Pediatricians may receive three credit hours in Category I for the Physician's Recognition Award of the American Medical Association by leading 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 oiher 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 Registra non Form at the end of the qui/. Retain a copy of your answers so that they can be compared with the correct answers that will be sent to vou later.
3. Type or print your full name and address and your Soc tal Security number in the spaces provided on the CME Registration Form.
4. Send the completed form, with your check or money order for SlS 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 h¿we passed for 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 maienal 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 guiz 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 medicai education, trie Lcxon Hiil Hospital of New York designates this continuing medical education activity as meeting the criteria for three credit hoys in Category l fo* Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions
Solid Tumors in Children
1. Wilms' tumor:
A. Is usually widespread (stage III or IV) at diagnosis.
B. Metastasizes most commonly to the brain.
C. Has an overall long-term disease-free survival of greater than 80%.
D. Histologically resembles the hypernephroma of adulthood.
2. Abdominal masses in childhood:
A. Most commonly involve the genitourinary tract in the neonatal period but not thereafter.
B. Are often malignant in the neonatal period.
C. Should first be evaluated by ultrasound.
D. Should be palpated with extreme caution because of the increased risk of microscopic pulmonary dissemination.
3. Treatment of Wilms' tumor:
A. Should always include surgery, radiation therapy and chemotherapy.
B. Should always include actinomycin-D, doxorubicin, and vincristine.
C. Should include doxorubicin for patients with advanced disease and/or unfavorable histology at diagnosis.
D. Should include radiation therapy for patients with microscopic residual (group II) disease.
4. Treatment of recurrent Wilms' tumor:
A. Is rarely if ever, curative.
B. Depends on the tumor histology and on the time and site(s) of recurrence.
C. May include agents used at the time of the recurrence.
D. Should include ifosfamide/mesna, VP- 1 6-2 1 3 and/or cisplatin if radiation therapy cannot be given.
5. Wilms' tumor:
A. Is associated with congenital malformations in less than 10% of cases.
B. Is familial in bilateral but not unilateral cases.
C. May develop in the offspring of cured Wilms' tumor patients whether in the index case was unilateral or bilateral.
D. Is associated with the development of hypernephroma in later life.
6. The most common histologic type of rhabdomyosarcoma in childhood is the:
A. Embryonal type.
B. Alveolar type.
C. Botryoid type.
D. Pleomorphic type.
7. An uncommon primary location of rhabdomyosarcoma is the:
C. Pelvic extremities.
8. The best imaging modality to follow patients with pelvic rhabdomyosarcoma following extensive surgical resection is the:
B. CT scan and gallium scan.
C. NMR (Nuclear Magnetic Resonance).
D. None of the above.
9. CNS prophylaxis therapy has been shown to improve the disease-free survival period of patients with rhabdomyosarcoma tumors localized to:
B. Info tempora I foass.
D. All of the above.
10. The most frequent sites of metastatic disease in rhabdomyosarcoma are the
D. All of the above.
11. The two most important prognostic factors in childhood rhabdomyosarcoma are:
A. Age of patient and primary site.
B. Primary site and clinical staging.
C. Clinical staging and age of patient.
D. Age and sex of patient.
12. Prognostic factors for progression of neuroblastoma include all of the following except:
A. Stage and age.
B. N-myc copy number.
C. Serum ferritin.
D. Calcifications of the tumor.
13. Patients with stage IVS disease can present with all of the following except:
A. Small primary tumor.
B. Bone marrow involvement.
C. Skeletal metastases.
D. Extensive liver metastases.
14. All but one of the following statements are true regarding myeloablative regimens with bone marrow transplantation for neuroblastoma:
A. This approach is based on the dose-responsiveness of neuroblastoma.
B. A transplant regimen is likely to achieve a cure in a stave IV patient who had an incomplete response to conventional chemotherapy.
C. Up to 30% to 35% of stage IV IV patients transplanted in complete remission may be long-term disease-free survivors.
D. Alkylating agents are the mainstay of transplant regimens for neuroblastoma.
15. Surgery should be performed for all of the following reasons except:
A. Histopathologic diagnosis.
B. Staging, with lymph node sampling.
C. Debulkmg prior to chemotherapy.
D. Prognostic marker studies.
16. The peak incidence of osteosarcoma is:
A. In adolescents.
B. In pre-school children.
C. In infants.
D. Between the ages 7 and 9.
17. Which of the following is known to be associated with increased rate of osteosarcoma?
A. Patients with retinoblastoma who had received radiotherapy
B. Patients with ankylosing spondylitis.
C. Patients with Charcot-Marie-Tooth disease.
D. Patients with Down's syndrome.
18. Which of the following statements is correct in surgical treatment of osteosarcoma of the long bones?
A. The resection of the involved bone should be madejust above the main tumor site leaving a clear margine.
B. The resection of the involved bone should be 7 to 1 0 cm above the main lesion.
C. The line of resection should be within 2 cm above the main tumor site.
D. En bloc resection and limb salvage is treatment of choice only in children prior to puberty.
19. Which of the following statements in the management of osteosarcoma undergoing amputation is correct?
A. Patients should be fitted with a temporary prosthetic limb immediately after amputation, or as soon as possible.
B. Fitting of a temporary prosthetic limb should await healing of the stump, decreasing edema, and start of chemotherapy.
C. Anticoagulation therapy during surgery has clearly been shown to prevent development of metastasis.
D. With surgery and current optimum adjuvant chemotherapy only 20% of patients survive their disease.
20. Which of the following statements regarding therapy of osteosarcoma is correct?
A. It has never been clearly demonstrated that adjuvant chemotherapy is effective in treatment of osteosarcoma.
B. Major effective drugs are methotrexate, cisplatin, adriamycin, and cyclophosphamide.
C. Major effective drugs include epiphyllotoxins, DTIC, DHAD, and mAmsa.
D. Resection of pulmonary metastasis should not be attempted because patients developing metastasis are not "salvagable."
ANSWERS TO THE JANUARY QUIZ