, Nelson Pediatrics Review(MCQs) 19 Edition
Q Q Q Q
1. WhichQofQtheQfollowingQstatementsQregardingQfosterQcareQisQtrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
□A minority of children in foster care have a history of abuse or neglect
Q Q Q Q Q Q Q Q Q Q Q Q Q
□The mission of foster care is to safely care for children while providing services to families to promote reunification
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
□Most (>70%) of children in foster care are reunited with their families
Q Q Q Q Q Q Q Q Q Q Q
■ AQandQC
descriptionQ TheQ missionQ ofQ fosterQ careQ isQ toQ provideQ forQ theQ health,Q safety,Q andQ well-
beingQ ofQ childrenQ whileQ assistingQ theirQfamiliesQ withQ servicesQtoQ promoteQ reunification.Q ChildrenQ enteringQ fosterQcareQ haveQ fr
equentlyQ experiencedQ earlyQ childhoodQtrauma.Q MoreQ thanQ 70%Q haveQ aQ historyQ ofQ abuse,Q neglect,Q orQ both.Q OnlyQ aboutQ 50%Q
ofQ childrenQ achieveQ reunification.Q InQ theQUSA,QtheQAdoptionQandQSafeQFamiliesQActQ(P.L.Q105-
89)QpassedQinQ1997QrequiresQthatQaQpermanencyQplanQbeQmadeQforQeachQ childQ noQ laterQ thanQ 12Q moQ afterQ entryQtoQ fosterQ car
eQ andQ thatQ aQ petitionQ toQ terminateQ parentalQ rightsQ typicallyQ mustQ beQ filedQwhenQaQchildQhasQbeenQinQfosterQcareQforQatQleastQ1
5QofQtheQpreviousQ22Qmo.Q(SeeQChapterQ35,QpageQ134,QandQe35-1.)
2. AQ4QyrQoldQgirlQisQadmittedQtoQtheQhospitalQforQherQthirdQevaluationQforQvaginalQbleeding.QThe
motherQnotedQbrightQredQbloodQonQtheQchild'sQunderwear.QPreviousQexaminationsQrevealedQaQn
ormalQ 4Q yrQ oldQ girl,Q TannerQ stageQ 1,Q withQ normalQ externalQ genitalia.Q PelvicQ ultrasoundQ resultsQw
ereQnormal,QasQwasQtheQserumQestradiolQlevel.QTheQhemoglobinQandQplateletQcountsQwereQnorm
al,QasQwereQtheQbleedingQtimeQandQcoagulationQstudies.QFindingsQonQpelvicQexaminationQconduc
tedQunderQanesthesiaQalsoQwereQnormal.QTheQnextQstepQinQtheQexaminationQisQto:
■ DetermineQtheQbloodQtypeQofQtheQbloodQonQtheQunderwear
□Interrogate the father
Q Q
□Isolate the parents and child
Q Q Q Q
□Determine von Willebrand factor levels
Q Q Q Q
, □Measure fibronectin in the vagina
Q Q Q Q
descriptionQConsiderationQofQfactitiousQdisorderQbyQproxyQshouldQbeQtriggeredQwhenQtheQreportedQsymptomsQareQrepeatedl
yQnotedQ byQ onlyQ oneQ parent,Q appropriateQ testingQ failsQ toQ confirmQ aQ diagnosis,Q andQ seeminglyQ appropriateQ treatmentQ isQ ineffec
tive.QAtQ times,Q theQ child'sQ symptoms,Q theirQ course,Q orQ theQ responseQ toQ treatmentQ mayQ beQ incompatibleQ withQ anyQ recognizedQ
disease.QPreverbalQ childrenQ areQ usuallyQ involved.Q BleedingQ isQ aQ particularlyQ commonQ presentation.Q ThisQ mayQ beQ causedQ byQ ad
dingQ dyesQtoQ samples,Q addingQ bloodQ (e.g.,Q fromQ theQ mother)Q toQ theQ child'sQ sample,Q orQ givingQ theQ childQ anQ anticoagulantQ (e.g.,
Q warfarin).Q(SeeQChapterQ37,QpageQ146.)
