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 each of the articles carefully Oo 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 $15 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.
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
1. Maternal ultrasound:
A. Is unlikely to be used as frequently as in the past.
B. Detects urinary obstruction in as many as 1 % of pregnancies.
C. Will readily differentiate oligohydramnios from normal amniotic fluid.
D. Cannot detect physiologic urinary obstructions, particularly in the later months.
E. Will ultimately improve the mortality with obstructive uropathy due to early diagnosis.
2. Renal function in the fetus:
A. Is mature by 36 weeks of gestation.
B. By term will excrete 600 to 800 cd day of urine.
C. Develops good concentrating ability so that urine volume is 250 cc/ day in the last month.
D. Is severely compromised by obstruction due to the inelasticity of the collecting system.
E. Is more affected by bilateral upper tract obstruction than by urethral obstruction.
3. Amniotic fluid is:
A. Primarily fetal urine during the first trimester.
B. Decreased with Gl obstruction.
C. Increased with urinary obstruction due to transudation of maternal plasma.
D. Important for pulmonary development.
E. Isotonic to plasma in later gestation.
4. The fetus with bilateral hydroureteronephrosis and a distended thickened bladder:
A. Is likely to have the prune belly syndrome.
B. Is likely to have posterior urethral valves.
C. Is likely to have bilateral vesicoureteral reflux.
D. And oligohydramnios should have prenatal intervention.
E. Has a very poor prognosis for neonatal survival.
5. In a baby with bilateral hydronephrosis and a normal VCUG, and the renal ultrasound shows good corticomedullary lucendes:
A. Immediate bilateral pyeloplasties is indicated to save function.
B. Delayed surgical intervention is a reasonable alternative.
C. Renal nuclear scan is an invalid study in the newborn.
D. Lasix diuresis is not effective in the newborn.
E. Renal ultrasound gives less valid information in the newborn than the IVP
6. In a baby girl when ureterocele is diagnosed by pre- ami postnatal ultrasound:
A. One must wait six to ten weeks to assess the function of the upper pole segment to choose the correct surgical intervention.
B. Prophylaxis is mandatory during the six to ten week assessment period.
C. Immediate partial nephroureterectomy and excision of ureterocele should be done.
D. Catheter drainage of the bladder for six to ten weeks will obviate the obstructive component of the ureterocele.
E. One should wait to see if the child becomes symptomatic before surgical correction; ureteroceles may resolve.
7. The incidence of cryptorchidism in adult males is approximately:
8. The most common testicular tumor found in the cryptorchid testis associated with intersex states is:
B. Embryonal cell carcinoma.
C. Yolk sac.
9. The optimal time for surgical correction of the undescended testis is at:
B. I year of age.
C. 3 years of age.
D. 5 years of age.
10. Surgical intervention is not Indicated for correction of the undescended Impalpable testis if it can be located by:
A. MRI scan.
E. None of the above.
11. The most important complications associated with cryptorchidism include:
E. All of the above.
12. The retractile testis:
A. Is easy to differentiate from the cryptorchid testis.
B. Requires surgical intervention.
C. Is associated with an increased risk of neoplasia.
D. Is a more common entity than cryptorchidism.
E. Is located in the Dennis-Browne pouch.
13. The processus vaginalis:
A. Is located within the testis.
B. Is an outpouching of peritoneum.
C. Forms the female internal reproductive organs.
D. Is derived from neuroectoderm.
14. A child with hypospadias frequently also has:
A. Meatal stenosis.
B. Inguinal hernias.
C. Undescended testes.
D. Any of the above.
E. None of the above.
15. The most complete screening test for children with suspected valves is:
A. Voiding cystourethrogram.
B. Renal scan.
E. Untravenous pyelogram.
16. An infant with posterior urethral valves and sepsis is identified. Initial management should consist of:
A. Immediate surgery for valve ablation.
B. Urine culture, semen electrolytes, antibiotics.
C. Urine culture, serum electrolytes, tube drainage, antibiotics.
D. Percutaneous nephrostomies.
17. After initial surgical treatment of the obstruction: A. No further intervention will be needed.
B. Serum creatinine, electrolytes, and infection response must be carefully monitored.
C. Renal biopsy should be performed.
D. Worsening renal function dictates the need for dialysis.
E. Higher diversion, if necessary must be performed within hours.
18. Vesicoureteral reflux:
A. Occurs on the side with a functioning kidney in the VURD syndrome.
B. Is the underlying problem in children with the full valve bladder syndrome.
C. Requires early operative intervention.
D. Is rare in posterior urethral valves.
E. Can spontaneously cease after definitive valve treatment.
19. Persistent urinary incontinence in a patient with treated valves:
A. May improve at puberty.
B. Is usually due to scarring of the urethra.
C. Has nothing to do with urinary volumes.
D. Will usually be helped by attempts to hold the urine for as long as possible.
E. Is seen in nearly all children followed for up to 15 years.
20. Significantly impaired renal function:
A. Is usually a minor problem.
B. Is predicted by the serum creatinine at presentation.
C. Can be avoided by better surgical technique.
D. Occurs in only 5% of children with valves.
E. Results from developmental causes rather than delayed diagnosis and treatment.
ANSWERS TO THE OCTOBER QUIZ
Gastrointestinal Diseases of Children