1. As an organization accredited for continuing medical education, the Lenox Hill Hospital certifies that this continuing-medical-education activity meets the criteria for three credit hours in Category 1 of the Physician's Recognition Award of the American Medical Association, provided it is used and completed as designed.
2. Read every question carefully. Answers to all questions will be found in the articles in this issue of Pediatric Annals. Select only one letter next to each of the numbers listed on the answer form.
3. Type or print your full name and address (including zip code) and your social security number in the spaces provided.
4. Send check or money order ($10) made out to Pediatric Annals CME Quiz. Mail with your answer form to:
501 Madison Avenue
New York, N.Y. 10022
5. After your answers are graded, you will be advised of your score and the answers to any incorrect or missed questions. Unanswered questions will be considered incorrect and so scored. A minimum score of 70 per cent must be obtained in order for credits to be awarded.
6. All replies and results are confidential. Answer sheets, once graded, will be returned, and no record of scores will be maintained. The Department of Pediatrics at Lenox Hill Hospital will keep only a record of participation, indicating the completion and awarding of three hours of Category 1 credit to individual physicians.
CME Quiz: Neonatal Medicine
1. A 1.9-kg. baby was born to a mother who admits to (1) having had no prenatal care, (2) having taken "five or six" alcoholic drinks every day for the past two to three years, and (3) having frequently taken phénobarbital to improve her mood. She admits having taken a pill just before the baby was born. In view of the preceding statements, which of the following is correct?
A. One would not expect the ingestion of alcohol to affect the newborn child.
B. Moderate or large intake of alcohol during pregnancy is deleterious to fetal growth and development.
C. The use of phenobarbital by the mother would not harm the infant.
D. None of the above statements is correct.
2. Following delivery, the infant in question 1 appears sleepy and has an Apgar Score of 4. This is most likely due to
A. The mother's having taken alcohol just before the birth of the baby.
B. The mother's having taken phenobarbital just before the birth of the baby.
C. The mother's having smoked marijuana just before delivery.
D. None of the above.
3. The mother in question 1 signs herself out of the hospital 24 hours after giving birth. The baby should
A. Be discharged with the mother.
B. Be kept in the hospital for three more days and be discharged then only if there are not withdrawal symptoms.
C. Be held in the hospital for five more days and be discharged then only if there are not withdrawal symptoms.
D. Be kept in the hospital 10 more days and be discharged then only if there are no withdrawal symptoms.
4. With the history obtained from the mother in question 1 and the sleepiness described in question 2, one would expect this baby to show
A. Tremors and hyperactivity in the nursery.
B. Retarded linear growth and weight gain at age two years.
C. Possible mental retardation, becoming very evident by age of four years.
D. All of the above.
5. At age two weeks, just before discharge, the baby described in questions 1-4 is noted to have a heart rate of 150, a respiratory rate of 40, and an occasional period of cyanosis. The liver edge is 4 cm. below the costal margin. No edema is noted. It is most likely that
A. This is a fairly normal finding in the neonate.
B. This condition is due to the withdrawal of drugs that the mother took during her pregnancy.
C. Left-ventricular failure has occurred in this child.
D. None of the above is responsible for the infant's condition.
6. The etiology of findings described in question 5 must be determined. It is not necessary to do which of the following?
A. Determine the blood pressure.
B. Obtain an electrocardbgram.
C. Determine arterial blood gases of baby.
D. Obtain an electroencephalogram.
7. Studies performed on the infant suggest coarctation of the aorta. If this diagnosis is correct
A. There will be a blood-pressure differential between the brachial and femoral arteries.
B. Chest x-ray will not usually show cardiomegaly.
C. The ECG will usually indicate right-ventricular hypertrophy.
D. None of the above will indicate coarctation of the aorta.
8. A consultant who sees this baby at age two weeks finds that the heart rate is greater than 200 beats per minute. A diagnosis of atrial tachycardia is made.
A. This diagnosis is frequently made in children who have coarctation of the aorta.
B. Neonatal supraventricular tachycardia is not usually associated with structural cardiac defect.
C. The rapid heart rate usually causes no pulmonary congestion.
D. The infant is treated with digitalis and sinus rhythm is restored. Digitalis can then be discontinued.
9. This same consultant feels that the infant may be cyanotic. If he is correct, central cyanosis may be due to
A. A cardiac defect.
B. A pulmonary defect.
C. A central-nervous-system disorder.
D. Any of the above.
10. Another newborn with cyanosis seen by the same consultant is determined to have transposition of the great arteries. This is compatible with life