3. MunchausenQ syndromeQ byQ proxyQ isQ characterizedQ byQ allQ ofQ theQ followingQ EXCEPT:
□Mother who appears devoted and wins over members of care team
Q Q Q Q Q Q Q Q Q Q
□Multiple hospitalizations and investigations without diagnosis
Q Q Q Q Q
□Symptoms on history but not witnessed by medical team
Q Q Q Q Q Q Q Q
■ SymptomsQ occurringQ inQ presenceQ ofQ differentQ caregiversQ (e.g.,Q whileQ motherQ isQ outQ ofQ town)
□Use of medications or toxins
Q Q Q Q
descriptionQSymptomsQinQyoungQchildrenQareQmostlyQassociatedQwithQproximityQofQtheQoffendingQcaregiverQtoQtheQchild.QTh
eQmotherQmayQpresentQasQaQdevotedQorQevenQmodelQparentQwhoQformsQcloseQrelationshipsQwithQmembersQofQtheQhealth
QcareQ
team.QWhileQappearingQveryQinterestedQinQherQchild'sQcondition,QsheQmayQbeQrelativelyQdistantQemotionally.Q(SeeQChapt
erQ37,QpageQ146.)
4. WhichQstatementQisQfalse?
■ MalnutritionQisQ theQ secondQ leadingQ causeQ ofQ acquiredQ immuneQ deficiencyQ worldwideQ behindQ HIVQinfection
□Zinc is important in immune function and linear growth
Q Q Q Q Q Q Q Q
□Kwashiorkor and marasmus are rare in developed countries
Q Q Q Q Q Q Q
□The Western diet is associated with increased noncommunicable disease
Q Q Q Q Q Q Q Q
descriptionQ TheQ significantQ globalQ burdenQ ofQ malnutritionQ andQ undernutritionQisQtheQleadingQ worldwideQ causeQ ofQacquiredQim
munodeficiencyQandQtheQ majorQunderlyingQfactorQ forQ morbidityQandQ mortalityQgloballyQforQchildrenQ<5Q yrQ ofQage.QZincQisQaQmi
cronutrientQthatQsupportsQmultipleQ metabolicQ functionsQinQtheQ body,QisQessentialQ forQnormalQimmuneQfunctioning,QandQisQrequir
edQtoQ supportQ linearQ growth;Q zincQ deficiencyQisQ associatedQ withQ impairedQimmuneQfunctioningQ andQ poorQlinearQ growth.Q InQpar
allelQ toQ theQ riskQ forQ nutrientQ andQ energyQ deficiencies,Q issuesQ relatingQ toQ excessesQ poseQ importantQ challengesQ becauseQ ofQ theirQ
negativeQhealthQeffects,QsuchQasQobesityQorQcardiovascularQdiseaseQriskQfactors.QTheQnutritionQtransitionQunderQwayQinQthe
, developingQ worldQ fromQ traditionalQ dietsQ toQ theQ WesternQ dietQ hasQ beenQ associatedQ withQ increasesQ inQ noncommunicableQdise
ases,Q oftenQ coexistingQ withQ undernutritionQandQ malnutrition,Q observedQ sometimesQ inQ theQ sameQ communitiesQ orQ evenQtheQsa
meQfamilies.Q(SeeQe41-1.)
5. ComponentsQ ofQ energyQ expenditureQ inQ childrenQ include:
□Thermal effect of food
Q Q Q
□Basal metabolic rate
Q Q
□Energy for physical activity
Q Q Q
□Energy to support growth
Q Q Q
■ AllQofQtheQabove
descriptionQTheQ3QcomponentsQofQenergyQexpenditureQinQadultsQareQtheQbasalQmetabolicQrate,QtheQthermalQeffectQofQfo
odQ(energyQrequiredQforQdigestionQandQabsorption),QandQenergyQforQphysicalQactivity.QAdditionalQenergyQintakeQandQexpendit
ureQareQrequiredQtoQsupportQgrowthQandQdevelopmentQforQchildren.Q(SeeQe41-4.)
