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  1. Which of the following children is at greatest risk for iron deficiency anemia?


    1: 4 month-old exclusively breast fed term infant
    2: 4 month corrected gestational age, former preemie on a transitional formula
    3: 10 month-old switched from formula to whole milk
    4: 17 month-old "picky eater"

    3: 10 month-old switched from formula to whole milk
  2. A morbidly obese 12 year old female is admitted to the hospital for an evaluation of sleep apnea. A diet history reveals that she drinks six 10 ounce sodas per day. What mineral may she be deficient in?


    1: Calcium
    2: Phosphorus
    3: Magnesium
    4: Potassium

    1: Calcium
  3. A child with cerebral palsy is admitted to the hospital for a fundoplication and a gastric feeding tube. Together, these procedures are used to treat


    1) gastroesophageal reflux.
    2) oral/motor dysfunction
    3) malnutrition.
    4) esophagitis.

    1) gastroesophageal reflux.
  4. The chronic use of steroids in premature infants has been associated with


    1) osteopenia.
    2) cholestasis.
    3) nephrolithiasis.
    4) hypoglycemia

    1) osteopenia.
  5. When used in assessment of critically ill children, how do predictive equations compare to indirect calorimetry?

    1) No consistent comparison can be found
    2) Equations typically overestimate needs
    3) Equations typically underestimate needs
    4) Equations correlate well with indirect calorimetry
    • 1) No consistent comparison can be found
  6. A 13-year-old boy whose body mass index (BMI) is at the 97th percentile on the Centers for Disease Control and Prevention growth chart for age and sex would be classified as


    1) underweight.
    2) normal weight.
    3) at risk for becoming overweight.
    4) obese.
    4) obese.
  7. Which of the following is NOT associated with a delayed bone age in a child with short stature?


    1) Hypothyroidism
    2) Precocious puberty
    3) Cushing syndrome
    4) Growth hormone deficiency

    2) Precocious puberty
  8. Which of the following preterm growth charts allows for comparison for preterm infants from 22 weeks gestational age up through 10 weeks post term age?


    1) Fenton
    2) Ehrenkranz
    3) Dancis
    4) Lubchenco
    1) Fenton
  9. How often does the American Academy of Pediatrics recommend screening for iron deficiency anemia?


    1) Once between the age of 9 and 12 months for all infants
    2) Once between the ages of 2 and 6 years in all children
    3) Once a year in all adolescents
    4) Yearly if a child drinks >24 ounces of milk per day
    1) Once between the age of 9 and 12 months for all infants
  10. Using the Waterlow criteria, weight for length is evaluated as an index of which of the following?


    1) Wasting due to acute malnutrition
    2) Wasting due to chronic malnutrition
    3) Wasting caused by illness
    4) Wasting caused by hypoalbuminemia

    1) Wasting due to acute malnutrition
  11. What is the suggested daily amount of potassium required for maintenance in an infant receiving parenteral nutrition?


    1) 0.8-1 mEq/kg
    2) 2-4 mEq/kg
    3) 5-6 mEq/kg
    4) 7-8 mEq/kg
    2) 2-4 mEq/kg
  12. What is the daily maintenance fluid requirement for a 5 kg infant?


    1) 300 mL
    2) 500 mL
    3) 700 mL
    4) 1000 mL
    • 2) 500 mL
    • Body Weight Fluid Requirement) 1st 10 kg-100 mL/kg/d; 2nd 10 kg- 50 mL/kg/d; Each additional kg-20 mL/kg/d (<= 50 kg.) or 15 mL/kg (> 50 kg.)
  13. On radiographic examination, a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum laboratory results show) Calcium) low. Phosphorus) low. Creatinine) normal. Alkaline phosphatase) high. 25-OH vitamin D) Low. 1,25 (OH)2 vitamin D) Low. PTH) high. Which of the following is the most likely diagnosis?


    1) Renal tubular acidosis
    2) Osteogenesis imperfecta
    3) Vitamin D deficiency rickets
    4) Vitamin D dependent rickets type 2
    3) Vitamin D deficiency rickets
  14. What is the recommended daily enteral iron dose for preterm infants?


