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 guestions in the guiz below. To obtain credits, follow these instructions.
1. Read each 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 guestion, choose the correct answer, and record your answer on the CME Registration Form at the end of the guiz. 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 SI 5 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 guestions 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 guiz will close, and correct answers will appear in the magazine.) Unanswered guestions 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 I for Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions
CME QUIZ HYPERTENSION IN INFANCYAND CHILDHOOD
1. "Tracking" of blood pressure refers to:
A. The tendency of systolic and diastolic blood pressure to rise with increasing age.
B. A phased diagnostic approach to the diagnosis of hypertension in childhood.
C. The tendency of patients to maintain rank order blood pressure centiles over time.
D. The greater likelihood of developing hypertension as an adult.
2. Proper office techniques to obtain useful and accurate blood pressure measurements Include all but which of the following:
A. Use of an electronic blood pressure monitor.
B. Measurement obtained in non threatening, unhurried manner.
C. Auscultating while manometer falls 2 to 3 mmHg/sec.
D. Serial charting of blood pressure percentiles.
3. The reason to measure blood pressure In children is:
A. The early discovery of potentially life-threatening secondary hypertension.
B. Identification of children who are at risk for hypertensive morbidity as adults.
C. Early lifestyle and dietary counseling for children with mild, essential hypertension.
D. All of the above.
4. All of the following statements are correct, EXCEPT:
A. Recommended blood pressure screening commences at the 3 year examination.
B. The incidence of secondary hypertension is highest in younger children.
C. Primary (essential) hypertension is the most common form of hypertension in children.
D. Cardiovascular abnormalities from hypertension do not occur until adulthood.
5. Which of the following variables Is NOT thought to have a bearing on blood pressure in hypertensive patients?
D. Family history of hypertension
6. All of the following factors will have a bearing on the accuracy of the blood pressure measurement EXCEPT:
A. Position of the limb being used for the measurement
B. Cuff size
C. Inability to obtain the fifth Korotkoff sound
D. Type of eguipment used
7. The most common cause of hypertension in children over age 6 is:
A. Essential (primary) hypertension
B. Renal artery stenosis
C. Renal parenchymal disease
D. Coarctation of the aorta
8. The most reliable test for detecting renovascular hypertension is:
A. Peripheral serum renin with spot urine sodium
B. Detection of an abdominal systodiastolic bruit
C. Renal arteriography
D. Blood pressure response to ßblockade medication
9. Of the following regarding neonatal hypertension, which is NOT true?
A. Hypertension is always symptomatic.
B. Congestive heart failure often resolves with therapy.
C. Neurological symptoms may include lethargy and seizures.
D. Captopril may be effective in low dosages.
10. Systemic blood pressure in newborns:
A. Increases with postnatal age.
B. Is difficult to measure.
C. Is unaffected by crying and agitation.
D. Must be measured by a direct intra-arterial method.
11. Which of the following Is false?
A. Essential hypertension is rare in the newborn.
B. Hypertension due to renal artery thrombosis generally has a favorable prognosis.
C. Renal artery thrombosis is usually treated by nephrectomy.
D. Ultrasonography is often helpful in the evaluation of neonatal hypertension.
1 2. A 1 5-year-old male has a blood pressure measurement of 128/90 mmHg taken by a school nurse. Appropriate assessment Includes the following:
A. History and physical examination
B. Repeat blood pressure measurement
C. Evaluation of cardiovascular risk factors
D. All of the above
13. A 15-year-old white female has a blood pressure measurement of 128/90 mmHg repeatedly over 3 months. She Is normal weight and has no family history of hypertension. Appropriate management Includes:
A. Low sodium-high potassium diet B. Diagnostic evaluation including blood chemistry urinalysis, and renal ultrasound
C. Restriction from sports
D. weight reduction diet
14. The following are beneficial for blood pressure control In adolescents with mild essential hypertension EXCEPT:
A. Reduce diet sodium intake
B. Increase diet potassium intake
C. Restrict physical activity
D. weight reduction diet
15. Pharmacotherapy would be Indicated In which of the following:
A. A 13-year-old male with chronic glomerulonephritis and blood pressure at 112/72 mmHg
B. A 17-year-old muscular, athletic male with blood pressure at 132/88 mmHg
C. A 16-year-old insulin dependent diabetic female with blood pressure at 132/88 mmHg
D. All of the above
16. Angiotensin converting enzyme inhibitors such as Captopril should be used with caution In hypertensive children with:
B. Bilateral renal artery stenosis
D. Elevated uric acid levels
17. Nifedipine Is useful In the treatment of acute severe hypertension In children; however, one problem with Ks use may be:
A. The need for continuous blood pressure monitoring
B. The need to administer the medication intravenously
C. The unpredictable duration of action
D. Associated hyperkalemia
18. The antihypertensive effect of angiotensin converting enzyme Inhibitors may be enhanced by the addition of:
B. Calcium channel blockers
19. The use of verapamil for treatment of hypertension Is contralndicated in:
A. Renal failure
B. Heart failure
20. Verapamil should be used with caution in patients who are receiving:
D. Angiotensin converting enzyme inhibitors
ANSWERS TO THE JUNE QUIZ