6. WhichQofQtheQfollowingQclinicalQscenariosQincreasesQtheQriskQofQvitaminQAQdeficiency?
□Vegetarian diet Q
□Chronic intestinal disorders
Q Q
□Zinc deficiency
Q
■ BQandQC
□All of the above
Q Q Q
descriptionQVitaminQAQisQanQessentialQmicronutrientQbecauseQitQcannotQbeQbiogeneratedQdeQnovoQbyQanimals.QItQmustQ
beQobtainedQ fromQ plantsQ inQ theQ formQ ofQ provitamin-
AQ carotenoids.Q InQ theQ USA,Q grainsQ andQ vegetablesQ supplyQ approximatelyQ55%QandQdairyQandQmeatQproductsQsupplyQappr
oximatelyQ30%QofQvitaminQAQintakeQfromQfood.QVitaminQAQandQtheQprovitamins-
AQ areQ fatQ soluble,Q andQ theirQ absorptionQ dependsQ onQ theQ presenceQ ofQ adequateQ lipidQ andQ proteinQ withinQ theQ meal.QChronicQ i
ntestinalQ disordersQ orQlipidQ malabsorptionQ syndromesQcanQ resultQinQ vitaminQ AQ deficiency.Q InQ developingQ countries,Qsubclinic
alQorQclinicalQzincQdeficiencyQcanQincreaseQtheQriskQofQvitaminQAQdeficiency.QThereQisQalsoQsomeQevidenceQofQmarginalQzincQi
ntakesQinQchildrenQinQtheQUSA.Q(SeeQChapterQ45,QpageQ188.)
7. WhichQstatementQaboutQvitaminQAQtoxicityQisQNOTQtrue?
Q Q Q Q
1. WhichQofQtheQfollowingQstatementsQregardingQfosterQcareQisQtrue?
□A permanency plan must be made for a child in foster care no later than 12 mo from the child's entry into care
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
□A minority of children in foster care have a history of abuse or neglect
Q Q Q Q Q Q Q Q Q Q Q Q Q
□The mission of foster care is to safely care for children while providing services to families to promote reunification
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
□Most (>70%) of children in foster care are reunited with their families
Q Q Q Q Q Q Q Q Q Q Q
■ AQandQC
descriptionQ TheQ missionQ ofQ fosterQ careQ isQ toQ provideQ forQ theQ health,Q safety,Q andQ well-
beingQ ofQ childrenQ whileQ assistingQ theirQfamiliesQ withQ servicesQtoQ promoteQ reunification.Q ChildrenQ enteringQ fosterQcareQ haveQ fr
equentlyQ experiencedQ earlyQ childhoodQtrauma.Q MoreQ thanQ 70%Q haveQ aQ historyQ ofQ abuse,Q neglect,Q orQ both.Q OnlyQ aboutQ 50%Q
ofQ childrenQ achieveQ reunification.Q InQ theQUSA,QtheQAdoptionQandQSafeQFamiliesQActQ(P.L.Q105-
89)QpassedQinQ1997QrequiresQthatQaQpermanencyQplanQbeQmadeQforQeachQ childQ noQ laterQ thanQ 12Q moQ afterQ entryQtoQ fosterQ car
eQ andQ thatQ aQ petitionQ toQ terminateQ parentalQ rightsQ typicallyQ mustQ beQ filedQwhenQaQchildQhasQbeenQinQfosterQcareQforQatQleastQ1
5QofQtheQpreviousQ22Qmo.Q(SeeQChapterQ35,QpageQ134,QandQe35-1.)
