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 questbns 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 social-, security 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.
7. All replies 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: Allergy
Record your answers on page 75.
Type A Questions: Choose one letter after each of the numbers listed below and transfer to the coupon. Only one answer is correct.
1 . A four-year-old boy who has had many coughs, occasional wheezing, sore throats, and diarrhea, has been diagnosed as atopic. Which of the following does not support such a diagnosis?
A. Father is allergic, and two-year-old sister has eczema.
B. There is selective synthesis of immunoglobulin E antibodies on exposure to some environmental substances.
C. Eosinophilia of nasal discharge.
D. Apparent dysfunction of the cholinergic receptors.
2. The child described above is sensitive to household dust. As a pediatrician, your treatment regimen should include:
A. Insistence that the child avoid all household dust.
B. Urging the parents to take steps to decrease his exposure to household dust as much as possible.
C. Instructing your aide to prepare extracts of the offending material.
D. Spraying for house-dust mites.
3. Immunotherapy should be considered for the child described above
A. If no cause-and-effect relationship between the allergy and the dust can be found.
B. As a part of the differential diagnosis.
C. When environmental control is inadequate.
D. Because it can permanently cure the child of his allergies.
4. Hay fever is a Type 1 anaphylactic reaction
A. Initiated by a reaction of allergen with previously sensitized mast cells.
B. Initiated by reaction of antibody with a hapten.
C. Initiated by the precipitation of antigen and antibody complex.
D. Representative of delayed-type hypersensitivity.
5. The symptoms of an allergic patient occur because there has been a reaction of allergen and the reaglnic antibody, immunoglobulin E. This occurs because
A. Immunologic receptors on the surface of mediator-containing mast cells and circulating basophils specifically bind IgE.
B. There is a prior release of chemical mediators that induces the mast cells to bind IgE
C. Intracellular enzymes are activated by the allergen, to prepare the immunologic receptors for binding.
D. The immune response has freed IgA and IgM from the surface of the tissue mast cells.
6. Factors capable of activating platelets (PAF)
A. Were discovered by Wiener in 1915.
B. Are released from human lung fragments by IgE-dependent mechanisms.
C. Cause aggregation of serotonin, with subsequent release of platelets.
D. Are bound by immunologic receptors on the surface of mediator-containing mast cells.
7. Histamine is a primary chemical mediator of immediate hypersensitivity that acts by
A. Eosinophil deactivation.
B. Causing platelet aggregation, with subsequent release of serotonin.
C. Contributing to the accumulation of neutrophils.
D. Causing increased vascular dilatation and vascular permeability in the skin.
8. In an allergic individual, bronchoconstriction is likely to result from
C. Release of acetylcholine as a result of stimulation of a temperature-sensitive receptor.
D. Chemical stimulation causing release of prostaglandins E, and E2.
9. Slow-reacting substance of anaphylaxis (SRS-A) is a chemical mediator of immune hypersensitivity that was not discovered until 1972. It is important to the practicing pediatrician because
A. It is capable of causing blood coagulatbn.
B. It is capable of inducing prolonged contraction of bronchial muscles.
C. It is the substance in beestings that causes toxicity.
D. It is a sign of the Prausnitz-Küstner reaction.
10. Selective stimulation of the cholinergic receptors has been important in contributing to our understanding of
A. Hymenoptera sensitivity.
C. Summers-Evans Syndrome.
D. Rh incompatibility.
11. Cyclic adenosine monophosphate (c-AMP) is a cyclic nucleotide identified so recently that it is still not mentioned in many commonly used pediatric or allergy texts. It is important for pediatricians to know about it because
A. It inhibits the release of histamine and causes smooth-muscle relaxation.
B. It stimulates the release of histamine and causes smooth-muscle contraction.
C. It is synthesized as a reaction to the house-dust mite found in many homes and schools.
D. It is the definitive sign of Summers-Evans syndrome.
Type B Questions: In the following questions, more than one answer may be 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
12. A six-month-old infant is brought to your office with severe dermatitis of four months' duration. In making the differential diagnosis, you decide the condition is seborrheic dermatitis instead of atopic dermatitis. The following sign(s) support such a diagnosis:
1 . The infant has severe pruritis.
2. "Potato-chip" scales have developed on the head and neck.
3. There is a complicating herpes simplex infection.
4. Pruritis does not seem to be present.
13. A 12-year-old boy comes to your office three days after his return from summer camp with severe pruritis. Following examination you decide he has severe contact dermatitis. Your decision is supported by the fact that
1 . Lichenification is present.
2. He complains of intense itching.
3. Lesions are restricted to the covered portions of his trunk and upper arms.
4. Itching did not begin until two days after he went on a hike.
14. A patient with atopic dermatitis has a herpes simplex infection. You can safely tell the patient and his parents that
1 . Primary eczema herpeticum should heal spontaneously in two to six weeks.
2. No specific antiviral therapy is available for the infection.
3. One can remove crusts with Burow's solution compresses.
4. The disease is not dangerous, and no permanent scarring will develop.
15. In making the differential diagnosis for erythema multiforme, you should keep in mind that
1 . Erythema multiforme in children is usually drug-related or follows an infectious disease.
2. Most patients will develop erosive lesions of the lips and exudative mucous membrane lesions of the mouth.
3. The condition can present with urticarial, erythematopapular, vesiculobullous, or other skin lesions.
4. Lesions will not resolve spontaneously without treatment.
16. A mother brings a six-year-old boy to your office with discoloration and swelling over his right eye, a transverse crease across his nose, and distinct facial pallor. Having ruled out child abuse as a possible factor, you suspect from the child's condition that these signs are indicative of
1 . Nummular eczema.
3. Candidal infection.
4. Allergic rhinitis.
17. Diaper dermatitis is usually caused by
1 . Formaldehyde resins impregnated in the diaper material.
3. The plastic diaper liner.
18. When asthma is the presenting problem in allergy, initial evaluation should always include
1 . A PRIST (paper immunosorbent test).
2. A tine test.
3. Sweat electrolytes.
4. Chest x-ray.
19. Direct challenge by eliminating one or more foods from the diet necessitates which of the following if it is to be effectively evaluated?
1 . Total elimination of the food in question.
2. Elimination of the food for at least three weeks.
3. Reintroduction of the food in such a way that it is not recognized by the patient.
4. Repeating of the elimination diet for several weeks if a negative response is obtained the first time.
20. The RAST
1 . Is an instrument used for opening the bronchial tree in cases of severe infection.
2. Is a report by the American Society of Thoracic Surgeons delineating the hallmarks for surgical intervention in allergy.
3. Should be used only by a skilled surgeon under scrupulously aseptic conditions.
4. Has largely replaced passive transfer testing because of the dangers of hepatitis in the latter.