Pediatricians may receive three credit hours in Category 1 for the Physician's Recognition Award of the American Medical Association by reading the materiai 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, MJ 08086.
5. Your answers will be graded, and you will De 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 mate rial 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 Lenox 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.
1. The term cyberphysiology is derived from the Greek word Kybernan meaning to steer or take the helm.
2. Applications of cyberphyslologic strategies in pediatrics include all of the following except:
A. helping the child to cope with anxiety over procedures.
B. controlling habit problems.
C. helping A.D.D. children to academically perform better in school.
D. controlling pain in chronic illness.
3. The success rate of hypnosis in controlling procedural pain in children is reported to be about:
D. greater than 90%
4. Current research indicates that:
A. peripheral endorphin levels are high in subjects under hypnosis.
B. decreasing anxiety is the sole mechanism through which hypnosis exerts its analgesic effect.
C. using diazepam decreases pain perception in laboratory settings.
D. Naloxone does not interfere with hypnoanalgesia.
5. All of the following are factors in the effectiveness of hypnoanalgesia in children except:
B. emotional significance of pain.
C. medication use.
D. attitude of medical staff towards hypnosis.
6. The types of biofeedback used most frequently in pediatrie settings are:
A. electomyographic (EMG) and electroencephalographic(EEG)feedback.
B. electromyographic (EMG) and peripheral temperature feedback.
C. Galvanic Skin Response (GSR) and peripheral temperature biofeedback.
D. Galvanic Skin Response (GSR) and electromyographic (EMG) biofeedback.
7. EMG biofeedback units accomplish all of the following except:
A. measure the amount of electrical discharge in muscle fibers.
B. transform the raw EMG signal into more meaningful information through use of integration techniques.
C. provide a biofeedback signal that is inversely proportional to the amount of electrical activity in the monitored muscle group.
8. The underlying mechanism of biofeedback training is now specifically known.
9. All of the following statements about biofeedback treatment practice programs are true except:
A. most treatment programs employ 4 to 12 biofeedback sessions of 30 to 60 minutes each.
B. after several EMG training sessions, most children and adolescents are comfortably able to provide fairly accurate EMG potentials on command without feedback.
C. the child or adolescent and not the parents must be the focus of training efforts.
D. home practice is not usually an important factor to treatment success.
10. The best substantiated specific indication for pediatrie biofeedback training with subsequent excellent results is:
A. migraine headaches.
B. fecal incontinence.
D. Raynaud's disease.
11. Before teaching self-hypnosis to a child for the treatment of a habit disorder, the clinician should particularly be sure that:
A. the family is disturbed and frustrated by the habit problem.
B. the classroom milieu is disrupted by the child's habit behavior.
C. the habit is causing physical problems in the child.
D. the child is unhappy enough with the habit that he or she is motivated towards working to change the habit.
12. All of the following are true statements about self-hypnosis for habit problems except:
A. while self-hypnosis is often effective in relieving a specific habit problem, it does not build a strong sense of personal self control for the child.
B. self-hypnosis is most effective when parents let children know that they believe the child is capable of making the change without their assistance.
C. since habits are largely unconscious phenomena, techniques like selfhypnosis that utilize the unconscious tend to be successful.
D. most habits can be easily managed with self-hypnosis even if the original reason for the habit is unknown.
13. Success in management of habit problems with self-hypnosis depends on all of the following except:
A. willingness of parents to allow the child to take control of the problem and of the self-hypnosis practice.
B. motivation of the child to give up the habit.
C. willingness of the child to practice self-hypnosis at home.
D. willingness of siblings, friends, and classmates to stop teasing the child about the habit.
14. All of the following problems can be thought of as habits or habitlike problems for the purpose of teaching and applying self-hypnosis techniques except:
A. trichotillomania hair twirling and pulling out).
B. nail biting.
15. Childhood habit problems are usually a reflection of deep-seeded and/or long-ago ingrained habituated emotional problems.
16. Habit problems in children:
A. are uncommon.
B. are not necessarily undesirable.
C. rapid shifts from one cognitive state to another.
D. frequently conlribute to difficulties with self esteem and happiness.
17. Preschooler characteristics that can be adapted to coping with medical procedures include all of the following except:
A. the tendency to live in the present.
B. concrete thinking,
C. rapid shifts from one cognitive state to another.
D. short attention span.
18. Components of imagination in young children that can be adapted to increasing comfort through a procedure include all of the following except:
C. auditory imagery.
D. ability to sustain clearly defined imagery.
19. Parents may help young children tolerate procedures more comfortably by:
A. telling the child to be very brave and reassuring the child in a stern voice that the procedure is not going to hurt.
B. reading a story to the child from a place in the room out of the child's sight.
C. talking with the child about what they will do when the procedure is completed while gently stroking the child's head and neck,
D. being in the waiting room during the procedure.
2O. Medical intervention with a preschool child rarely offers the opportunity for the clinician to be inventive, spontaneous, or playful.
ANSWERS TO THE DECEMBER QUIZ IMMUNIZATION UPDATE