    1) 0.5-1 mg/kg/d
    2) 1-2 mg/kg/d
    3) 2-4 mg/kg/d
    4) 5-6 mg/kg/d
    3) 2-4 mg/kg/d
  15. Which of the following trace elements has been used in the treatment of infantile diarrhea?


    1) Iron
    2) Zinc
    3) Copper
    4) Selenium

    2) Zinc
  16. Which of the following is recommended to prevent vitamin D deficiency in a 1-month-old breastfed infant?


    1) Supplement with 100 IU vitamin D per day
    2) Supplement with 200 IU vitamin D per day
    3) Supplement with 300 IU vitamin D per day
    4) Supplement with 400 IU vitamin D per day
    • 2) Supplement with 200 IU vitamin D per day
  17. A 7 month-old infant fed ready-to-feed infant formula and other age-appropriate complementary foods may benefit from supplementation with which of the following?


    1) Vitamin A
    2) Fluoride
    3) Vitamin E
    4) Iron
    2) Fluoride
  18. Nipple feeding and/or nonnutritive oral stimulation should be used in the neonate less than 32 weeks corrected gestational age while being fed enterally to promote


    1) mother/child bonding.
    2) appropriate swallowing response.
    3) correct development of facial and jaw muscles.
    4) ability to feed orally when developmentally appropriate.
    4) ability to feed orally when developmentally appropriate
  19. Which of the following is NOT a contraindication to nasogastric tube feedings in a pediatric patient with cystic fibrosis?


    1) Chronic sinusitis
    2) Chronic otitis
    3) NGT feedings cannot be absorbed when pancreatic insufficiency is present
    4) Need for long term nutrition support

    • 3) NGT feedings cannot be absorbed when pancreatic insufficiency is present
  20. Which of the following is the BEST indication for use of a soy-based infant formula?


    1) Diarrhea
    2) Cow's milk protein allergy
    3) Galactosemia
    4) Regurgitation with feeds

    3) Galactosemia
  21. Which of the following is considered to be an upper limit for the osmolality of infant formulas to avoid tolerance issues?


    1) 460 mOsm/kg
    2) 360 mOsm/kg
    3) 260 mOsm/kg
    4) 560 mOsm/kg
    1) 460 mOsm/kg
  22. Which of the following is FALSE regarding regurgitation in infants?


    1) Regurgitation is rare in infants
    2) Regurgitation in neonates is related to relaxation of the lower esophaleal sphinter
    3) Regurgitation may occur if enteral nutrition is infused too quickly
    4) Regurgitation is associated with delayed gastric emptying

    1) Regurgitation is rare in infants
  23. Which of the following is TRUE regarding aspiration in critically ill children?


    1) The incidence of aspiration directly caused by enteral nutrition is difficult to determine due to a lack of good clinical research
    2) Formula should be colored with blue food dye if aspiration is suspected
    3) Children have strong coordination of pharyngeal muscles, making aspiration less likely than in adults
    4) Children have strong cough reflex which helps protect them from aspiration
    1) The incidence of aspiration directly caused by enteral nutrition is difficult to determine due to a lack of good clinical research
  24. Which of the following best describes the appropriate use of powdered infant formula in healthcare facilities?


    1) Freeze open containers and discard after 30 days from opening
    2) Refrigerate open containers and discard after 30 days from opening
    3) Use interchangeably with comparable sterile liquid formulations
    4) Use only when comparable sterile liquid formulations are not available

    4) Use only when comparable sterile liquid formulations are not available
  25. What is the hang time for breast milk when used for continuous enteral feedings?


    1) 2 hours
    2) 4 hours
    3) 8 hours
    4) 12 hours
    2) 4 hours
  26. A 4-month-old male has acute onset of diarrhea for 48 hours. His parents noticed that he hasn't been wetting as many diapers and his mucous membranes are slightly dry. His anterior fontanel is soft and not depressed. He normally ingests breast milk ad lib. Which of the following is the most appropriate nutrition intervention for this infant?


