Pediatricians may receive three credit hours in Category Î 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 S 1 8 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 rtn organization accredited for continuing medical education, the I.enox Hill Hospital of New York designates this continuing medical education activity as meeting the enterb for three credit hours in Category 1 for Educational Materials for the Physician's Recognition Award of lhe American Medical Association, provided it has been completed according to instructions.
Substance Abuse During Pregnancy
1. Teratogenie drug effects are usually attributed to fetal drug exposure during organogénesis, a process that is usually completed in the fetus by:
A. End of first month of gestation.
B. End of second month of gestation.
C. End of first trimester of gestation.
D. Twenty weeks of gestation.
2. All of the following statements regarding drug abuse in pregnancy are true except;
A. Illicit drug use occurs in as many as one quarter of all pregnancies, although this figure varies among population groups.
B. There is a 20% risk of major birth defects with these pregnancies.
C. The two most common complications of maternal drug abuse during pregnancies are increases in spontaneous abortion and low birth weight.
D. Concurrent medical and socioeconomic problems complicate the interpretation of the majority of studies on these pregnancies.
3. Factors that can lead to adverse pregnancy outcomes in the drugabusing patient include all of the following except;
A. Direct damage to fetal cells from drug.
B. Poor maternal nutrition.
C. Abnormal placental function.
D. Increased risk of preeclampsia.
4. A true statement regarding drug abuse in pregnancy is that:
A. Majority of women in this country use no drugs of any kind while pregnant.
B. Cocaine is currently the most popular drug in the reproductive age group.
C. Narcotic withdrawal is best accomplished during the second trimester.
D. Known physiologic mechanisms explain most oí the adverse effects of drug abuse during pregnancy.
5. Routine management of the drugabusing pregnant woman should include:
A. Weekly nonstress tests beginning at approximately 32 weeks.
B. Monthly ultrasound examinations for anomalies and fetal growth measurements.
C. Hospitalizaron and detoxification.
D. Delivery no later than 40 weeks.
6. In determining whether a street drug is teratogenic, all of the following are true factors except:
A. Population is averse to taking drugs.
B. Drugs are of variable potency and purity.
C. Abusers neglect proper nutrition.
D. Abusers usually take more than one street drug at a time.
7. The pharmacologie mechanism of action that best characterizes cocaine is:
A. It binds to and activates alphaadrenergic receptors.
B. It binds to and activates betaadrenergic receptors.
C. It blocks active uptake of catecholamines and serotonin into nerve endings.
D. It induces the release of intracellular catecholamines and serotonin from nerves.
8. Production of genitourinary defects by prenatal administration of cocaine to pregnant mice is most likely due to:
A. Inhibition of sodium ion uptake in embryonic cells.
B. Vasoconstriction of uterine and/or embryonic-fetal circulation.
C. Inhibition of synthesis of cyclic adenylate kinase and protein kinase A.
D. Activation of neuronal dopamine pathways.
9. The consequences of cocaine abuse by pregnant mothers to their newborn children would least likely include:
C. Prune belly syndrome.
D. Cleft palate.
10. A true statement about women substance abusers is that:
A. Majority of women substance abusers were victims of childhood abuse.
B. A small but nonsignificant positive correlation exists between childhood abuse and adult substance abuse among women.
C. There is no correlation between childhood abuse and later patterns of substance abuse among women.
D. Substance abuse among women is correlated with birth order making younger children more vulnerable to addiction.
11. All of the following statements about crack cocaine are true except:
A. It is inexpensive and readily available.
B. It is one of the most addictive substances known.
C. There is a significant difference in its abuse rate between publicly and privately insured women.
D. It has become the abusive drug of choice for young poor women who have no other way to experience illusions of power and control.
12. All of the following reasons for substance abuse among pregnant women recently receiving widespread public attention are true except:
A. Advances in perinatal medicine in the past decade have improved survival rates of infants of drug-addicted women.
B. Alcohol use during pregnancy has been documented as a major cause of birth defects.
C. Impact of the epidemic of maternal substance abuse has resulted in widely reported strains on other systems that serve mothers and their infants.
D. Development of accurate and widely used measures of substance abuse during pregnancy has allowed physicians to reliably diagnose substance abuse among pregnant women.
1 3. Given the recent attention to the problems of substance abuse among women, which of the following statements is true?
A. Treatment programs that concentrate on breaking client's addiction rather than accepting responsibility for provision of a range of services, such as employment training, housing, and health care, have higher success rates
B, Because of fear of negative attitudes about addiction, substance-abusing women tend to identify related problems to health-care providers without stating that they are substance abusers.
C. Fear of prosecution has been shown to be an effective deterrent to drug use among pregnant women.
D. Providers of prenatal and substance abuse treatment programs continue to be very supportive (o these patients.
14. The incidence of fetal alcohol syndrome in the US is approximately:
A. 0.1 per 1000 live births.
B, 1 per 1000 live births.
C. 10 per 1000 live births.
D. 50 per 1000 live births.
15. In a well-documented national survey of physician-initiated court actions against pregnant women whose behaviors endangered their fetuses:
A. Prediction of fetal harm was 100% accurate.
B. None of the heads of fellowship programs in materna I -fetal medicine supported obtaining court orders.
C. All pregnant women in physicianinitialed court actions were white.
D. Court actions involved only the poor.
16. Studies have shown that drugdependent pregnant women:
A. Have no increased incidence of sexual abuse in their backgrounds when compared to nondrug-dependent pregnant women,
B. Have increased incidence of family violence and abuse in their backgrounds.
C. Rarely resort to prostitution to obtain drugs.
D. Favor prescription drugs as their main substance of abuse.
1 7. The AAP Committee on Substance Abuse recommends all of the following except:
A. Universal neonatal screening for illicit drugs.
B. Obtaining thorough maternal history.
C. Coordinated, multidisciplinary approach suited to each community's needs.
D. Supporting state child protective agencies and working with state social service agencies and legislatures.
1 8. No convincing data currently exist that narcotics exert a morphologic teratogenic effect.
19. The drug of choice for treating infants suffering from withdrawal of mothers using narcotics alone is:
A. Paregoric or denatured tincture of opium.
20. All of the following statements about cocaine abuse in pregnant women are true except:
A. It blocks norepinephrine uptake leading to cardiac stimulation of both mother and fetus.
B. It leads to decreased oxygen exchange in the placenta and increases the likelihood of placental bleeding and abruption.
C. It causes hypoxemia and subsequent vasospasm in the fetus leading to fetal distress and intrauterine growth retardation.
D. It leads to significant withdrawal symptoms in neonates as measured by the neonatal abstinence scale and clinical checklists.
ANSWERS TO THE JULY QUIZ ARRHYTHMIAS