A. If communication exists between the pulmonic and aortic circuits.
B. If no communication exists between the pulmonic and aortic circuits.
C. If the only communication between the two circuits is a patent ductus arteriosus that slowly closes.
D. If a patent ductus arteriosus and a patent foramen ovale are both present at birth and close shortly thereafter.
11. A 32-week -gestational-age baby is born with only gasping respiration. The Apgar score is 4 at one minute. Vigorous resuscitation and intravenous fluids are required during the first 48 hours of life. There is marked respiratory distress. Air is seen by x-ray in the portal vein. The most likely diagnosis is
A. Diaphragmatic hernia.
B. Tension hemothorax.
C. Necrotizing enterocolitis.
D. Esophageal atresia.
12. If diaphragmatic hernia is the correct answer in question 11
A. The abdomen is distended.
B. The lungs are likely to be affected.
C. Conservative therapy to prevent further intestinal dilatation is the treatment of choice.
D. Immediate operative intervention with replacement of the viscera into the abdominal cavity is essential.
13. The neonatal manifestation of cystic fibrosis is meconium ileus.
A. This is present in 80 per cent of all cystic-fibrosis cases.
B. Operative intervention should be avoided because of the underlying disease.
C. With obstruction due to meconium ileus, operative intervention is indicated if conservative therapy fails.
D. The diagnosis of cystic fibrosis is verified by a sweat test even in a two-week-old infant.
14. In a one-day-old infant a 4x3-cm. mass is palpated in the right upper quadrant. Such masses most often are
A. Of genitourinary origin.
B. Of gastrointestinal origin.
C. Mesenteric cysts.
15. A urinalysis performed on the baby in question 14 on the second day reveals a trace of protein, glycosuria, and 3-5 WBC/cu. mm.
A. These findings are abnormal.
B. This strongly indicates that the mass described in question 14 is of genitourinary origin.
C. The most abnormal finding is the presence of proteinuria.
D. All the findings may be normal.
16. If the infant described in question 14 has not voided after 48 hours
A. No pathology should be suspected unless the baby does not urinate for another 48 hours.
B. A nephrourologic disorder should be strongly suspected.
C. Bilateral renal agenesis could not be the diagnosis.
D. An obstruction due to posterior urethral valve is so rare that it should not be considered in the differential diagnosis.
17. A repeat urinalysis is performed on the infant described in question 15 on the fourth and seventh days of life. The protein increases, but the sugar and cells are no longer present. This persistent proteinuria
A. Should be followed only.
B. Probably is of no significance since the cells and glycosuria have cleared.
C. Requires further diagnostic evaluation beside follow-up.
D. Always requires a renal biopsy.
18. A baby born weighing only 1,900 gm. was delivered after a 40-week gestation. Physical examination is entirely normal. The mother wishes to breast-feed the Infant.
A. She should be discouraged from breast-feeding because of the low weight.
B. She should be discouraged because breast-feeding is not as nutritious as formula feeding for an infant so small.
C. She should be discouraged from breast-feeding because in premature infants there is a greater incidence of necrotizing enterocolitis than in those fed artificial formulas.
D. She should be discouraged from breast-feeding if she elected to do this only because of guilt feelings.
19. Compared with cow's milk, breast milk is
A. Richer in protein content.
B. Richer in unsaturated fatty acids.
C. Richer in mineral content.
D. Richer in vitamin K content.
20. There are certain disadvantages to breast-feeding compared with cow's milk formulas. Indicate which statement is false.
A. There is a slow growth rate in breast-fed very small prematures.
B. There may be transmission of environmental pollutants.
C. There is a marked tendency to jaundice in the breast-fed during the early weeks of life.
D. There may be a transmission of drugs through the mother.
PRE-TEST ON NEXT MONTH'S ISSUE
FEBRILE CONVULSIONS AND EPILEPSY
Next month's issue of Pediatric Annals will also provide pediatricians with the opportunity to earn Category 1 continuing-medical-education credits through a program jointly sponsored by this journal and Lenox Hill Hospital of New York. As with this issue, credits can be earned by reading articles in the issue and successfully completing the quiz at the end of the issue.
Our continuing-education offering in March will be devoted to the diagnosis and treatment of febrile convulsions and the diagnosis and classification of epilepsy. The Pre-Test below is planned to give you an idea of some of the areas to be covered in the March issue and will give you an opportunity to challenge your own knowledge of the subjects to be treated. Answers can be found by reading the articles in next month's issue.
1. A two-year-old child develops a temperature of 103°-105°F. He is diagnosed as having pharyngitis. Forty-eight hours after the onset of fever, white he stilt has a temperature of 102°, he develops a shaking of his right arm and a rolling of his eyes. This is most likely not due to
A. The fever.
B. A serious illness, such as meningitis.
C. An epileptic disorder.
D. Any of the above.
2. A five-year-old child has recurrent grand mal convulsions. An electroencephalogram Is read as being "slightly irregular." Before a diagnosis of epilepsy is made the patient should have
A. A lumbar puncture.
B. Skull x-rays.
C. Computerized axial tomography (CAT) scan.
D. None of the above.
3. " Jacksonlan seizure" is a term that is used very loosely in the medical literature.
4. "Abdominal epilepsy," a condition in which gastrointestinal symptoms may be a manifestation of epilepsy, is fairly common.