Test bank for MCQs in Pediatrics Review of NelsonText
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bookof Pediatrics 20 Edition
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, Nelson Pediatrics Review(MCQs) 19 Edition
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1. Whichiofitheifollowingistatementsiregardingifostericareiisitrue?
□A permanency planmust bemade for a childin foster care nolater than 12 mo fromthe child's entryinto care
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□Aminorityofchildreninfostercarehaveahistory of abuseorneglect i i
□Themissionoffostercareistosafelycareforchildren i whileprovidingservicestofamiliestopromotereunification
□Most(>70%)ofchildrenin fostercarearereunitedwiththeirfamilies
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■ AiandiC
descriptioniTheimissioniofifostericareiisitoiprovideiforitheihealth,isafety,iandiwell-
beingiofichildreniwhileiassistingitheirifamiliesiwithiservicesitoipromoteireunification.iChildrenienteringifostericareihaveifrequentlyiex
periencediearlyichildhooditrauma.iMoreithani70%ihaveiaihistoryiofiabuse,ineglect,ioriboth.iOnlyiabouti50%iofichildreniachieveireuni
fication.iInithei USA,itheiAdoptioniandiSafeiFamiliesiActi(P.L.i105-
89)ipassediini1997irequiresithatiaipermanencyiplanibeimadeifori eachchildinoilaterithani12imoiafterientryitoifostericareandthatapetit
ionitoiterminateparentalirightsitypicallymustibeifiledi wheniaichildi hasibeeniinifostericareiforiatileasti15iofitheipreviousi22imo.i(Seei
Chapteri35,ipagei134,iandie35-1.)
2. Ai4iyrioldigirliisiadmitteditoitheihospitaliforiherithirdievaluationiforivaginalibleeding.iTheimothe
ri notedi brighti redi bloodi onithei child'si underwear.i Previousi examinationsi revealedi a
normali4iyrioldigirl,iTanneristagei1,iwithinormaliexternaligenitalia.iPelviciultrasoundiresultsi were
normal,iasiwasitheiserumiestradiolilevel.iTheihemoglobiniandiplateleticountsiwerei normal,iasiwereith
eibleedingitimeiandicoagulationistudies.iFindingsionipelviciexaminationiconductediunderianesthesi
aialsoiwereinormal.iTheinextistepiinitheiexaminationiisito:
■ Determineitheiblooditypeiofitheibloodionitheiunderwear
□Interrogate the father
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□Isolate the parents and child
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□DeterminevonWillebrand factorlevels
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, □Measurefibronectin inthevagina
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descriptioniConsiderationiofifactitiousidisorderibyiproxyishouldibeitriggerediwhenitheireportedisymptomsiareirepeatedlyinotedbyonl
yoneparent,appropriatetestingifailstoconfirmadiagnosis,andseeminglyappropriatetreatmentisiineffective.
Attimes,thechild'ssymptoms,theircourse,iortheresponsetoitreatmentmaybeincompatiblewithianyrecognizeddisease.iPreverba
lchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes
tois
amples,iaddingibloodi(e.g.,ifromitheimother)itoitheichild'sisample,iorigivingitheichildianianticoagulanti(e.g.,iwarfarin).i (SeeiChapt
eri37,ipagei146.)
3. MunchausenisyndromeibyiproxyiisicharacterizedibyialliofitheifollowingiEXCEPT:
□Mother who appears devoted and wins over members of careteam
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□Multiple hospitalizations and investigations without diagnosis
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□Symptomsonhistorybutnotwitnessedbymedicalteam
■ Symptomsoccurringiinipresenceiofdifferenticaregiversi(e.g.,iwhileimotherisoutiofitown)
□Use of medications or toxins
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descriptioniSymptomsiiniyoungichildreniareimostlyiassociatediwithiproximityiofitheioffendingicaregiveritoitheichild.iTheimothe
rimayipresentiasiaidevotediorievenimodeliparentiwhoiformsicloseirelationshipsiwithimembersiofitheihealthicareiteam.iWhilei
appearingiveryiinterestediiniherichild'sicondition,isheimayibeirelativelyidistantiemotionally.i(SeeiChapteri37,i pagei146.)
4. Whichistatementiisifalse?
■ Malnutritioniisitheisecondileadingicauseiofiacquirediimmuneideficiencyiworldwidei behindi HIViinfection
□Zinc is important in immune function and linear growth
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□Kwashiorkor and marasmus are rare in developed countries
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□The Western diet is associated with increased noncommunicable disease
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descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquirediimmun
odeficiencyandthemajorunderlyingfactorformorbidityandmortalitygloballyforchildren i<5iyriofage.iZincisaimicronutrientthatsu
pportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis irequireditosupportlineargrowth;zin
cdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.Iniparalleltoitheriskfornutrientandenergydeficie
ncies,issuesrelatingtoiexcessesposeimportantchallengesbecauseoftheirinegativeihealtheffects,isuchiasiobesityioricardiovasculari
diseaseiriskifactors.iTheinutritionitransitioniunderiwayiinithe
, developingiworldifromitraditionalidietsitoitheiWesternidietihasibeeniassociatediwithiincreasesiininoncommunicableidiseases,iofteni
coexistingiwithiundernutritioniandimalnutrition,iobservedisometimesiinitheisameicommunitiesiorievenitheisameifamilies.i(Seeie41-
1.)
5. Componentsiofienergyiexpenditureiinichildreniinclude:
□Thermal effect offood i i
□Basal metabolic rate
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□Energy for physical activity
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□Energyto support growth
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■ Alliofitheiabove
descriptioniThei3icomponentsiofienergyiexpenditureiiniadultsiareitheibasalimetabolicirate,itheithermalieffectiofifoodi(ener
gyirequirediforidigestioniandiabsorption),iandienergyiforiphysicaliactivity.iAdditionalienergyiintakeiandiexpenditureiiareirequiredit
oisupportigrowthiandidevelopmentiforichildren.i(Seeie41-4.)
6. Whichiofitheifollowingiclinicaliscenariosi increasesitheiriskiofivitaminiAideficiency?
□Vegetarian diet i
□Chronic intestinal disorders
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□Zinc deficiency
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■ BiandiC
□Allof theabove
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descriptioniVitaminiAiisianiessentialimicronutrientibecauseiiticannotibeibiogeneratedideinovoibyianimals.iItimustibeiobtainedi
fromiplantsiinitheiformiofiprovitamin-
Aicarotenoids.iInitheiUSA,igrainsiandivegetablesisupplyiapproximatelyi55%iandidairyiandimeatiproductsisupplyiapproximatelyi
30%iofivitaminiAiintakeifromifood.iVitaminiAiandithei provitamins-
Aiarefatsoluble,iandtheirabsorptiondependsionthepresenceofiadequatelipidandproteinwithinthemeal.
ChroniciintestinalidisordersiorilipidimalabsorptionisyndromesicaniresultiinivitaminiAideficiency.iInidevelopingicountries,isubclinicalior
clinicalizincdeficiencycanincreasetheriskiofvitaminiAdeficiency.iThereisialsoisomeevidenceofimarginali zinciintakesiinichildreni
initheiUSA.i(SeeiChapteri45,ipagei188.)
7. WhichistatementiaboutivitaminiAitoxicityiisiNOTitrue?