    1) 1/2 strength infant formula
    2) Oral rehydration therapy
    3) Full strength soy formula
    4) Short course of parenteral nutrition

    • 2) Oral rehydration therapy
  27. What should be the MAXIMUM parenteral dextrose infusion rate for a preterm infant?


    1) 4 mg/kg/min
    2) 6 mg/kg/min
    3) 10 mg/kg/min
    4) 12 mg/kg/min
    4) 12 mg/kg/min
  28. In an infant with adequate energy intake, what is the MINIMUM amount of fat emulsion containing long chain fatty acids needed to prevent essential fatty acid deficiency?


    1) 0.2-0.4 g/kg/day
    2) 0.5-1.0 g/kg/day
    3) 1.1-1.5 g/kg/day
    4) 1.8-2.0 g/kg/day

    2) 0.5-1.0 g/kg/day
  29. Standard parenteral amino acid solutions available for neonates differ from standard adult parenteral amino acid solutions by having a higher content of


    1) cysteine.
    2) phenylalanine.
    3) taurine and tyrosine.
    4) methionine and glycine.
    3) taurine and tyrosine.
  30. In a preterm infant, which of the following amino acids is separately added to parenteral nutrition solutions due to solubility concerns?


    1) Glycine
    2) Cysteine
    3) Methionine
    4) Phenylalanine
    2) Cysteine
  31. What is the recommended intake of selenium for infants receiving parenteral nutrition?


    1) 1.3 - 4.5 mcg/kg/day
    2) 3.3 - 6.5 mcg/kg/day
    3) 5.3 - 8.5 mcg/kg/day
    4) There is no recommended intake of selenium for infants receiving parenteral nutrition.

    1) 1.3 - 4.5 mcg/kg/day
  32. Approximately how many calories are needed enterally to achieve adequate growth in an infant with congenital heart disease?


    1) 120-170 kcal/kg/day
    2) 100-120 kcal/kg/d
    3) 80-100 kcal/kg/d
    4) unknown

    1) 120-170 kcal/kg/day
  33. Which of the following therapies would be considered most appropriate in the nutritional management of bronchopulmonary dysplasia?


    1) Use of concentrated formula
    2) Use of a high fat, low carbohydrate formula
    3) Use of a hydrolyzed protein formula
    4) Use of an MCT oil predominant formula
    1) Use of concentrated formula
  34. Pancreatic enzymes supplemented at high doses in children with cystic fibrosis could result in


    1) steatorrhea.
    2) meconium ileus.
    3) fibrosing colonopathy.
    4) cystic fibrosis related diabetes.
    3) fibrosing colonopathy.
  35. The dietary reference intake for calcium for adolescents is based on the amount of calcium


    1) needed to maintain serum calcium levels in normal range during rapid growth.
    2) needed to achieve maximal accretion during rapid growth.
    3) consumed by upper quartile in calcium intake studies.
    4) consumed by adolescents who later in life show no osteopenia based on epidemiologic data.
    2) needed to achieve maximal accretion during rapid growth.
  36. The use of Lactobacillus GG in pediatric practice has been found to be MOST effective in


    1) treating infectious diarrhea.
    2) reducing the incidence of NEC.
    3) prolonging time to remission in children with Crohn’s.
    4) eradicating heliobacter pylori infection.

    • 1) treating infectious diarrhea.
  37. An infant has a complete ileal resection with preservation of the ileo-cecal valve. The primary nutrition-related concern will be


    1) fluid and electrolyte loss.
    2) water soluble vitamin malabsorption.
    3) dumping syndrome.
    4) protein malabsorption due to decreased cholecystokinin secretion.

    1) fluid and electrolyte loss.
  38. The nutrient content of preterm follow-up formula is approximately halfway between


    1) term formulas and pediatric formulas.
    2) preterm formulas and elemental formulas.
    3) preterm formulas and term infant formulas.
    4) milk-based term formulas and soy formulas.
    • 3) preterm formulas and term infant formulas.
  39. Which of the following does NOT describe the use of minimum enteral feeds in preterm neonates?


