1. Read the Educational Objectives and answer the self-assessment quiz at the beginning of this issue before you read the articles. This is designed to highlight key areas to be covered.
2. Read each of the articles in the issue carefully and thoroughly; do not neglect the charts, tables, and other illustrative material, as they have been carefully selected to enhance your knowledge and understanding.
3. The questions on patient management that follow are designed to provide a useful link between the articles in this issue and your everyday practice. Read the questions below, choose the correct answer to each, and record your answer on the CME Registration form printed at the end of the quiz.
4. Type or print your full name and address (including zip code) and your socialsecurity number in the spaces provided.
5. Send check or money order ($10) made out to Pediatric Annals CME Quiz. Mail with your CME Registration form to:
501 Madison Avenue
New York, N.Y. 10022.
6. After your answers have been graded, you will be advised of your score and the answers to any incorrect or missed questions. Review those parts of the article dealing with any questions you answered incorrectly, and read the supplemental materials on this aspect of the subject that are listed in the bibliography. Unanswered questions will be considered incorrect and are so scored. A minimum score of 70 per cent must be obtained in order for credits to be awarded.
CME Quiz: Environmental Hazards
Record your answers on page 70.
Type A Questions. Choose one letter after each of the numbers listed below, and transfer to the coupon. Only one answer is correct.
1. In such a teratogenic as thalidomide, which action by the mother is most iikely to deform her infant?
A. Ingestion of a single small dose on the 24th day of gestation.
B. Ingestion of two small doses during the eighth week of gestation.
C. Ingestion of a single large dose in the sixth month.
D. Thrice-weekly doses during the ninth month of pregnancy.
2. Animal tests are often helpful in determining whether a drug can safely be used by human beings. Had hamster tests been employed with thalidomide.
A. The results would have indicated that fetal malformation would occur in human beings.
B. The results would not have been helpful, since people are many times more sensitive to the drug than are hamsters.
C. The results would have shown that thalidomide is fatal to hamsters.
D. Hamsters would have been found to be 100 times more sensitive to the drug than human beings.
3. An 1,800-gm. male infant is born after 34 weeks of gestation. There were no unusual maternal symptoms during pregnancy, and the birth is vaginal in a hospital delivery room.
A. Since the hospital delivery room has a temperature of 220C, the neonate should not lose any heat.
B. If the infant is hypothermic, resuscitation will be easier if the delivery room is kept at 20-220C.
C. Since the room is being kept at 22°. it is extremely important to keep compromised infants away from open radiant heaters to prevent fluid loss.
D. Since the delivery room is being kept at 22°, the neonate can be expected to lose heat rapidly, mostly from evaporation.
4. Of all the hazards to which the newborn infant is subjected in the hospital nursery, the most significant (according to Drs. Brown and Glass) is
A. Loss of vision due to phototherapy.
B. Inadequate cleaning of incubators.
C. Contamination from unwashed hands of hospital personnel.
D. Lead poisoning from peeling paint in hospital nursery.
5. You are directed to establish proper hand-washing techniques for hospital personnel In the neonatal nursery of a large urban hospital. In establishing procedures, you decide to base your policies on the conclusions reached by Drs. Brown and Glass in this issue, which hold that
A. The type of soap chosen is critical.
B. Proper hand-washing techniques may remove transiently acquired bacteria but may not eradicate drug-resistant gram-negative bacilli.
C. Proper hand-washing techniques will remove all bacteria.
D. Hexachlorophene should be used to cleanse the neonate's perineum.
6. Three per cent of all low-birth-weight infants
A. Are born with congenital abnormalities.
B. Have high urinary mercury levels.
C. Are asymptomatic carriers of cytomegalovirus.
D. Are born to primigrávidas.
7. A child with ciguatera poisoning is most likely to have
A. Eaten beef imported from Argentina.
B. Recently returned from a week-long fishing trip to the West Indies.
C. Been playing with an old automobile battery.
D. Eaten a marijuana cookie.
8. A soft-tissue sarcoma is diagnosed in an eight-year-old girl after histologic studies. According to studies reported by Or. Miller, the sarcoma may have been influenced by:
A. Fatty food substances.
B. Polybrominated biphenyls.
C. Exposure to DES in utero.
D. Androgenic steroid therapy.
9. The most common food additive is sucrose. H can be an "environmental hazard" to children
A. By increasing the solute load.
B. By causing meiabolic alkalosis.
C. By diluting the per-calohe amount of other primary energy sources.
D. By causing galactosemia.
10. Mercury poisoning has recently resulted in children because
A. Parents erroneously suspected that mercury compounds were good for their infants.
B. Fungicide-treated grain has been inadvertently used for animal feed.
C. Mercury-painted walls in nurseries have contaminated newborns.
D. A manufacturer of hospital thermometers neglected to adequately seal the glass tubes.
11. As a result of the discovery that women ingesting polychlorinated biphenyls may pass them on to their infants while nursing, the American Academy of Pediatrics' Committee on Environmental Hazards has recommended that
A. Pediatricians be encouraged to promote bottle-feeding rather than breast-feeding.
B. Pediatricians encourage women to breast-feed their infants unless a high PCB level has been found in the mother.
C. Women in the 11 Western states refrain from breast-feeding until PCB levels in mountain streams are reduced.
D. Pediatricians take no stand on breast-feeding until more conclusive double-blind tests can be conducted.
12. The mother of one of your adolescent patients, on checking records, finds that she had taken DES during the sixth month of her pregnancy. Her daughter is now 10, and the mother is concerned that the girl may be at risk for vaginal cancer. You should advise her:
A. The daughter is indeed at risk, since laboratory studies indicate that transplacental carcinogenesis entails intrauterine exposure after organogenesis.
B. The daughter is not at risk if the mother did not take DES at any other time.
C. The daughter is at risk only if she was breast-fed.
D. Immediate immunotherapy is indicated.
Type B Questions. In the following questions, one or more answers is correct. Answer:
if 1, 2, and 3 are correct
If 1 and 3 are correct
If 2 and 4 are correct
If only 4 is correct
13. Phototherapy for hyperbilirubinemia can cause the following side effects:
1. Frequent loose, greenish stools.
2. Transient skin rashes.
3. Transient skin discoloration.
14. A 2-month-old infant is brought to you with symptoms of lead poisoning. After taking the history, you realize that the poisoning may have been caused by
1. Playing with yellow-colored newspaper supplements.
2. Inhaling lead in fumes from the automobile garage downstairs.
3. Eating peeling paint from the old tenement in which she lives.
15. The mother of an eight-month-old infant is still nursing him and is also under the care of a gastroenterologist and a psychiatrist. You must advise her not to take which of the following drugs as long as she nurses the infant?
2. An antidiarrheal agent.
4. An occasional aspirin for headache.
Type C Questions. Many agents taken by the mother can affect the fetus during or after birth. Indicate the correct column in which each of these agents should be placed.
Can cause fetal death.
May cause withdrawal effects in infant.
May cause hematologic effects in infant.
May cause cancer in child later in life.
May result in low birth weight.
Will have no effect on fetus.
17. Chloral hydrate
18. Cigarette smoking
QUIZ ANSWERS WILL APPEAR IN THE MARCH, 1980, ISSUE
ANSWERS TO THE CME QUIZ IN THE SEPTEMBER ISSUE
Asthma and Other Allergic Disorders
* Transmission difficulties resulted in four incorrect answers' being printed for question 7 in trie above test, and an incorrect question's being printed for Question 11. All readers taking the September test have been automatically given credit tor correct answers to these two questions.