2. AQ4QyrQoldQgirlQisQadmittedQtoQtheQhospitalQforQherQthirdQevaluationQforQvaginalQbleeding.QThe
motherQnotedQbrightQredQbloodQonQtheQchild'sQunderwear.QPreviousQexaminationsQrevealedQaQn
ormalQ 4Q yrQ oldQ girl,Q TannerQ stageQ 1,Q withQ normalQ externalQ genitalia.Q PelvicQ ultrasoundQ resultsQw
ereQnormal,QasQwasQtheQserumQestradiolQlevel.QTheQhemoglobinQandQplateletQcountsQwereQnorm
al,QasQwereQtheQbleedingQtimeQandQcoagulationQstudies.QFindingsQonQpelvicQexaminationQconduc
tedQunderQanesthesiaQalsoQwereQnormal.QTheQnextQstepQinQtheQexaminationQisQto:
■ DetermineQtheQbloodQtypeQofQtheQbloodQonQtheQunderwear
□Interrogate the father
Q Q
□Isolate the parents and child
Q Q Q Q
□Determine von Willebrand factor levels
Q Q Q Q
, □Measure fibronectin in the vagina
Q Q Q Q
descriptionQConsiderationQofQfactitiousQdisorderQbyQproxyQshouldQbeQtriggeredQwhenQtheQreportedQsymptomsQareQrepeatedl
yQnotedQ byQ onlyQ oneQ parent,Q appropriateQ testingQ failsQ toQ confirmQ aQ diagnosis,Q andQ seeminglyQ appropriateQ treatmentQ isQ ineffec
tive.QAtQ times,Q theQ child'sQ symptoms,Q theirQ course,Q orQ theQ responseQ toQ treatmentQ mayQ beQ incompatibleQ withQ anyQ recognizedQ
disease.QPreverbalQ childrenQ areQ usuallyQ involved.Q BleedingQ isQ aQ particularlyQ commonQ presentation.Q ThisQ mayQ beQ causedQ byQ ad
dingQ dyesQtoQ samples,Q addingQ bloodQ (e.g.,Q fromQ theQ mother)Q toQ theQ child'sQ sample,Q orQ givingQ theQ childQ anQ anticoagulantQ (e.g.,
Q warfarin).Q(SeeQChapterQ37,QpageQ146.)
3. MunchausenQ syndromeQ byQ proxyQ isQ characterizedQ byQ allQ ofQ theQ followingQ EXCEPT:
□Mother who appears devoted and wins over members of care team
Q Q Q Q Q Q Q Q Q Q
□Multiple hospitalizations and investigations without diagnosis
Q Q Q Q Q
□Symptoms on history but not witnessed by medical team
Q Q Q Q Q Q Q Q
■ SymptomsQ occurringQ inQ presenceQ ofQ differentQ caregiversQ (e.g.,Q whileQ motherQ isQ outQ ofQ town)
□Use of medications or toxins
Q Q Q Q
descriptionQSymptomsQinQyoungQchildrenQareQmostlyQassociatedQwithQproximityQofQtheQoffendingQcaregiverQtoQtheQchild.QTh
eQmotherQmayQpresentQasQaQdevotedQorQevenQmodelQparentQwhoQformsQcloseQrelationshipsQwithQmembersQofQtheQhealth
QcareQ
team.QWhileQappearingQveryQinterestedQinQherQchild'sQcondition,QsheQmayQbeQrelativelyQdistantQemotionally.Q(SeeQChapt
erQ37,QpageQ146.)