    1) Prevents gut atrophy
    2) Increases the risk of necrotizing enterocolitis
    3) Improves feeding tolerance and time to full enteral feeds
    4) Should be started as soon as medically feasible

    2) Increases the risk of necrotizing enterocolitis
  40. In children with active and recently diagnosed Crohn's disease, which of the following is more effective than corticosteroids in inducing healing of gut inflammatory lesions?


    1) polymeric formula as the sole source of nutrition
    2) antibiotic therapy
    3) elemental formula administered as enteral feedings
    4) parenteral nutrition
    1) polymeric formula as the sole source of nutrition
  41. Which of the following is NOT a common clinical symptom of celiac disease in childhood?


    1) Malabsorption
    2) Failure to thrive
    3) Constipation
    4) Anemia
    3) Constipation
  42. A 2-month-old infant, who has been exclusively fed with cow's milk based formula develops a full body rash. Which of the following would be the most appropriate next step?


    1) Switch to a soy protein based formula
    2) Supplement the feedings with lactase
    3) Switch to a protein hydrolysate based formula
    4) Switch to a lactose free cow's milk based formula
    3) Switch to a protein hydrolysate based formula
  43. The biochemical defect in phenylkenonuria (PKU) is a functional deficiency of the liver enzyme phenylalanine hydroxylase, which catalyzes the para-hydroxylation of phenylalanine to yield what amino acid?


    1) Threonine
    2) Phenylacetic acid
    3) Phenylethylamine
    4) Tyrosine
    4) Tyrosine
  44. Biliary atresia in infancy is most frequently associated with which of the following?


    1) Fat malabsorption
    2) Chylothorax
    3) Zinc Deficiency
    4) Essential fatty acid deficiency
    1) Fat malabsorption
  45. Which of the following is characteristic of hypermetabolism in pediatric oncology patients?


    1) Incidence of hypermetabolism is very rare
    2) Infection is not a cause of hypermetabolism
    3) Children with acute leukemia receiving maintenance chemotherapy are likely to be hypermetabolic
    4) The basal metabolic rate of children with solid tumor may be significantly higher than the estimated basal metabolic rate at diagnosis

    4) The basal metabolic rate of children with solid tumor may be significantly higher than the estimated basal metabolic rate at diagnosis
  46. Which of the following methods of estimating energy requirements in critically ill children is LEAST accurate when compared to resting energy expenditure measurement by indirect calorimetry?


    1) Mayo Clinic nomogram
    2) Harris-Benedict equations
    3) World Health Organization equations
    4) Recommended Dietary Allowance (RDA) for energy
    4) Recommended Dietary Allowance (RDA) for energy
  47. Nutrition therapy for pediatric patients with <20% total body surface area (TBSA) burn typically includes


    1) oral intake of high calorie, high protein diet.
    2) enteral nutrition therapy.
    3) parenteral nutrition therapy.
    4) enteral and parenteral nutrition therapy.
    1) oral intake of high calorie, high protein diet.
  48. Which of the following is true regarding use of the Curreri junior formula to estimate calorie needs in the burned pediatric patient?


    1) It typically overestimates needs for patients with burns >50% TBSA (total body surface area)
    2) It typically overestimates needs for patients with burns <50% TBSA
    3) It typically underestimates needs for patients with burns >50% TBSA
    4) It underestimates needs for patients with burns <50% TBSA

    1) It typically overestimates needs for patients with burns >50% TBSA (total body surface area)
  49. Which of the following is considered to be diagnostic of infantile anorexia?


    1) Failure to eat adequately with poor weight gain for > = 1 month
    2) Failure to eat adequately associated with childhood depressive disorder
    3) Failure to gain weight associated with a malabsorptive disorder
    4) Chronic weight loss associated with a malabsorptive disorder

    1) Failure to eat adequately with poor weight gain for > = 1 month

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