Pediatric Annals

CME QUIZ

Abstract

INSTRUCTIONS

Pediatricians may receive three credit hours in Category I 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 each of 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 you 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 SI5 made out to PEDIATRIC ANNALS CME CENTER. 6900 Grove Road. Thorofare. NJ. 08086.

5. Your answers will be graded, and you will be advised 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 mail 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.

CERTIFYING INSTITUTION

As an organization accredited for 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 1 for Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions'

CMEQuIz Childhood Diabetes

1. If there were no relationship Between diabetes and the HLA (human leukocyte antigen) system, the expectation would be that:

A. 25% of diabetic sibpairs wouid be HLA-identical;

50% would be haploidentical;

25% would share no haploiype.

B. 50% would be HLA identical;

25% would be haploidentical;

25% would share no haplotype.

C. 25% would be HLA identical;

25% would be haploidentical;

50% would share no haplotype.

D. All of the above are false.

2. Viral Infections

A. Never lead to the development of insulin dependent diabetes mellitus (IDDM).

B. Serve as an environmental trigger leading to development of some forms of IDDM.

C. Serve as an environmental trigger leading to development of all forms of IDDM.

D. Must also have a bacterial component to lead to development of IDDM.

3. The role viruses play In IDDM Is supported by

A. A number of case reports of diabetes emerging in temporal relationship with viral infections.

B. The peak incidence of diabetes may coincide with the prevalence of common viral infections in a given community

C. Evidence that a number of viruses can damage islet beta cells in experimental animals.

D. All of the above are correct

4. Evidence h consistent wfth the theory that

A. There is a slow continuing immune process antedating the clinical diagnosis of IDDM.

B. There is no relationship between an immune process and the clinical diagnosis of IDDM.

C.…

INSTRUCTIONS

Pediatricians may receive three credit hours in Category I 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 each of 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 you 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 SI5 made out to PEDIATRIC ANNALS CME CENTER. 6900 Grove Road. Thorofare. NJ. 08086.

5. Your answers will be graded, and you will be advised 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 mail 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.

CERTIFYING INSTITUTION

As an organization accredited for 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 1 for Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions'

CMEQuIz Childhood Diabetes

1. If there were no relationship Between diabetes and the HLA (human leukocyte antigen) system, the expectation would be that:

A. 25% of diabetic sibpairs wouid be HLA-identical;

50% would be haploidentical;

25% would share no haploiype.

B. 50% would be HLA identical;

25% would be haploidentical;

25% would share no haplotype.

C. 25% would be HLA identical;

25% would be haploidentical;

50% would share no haplotype.

