Pediatricians may receive three credit hours in Category 1 for the Physician's Recognition Award of the American Medical Association by reading the material in this issue and successfully answering the questions in the quiz below To obtain credits, follow these instructions.
1. Read «ach off the articles carefully Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.
2. The following questions have been designed to provide a useful link between the articles in the issue and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME Registration Form at the end of the quiz. Retain a copy of your answers so that they can be compared with the correct answers that will be sent to your later.
3. Type or print your full name and address and your Social Security number in the spaces provided on the CME Registration Form.
4. Send the completed form, with your check or money order for S 15 made out to PEDIATRIC ANNALS CME CENTER, 6900 Grove Road. Thorofare, N.J. 08086.
5. Your answers will be graded, and you will be adivsed that you have passed (or failed). An answer sheet containing all correct answers will be mailed to you. Review the parts of the articles dealing with any questions you have missed, and read the supplemental material on this aspect of the subject listed in the references in this issue.
6. Be sure to mall the form on or before the deadline listed on the CME Registration Form, so that credit can be awarded. (After that date, the quiz will close, and correct answers will appear in the magazine.) Unanswered questions will be considered incorrect and so scored. A minimum score of 70 must be obtained in order for credits to be awarded.
As an organization accredited tor continuing medical education, the Lexon Hill Hospital of New York designates this continuing medical education activity as meeting the criteria for three credit hours in Category I for Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions
Liver Disorders of Infancy and Childhood
1. Hereditary Fructosemia Is commonly associated with:
A. Exclusive breast feeding.
C. An autosomal dominant form of inheritance.
O. Intolerance of sweets.
2. Alpha- 1 -antitrypsin deficiency can cause:
A. Infantile emphysema.
C. Neonatal cholestasis.
D. Extrahepatic biliary atresia.
3. Hypoglycemia in a jaundiced infant does not occur in:
B. Hereditary Tyrosinemia.
C. Hereditary Fructosemia.
D. Wilson's disease.
4. Portal hypertension most often results from:
A. Increased flow through the portal system.
B. Increased resistance in the portal system.
D. Collateral circulation.
5. The most common cause of portal hypertension in children is:
A. Extrahepatic portal vein thrombosis.
D. Not certain.
6. A patient with an enlarged spleen and ascites would be least likely to have:
A. Extrahepatic portal vein thrombosis.
C. Veno-occlusive disease.
D. Budd-Chian syndrome.
7. Therapy for acute hemorrhage from esophageal varices includes all of the following but:
A. Intravenous vasopressin.
B. Gastric lavage.
C. Portosystemic shunt.
D. Endoscopic sclerotherapy.
8. In the vast majority of cases of Reyes syndrome we find:
A. An association with ingestion of acetaminophen.
B. An abnormal spinal fluid.
D. Elevation of serum aminotransferases and ammonia.
9. After surgery for extrahepatic biliary atresia (portoenterostomy):
A. Bile drainage is accomplished in less than 50% of infants.
B. Bile drainage is accomplished only if there are dilated bile ducts at the porta hepatis.
C. Bile drainage is usually accomplished but fibrosis may progress despite drainage.
D. The best chance to achieve bile drainage is after 3 months, when the ducts have had a chance to dilate.
10. The diagnosis of biliary atresia has been simplified by:
A. CT scanning and ultrasound.
B. Combining a variety of liver function studies including viral studies.
C. Maternal ultrasound.
D. Nuclear scanning.
11. Cholangitis following the Kasai procedure:
A. Results from reflux of intestinal contents into the liver.
B. Occurs only if the operation fails to provide bile drainage.
C. Is best prevented by the prophylactic administration of antibiotics and phenobarbital.
D. Is a late complication which can jeopardize the outcome.
12. Hepatic transplantation for patients with end-stage liver disease from biliary atresia:
A. Is simplified if the donor liver is placed in a heterotopic position.
B. Is promising especially because of advances in immunosuppressive therapy.
C. Is not a reasonable alternative because the recipienti liver cannot be removed after a Kasai portoenterostomy procedure.
D. Can only be accomplished if HLA match is perfect.
13. Cholangitis after Kasai s portoenterostomy Is most frequently caused by:
A. Skin organisms.
C. Enteric gram-negatives and anaerobes.
D. None of the above.
14. Deficiency of which fat soluble vitamin has been shown to result In neurological abnormalities?
A. Vitamin E.
B. Vitamin D.
C. Vitamin K
D. Vitamin A
15. The stimulation of bile flow and increased bilirubin clearance by phenobarbital has been demonstrated in the following conditions, except:
A. Crigler-Najjar Syndrome, type II.
B. Syndromes of paucity of intrahepatic bile ducts.
C. Extrahepatic biliary atresia.
D. Familial recurrent cholestasis.
16. Of the following, which has not been generally used In the treatment of cholestatic pruritis?
C. Vitamin C
17. Of the following statements concerning vitamin E deficiency, which is not true?
A. The neurologic manifestations are irreversible in all cases.
B. Potential for recovery is age-related.
C. Oral supplementation is indicated for all cholestatic patients- parenteral supplementation may be required.
D. Areflexia may be the first clinicai feature of vitamin E deficiency.
18. Which of the following is not appropriate In the dietary management of the cholestatic child?
A. Replacement of medium chain with long chain triglycerides.
B. Replacement of fat soluble vitamins.
C. Careful follow-up of growth indices.
D. Sodium restriction in the presence of ascites.
19. The first therapeutic Intervention In the patient with ascites should generally be:
A. Institution of diuretic therapy.
B. Fluid restriction.
C. Sodium restriction.
D. Albumin replacement.
20. Liver transplantation in patients with chronic cholestasis:
A. Is too dangerous and should never be considered.
B. Now has a possible survival rate of 35%.
C. Now has a possible survival rate of over 65%.
D. Now has a possible survival rate of nearly 90%.
ANSWERS TO THE APRIL QUIZ
New Advances In Pediatric Therapeutics