeminglygappropriategtreatmentgisgineffective.g Atgtimes,gthegchild'sgsymptoms
,gtheirgcourse,gorgthegresponsegtogtreatmentgmaygbegincompatiblegwithganygrecognizedgdisease.g Preverbalgchildrengaregusuallyginvolved.gBlee
dinggisgagparticularlygcommongpresentation.gThisgmaygbegcausedgbygaddinggdyesg togsamples,gaddinggbloodg(e.g.,gfromgthegmother)gtogthegchild'
sgsample,gorggivinggthegchildganganticoagulantg(e.g.,gwarfarin).g (SeegChapterg37,gpageg146.)
3. MunchausengsyndromegbygproxygisgcharacterizedgbygallgofgthegfollowinggEXCEPT:
□Mother who appears devoted and wins over members of care team
g g g g g g g g g g
□Multiple hospitalizations and investigations without diagnosis
g g g g g
□Symptoms on historybut not witnessed by medicalteam
g g g g g g g g
■ Symptomsgoccurringgingpresencegofgdifferentgcaregiversg(e.g.,gwhilegmothergisgoutgofgtown)
□Use of medications or toxins
g g g g
descriptiongSymptomsgingyounggchildrengaregmostlygassociatedgwithgproximitygofgthegoffendinggcaregivergtogthegchild.gTheg mothergmaygpr
esentgasgagdevotedgorgevengmodelgparentgwhogformsgclosegrelationshipsgwithgmembersgofgtheghealthgcareg team.gWhilegappearinggverygi
nterestedginghergchild'sgcondition,gshegmaygbegrelativelygdistantgemotionally.g(SeegChapterg37,ggpageg146.)
4. Whichgstatementgisgfalse?
■ MalnutritiongisgthegsecondgleadinggcausegofgacquiredgimmunegdeficiencygworldwidegbehindgHIVginfection
□Zinc is important in immune function and linear growth
g g g g g g g g
□Kwashiorkor and marasmusare rare in developed countries
g g g g g g g
□The Western diet is associated with increased noncommunicable disease
g g g g g g g g
descriptiongThegsignificantgglobalgburdengofgmalnutritiongandgundernutritiongisgthegleadinggworldwidegcausegofgacquiredg immunodeficiencygan
dgthegmajorgunderlyinggfactorgforgmorbiditygandgmortalityggloballygforgchildreng<5gyrgofgage.gZincgisgag micronutrientgthatgsupportsgmultiplegmetaboli
cgfunctionsgingthegbody,gisgessentialgforgnormalgimmunegfunctioning,gandgisg requiredgtogsupportglinearggrowth;gzincgdeficiencygisgassociatedgwithgim
pairedgimmunegfunctioninggandgpoorglinearggrowth.gIng parallelgtogthegriskgforgnutrientgandgenergygdeficiencies,gissuesgrelatinggtogexcessesgpose
gimportantgchallengesgbecausegofgtheirg negativeghealthgeffects,gsuchgasgobesitygorgcardiovasculargdiseasegriskgfactors.gThegnutritiongtransitio
ngundergwaygingthe
, developinggworldgfromgtraditionalgdietsgtogthegWesterngdietghasgbeengassociatedgwithgincreasesgingnoncommunicableg diseases,goftengcoexisti
nggwithgundernutritiongandgmalnutrition,gobservedgsometimesgingthegsamegcommunitiesgorgevengtheg samegfamilies.g(Seege41-1.)
5. Componentsgofgenergygexpendituregingchildrenginclude:
□Thermal effect of food g g g
□Basal metabolic rate
g g
□Energy for physical activity
g g g
□Energy to support growth g g g
■ Allgofgthegabove
descriptiongTheg3gcomponentsgofgenergygexpendituregingadultsgaregthegbasalgmetabolicgrate,gthegthermalgeffectgofgfoodg (energygrequir
edgforgdigestiongandgabsorption),gandgenergygforgphysicalgactivity.gAdditionalgenergygintakegandgexpenditureg aregrequiredgtogsupportggro
wthgandgdevelopmentgforgchildren.g(Seege41-4.)
6. WhichgofgthegfollowinggclinicalgscenariosgincreasesgthegriskgofgvitamingAgdeficiency?
□Vegetarian diet g
□Chronic intestinal disorders
g g
□Zinc deficiency
g
■ BgandgC
□All of the above
g g g
descriptiongVitamingAgisgangessentialgmicronutrientgbecausegitgcannotgbegbiogeneratedgdegnovogbyganimals.gItgmustgbeg obtainedgfromgpl
antsgingthegformgofgprovitamin-
Agcarotenoids.gIngthegUSA,ggrainsgandgvegetablesgsupplygapproximatelyg 55%gandgdairygandgmeatgproductsgsupplygapproximatelyg30%gofg
vitamingAgintakegfromgfood.gVitamingAgandgtheg provitamins-
Agaregfatgsoluble,gandgtheirgabsorptiongdependsgongthegpresencegofgadequateglipidgandgproteingwithingthegmeal.g Chronicgintestinalgdisordersg
orglipidgmalabsorptiongsyndromesgcangresultgingvitamingAgdeficiency.gIngdevelopinggcountries,g subclinicalgorgclinicalgzincgdeficiencygcangincrea
segthegriskgofgvitamingAgdeficiency.gTheregisgalsogsomegevidencegofgmarginalg zincgintakesgingchildrengingthegUSA.g(SeegChapterg45,gpageg
188.)
7. WhichgstatementgaboutgvitamingAgtoxicitygisgNOTgtrue?