D. All of the above are false.

2. Viral Infections

A. Never lead to the development of insulin dependent diabetes mellitus (IDDM).

B. Serve as an environmental trigger leading to development of some forms of IDDM.

C. Serve as an environmental trigger leading to development of all forms of IDDM.

D. Must also have a bacterial component to lead to development of IDDM.

3. The role viruses play In IDDM Is supported by

A. A number of case reports of diabetes emerging in temporal relationship with viral infections.

B. The peak incidence of diabetes may coincide with the prevalence of common viral infections in a given community

C. Evidence that a number of viruses can damage islet beta cells in experimental animals.

D. All of the above are correct

4. Evidence h consistent wfth the theory that

A. There is a slow continuing immune process antedating the clinical diagnosis of IDDM.

B. There is no relationship between an immune process and the clinical diagnosis of IDDM.

C. An immune process is always involved in the clinical diagnosis of IDDM.

D. An immune process is always involved in the clinical diagnosis of IDDM if another chronic condition is also present

5. Immune intervention strategy in IDDM has included

A. Plasmophoresis.

B. Glucocorticoids.

C. Interferon.

D. All of the above are correct

6. Clinical studies of the relationship between diabetic con troland complications

A. Is clear.

B. Is controversial.

C. Has no relationship to the duration of the disease.

D. All of the above are false.

7. Progression of diabetic renal disease

A. Can be arrested.

B. Cannot be arrested.

C. Can be influenced in the later course of the disease.

D. Has been studied for long durations.

8. Muscle and skin capillaries show changes in IDDM.

A. The quadriceps muscle for this purpose is difficult to biopsy in children.

B. CBM (capillary basement membrane) thickening is related to severity of diabetes.

C. Improved glycémie control has no influence on CBM width or thickening.

D. CBM changes in IDDM can be explained by genetics.

9. Renal biopsy changes In children with diabetes

A. Are normal at onset of disease.

B. Show very slight glomerular changes within the first few months of onset

C. Still show no changes after 3 to 5 years duration of disease.

D. Show progressive changes in serial biopsies of individual patients.

10. There Is evidence for a relationship between glucose control and diabetic complications.

A. Hyperglycemia is necessary for the emergence of diabetic neuropathy

B. These complications should be reduced by good metabolic control.

C. we do not yet know the degree of control necessary to minimize the risk of complications.

D. All of the above are correct

11. At the time of diagnosis of diabetes, the most obvious physical sign is

A. Flushing of the skin.

B. Hepatomegaly

C. weight loss.

D. None of the above is correct

12. Wtthin a few days after the diagnosis of diabetes

A The children are usually asymptomatic

B. The urine is free of acetone.

C. Children usually do not require insulin.

D. The caloric requirement is usually at its peak.

13. Initiating treatment of diabetes in the home environment is advantageous because

A It eliminates the stress of hospitalization.

B. It allows the mastery of new knowledge at home.

C. It helps the family to be less dependent on the hospital staff

D. All of the above are correct.

14. The major complication of diabetic ketoacidosis (DKA) In children is

A Cerebral edema.

B. Pulmonary failure.

C. Cardiac failure.

D. Hepatic failure.

15. The most frequent complication of insulin therapy is hypoglycemia which Is frequently caused by

A. Skipping meals.

B. Excess of physical activity without simultaneous increase of food.

C. Dramatic reductions of insulin requirements during the "honeymoon period."

D. All of the above are correct.

16. Maladaptive parental attitude has been described as a determinant of the child's adaptation to diabetes. This Includes

A Parental overprotectiveness.

B. Parental lenience with child.

C. Parental self pity.

D. Parental rejection of child.

Which of the above Is false?

17. The best controlled diabetic children come from families with

A Few conflicts.

B. High level of stress in the parentdiabetic child relationship.

C. Satisfactory home adjustment by the child.

D. No money worries.

Which of the above Is false?

18. Psychosocial problems In diabetic patients should be prevented. This can be achieved by:

A At diagnosis the physician must strike a balance between being realistic and avoiding unnecessary anxiety

B. A member of the team must get as much background information as possible about the family.

C. The team dealing with a particular child should be large so that the child can obtain information from a variety of sources.

D. Continuing support should be provided.

Which of the above is false?

19. Factors known to encourage compliance in following doctors' suggestions include

A. A patient's appreciation of the seriousness of the illness.

B. A reward for compliance or a disincentive for noncompliance.

C. An easy regimen which requires little behavioral change.

D. Loose supervision so that the child is not constantly scolded or molested.

Which of the above Is false?

20. Brittle diabetes

A Occurs in patients whose lives are constantly disrupted by episodes of hypo- or hyperglycemia.

B. Occurs in patients whose lives are constantly disrupted by hypoglycemia.

C. Occurs in patients whose lives are constantly disrupted by hypergfycemia.

D. Only occurs in juvenile diabetes.

ANSWERS TO THE JUNE QUIZ

Pediatric Immunology II

1. A

2. B

3. C

4. B

5. C

6. D

7. B

8. D

9. C

10. D

11. D

12. D

13. B

14. C

15. A

16. D

17. A

18. B

19. C

20. C

10.3928/0090-4481-19870901-10

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