4. WhichQstatementQisQfalse?
■ MalnutritionQisQ theQ secondQ leadingQ causeQ ofQ acquiredQ immuneQ deficiencyQ worldwideQ behindQ HIVQinfection
□Zinc is important in immune function and linear growth
Q Q Q Q Q Q Q Q
□Kwashiorkor and marasmus are rare in developed countries
Q Q Q Q Q Q Q
□The Western diet is associated with increased noncommunicable disease
Q Q Q Q Q Q Q Q
descriptionQ TheQ significantQ globalQ burdenQ ofQ malnutritionQ andQ undernutritionQisQtheQleadingQ worldwideQ causeQ ofQacquiredQim
munodeficiencyQandQtheQ majorQunderlyingQfactorQ forQ morbidityQandQ mortalityQgloballyQforQchildrenQ<5Q yrQ ofQage.QZincQisQaQmi
cronutrientQthatQsupportsQmultipleQ metabolicQ functionsQinQtheQ body,QisQessentialQ forQnormalQimmuneQfunctioning,QandQisQrequir
edQtoQ supportQ linearQ growth;Q zincQ deficiencyQisQ associatedQ withQ impairedQimmuneQfunctioningQ andQ poorQlinearQ growth.Q InQpar
allelQ toQ theQ riskQ forQ nutrientQ andQ energyQ deficiencies,Q issuesQ relatingQ toQ excessesQ poseQ importantQ challengesQ becauseQ ofQ theirQ
negativeQhealthQeffects,QsuchQasQobesityQorQcardiovascularQdiseaseQriskQfactors.QTheQnutritionQtransitionQunderQwayQinQthe
, developingQ worldQ fromQ traditionalQ dietsQ toQ theQ WesternQ dietQ hasQ beenQ associatedQ withQ increasesQ inQ noncommunicableQdise
ases,Q oftenQ coexistingQ withQ undernutritionQandQ malnutrition,Q observedQ sometimesQ inQ theQ sameQ communitiesQ orQ evenQtheQsa
meQfamilies.Q(SeeQe41-1.)
5. ComponentsQ ofQ energyQ expenditureQ inQ childrenQ include:
□Thermal effect of food
Q Q Q
□Basal metabolic rate
Q Q
□Energy for physical activity
Q Q Q
□Energy to support growth
Q Q Q
■ AllQofQtheQabove
descriptionQTheQ3QcomponentsQofQenergyQexpenditureQinQadultsQareQtheQbasalQmetabolicQrate,QtheQthermalQeffectQofQfo
odQ(energyQrequiredQforQdigestionQandQabsorption),QandQenergyQforQphysicalQactivity.QAdditionalQenergyQintakeQandQexpendit
ureQareQrequiredQtoQsupportQgrowthQandQdevelopmentQforQchildren.Q(SeeQe41-4.)
6. WhichQofQtheQfollowingQclinicalQscenariosQincreasesQtheQriskQofQvitaminQAQdeficiency?
□Vegetarian diet Q
□Chronic intestinal disorders
Q Q
□Zinc deficiency
Q
■ BQandQC
□All of the above
Q Q Q
descriptionQVitaminQAQisQanQessentialQmicronutrientQbecauseQitQcannotQbeQbiogeneratedQdeQnovoQbyQanimals.QItQmustQ
beQobtainedQ fromQ plantsQ inQ theQ formQ ofQ provitamin-
AQ carotenoids.Q InQ theQ USA,Q grainsQ andQ vegetablesQ supplyQ approximatelyQ55%QandQdairyQandQmeatQproductsQsupplyQappr
oximatelyQ30%QofQvitaminQAQintakeQfromQfood.QVitaminQAQandQtheQprovitamins-
AQ areQ fatQ soluble,Q andQ theirQ absorptionQ dependsQ onQ theQ presenceQ ofQ adequateQ lipidQ andQ proteinQ withinQ theQ meal.QChronicQ i
ntestinalQ disordersQ orQlipidQ malabsorptionQ syndromesQcanQ resultQinQ vitaminQ AQ deficiency.Q InQ developingQ countries,Qsubclinic
alQorQclinicalQzincQdeficiencyQcanQincreaseQtheQriskQofQvitaminQAQdeficiency.QThereQisQalsoQsomeQevidenceQofQmarginalQzincQi
ntakesQinQchildrenQinQtheQUSA.Q(SeeQChapterQ45,QpageQ188.)
7. WhichQstatementQaboutQvitaminQAQtoxicityQisQNOTQtrue?
