Pediatricians may receive three credit hours in Category 1 for the Physician's Recognición 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 guestion. 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 al/ 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 ¿in organization accredited for continuing medical education, the Lenox Hill Hospital of New York designates this continuing medical education activity as meeting the entena for three credit hours in Category 1 for Educational Materials For the Physicians Recognition Award of the American Medical Association, provided it has been completed according to instructions
Infection Related to Day-Care Attendance
1 . Acute respiratory illnesses in preschool children:
A. Rarefy result in a physician contact regarding the illness.
B. Are usually caused by respiratory viruses.
C. Rarely cause complications involving the middle ears or lower respiratory tract.
D. Are less frequent among young children in a group day care than in home care.
2. The most common and important viral causes of acute respiratory illness in children in day-care settings are:
A. Rhinoviruses, respiratory syncytial virus, and parainfluenza viruses.
B. Coronaviruses, ente rovi ruses, and influenza viruses.
C. Adenoviruses, influenza viruses, and respiratory syncytia! virus.
D. Adenoviruses, coronavi ruses, and ente rovi ruses.
3. Children in a group day-care setting when compared to children in home care will experience:
A. Fewer episodes of otitis media and need for myringotomy and tube placement.
B. The same number of hospitalizations for lower respiratory illnesses.
C- Respiratory illnesses of shorter duration and of less consequence.
D. More respiratory illnesses with longer duration and more complications.
4. Which of the following possible methods of controlling respiratory illnesses in day-care settings is not practical?
A. Education and monitoring programs for personnel about hygienic practices.
B. Discourage admission to group day care of infants younger than 6 months old during the respiratory disease season.
C. Limit contact of infants with toddlers.
D. Exclude all children with new respiratory illnesses.
5. Children who attend group day care are at increased risk of Hib infections because:
A. Unlike other children, children in group day care sometimes are asymptomatic carriers oí Hib.
B. Children in group day care are more likely to be exposed to Hib.
C. Many children in day-care centers are in diapers, which increases the risk of hand-to-mouth transmission of infection.
D. Adult staff members are likely to transmit Hib to the children.
6. Chemopropnylaxis for close contacts of a patient with invasive Hib infection:
A. Is designed to treat incubating infection in susceptible individuals.
B. Is designed to eliminate colonization in the entire group, thus preventing susceptible individuals from being exposed to the organism.
C Is effective in preventing primary Hib infections.
D. Is unnecessary if the index patient does not have meningitis,
7. The main difference in the epidemiology of meningococcal infections compared to Hib infections is that:
A. Meningococcal infections are usually less severe.
B The risk of primary meningococcal infection is greater than the risk.
C Older children and adults are at risk of Hib infections.
D. Older children and adults are at risk of meningococcal infections.
8. The most effective method to prevent Hib infections in all infant care settings is active vaccination of infants at the earliest recommended age (ie, beginning at 2 months).
9. Otitis media:
A. Is more common in children who attend group day care because of the high frequency of viral respiratory infections in that setting.
B. Can effectively be prevented by prophylaxis with rifampin.
C. Is usually caused by Haemophilus influenza b infection.
D. Is often acquired through person-toperson transmission.
10. After acquisition of cytomegalovirus (CMVJ, preschool-aged children will:
A. Usually have a febrile illness with pharyngitis.
B. Develop characteristic skin lesions.
C. Shed virus in urine for years.
D. Be able to infect others for only 2 to 3 months.
1 1 . Initial acquisition of CMV during pregnancy usually results in:
A. Maternal mononucleosis syndrome.
B. CMV infection of the fetus.
C. Birth of a premature infant.
D. Birth o1 a healthy appearing newborn.
12. All of the following statements regarding control of CMV and parvovirus in day-care centers are true except:
A. Exposure to children shedding CMV virus is inevitable for day-care center workers.
B. The greatest risk of transmitting parvovirus B1 9 occurs prior to the onset of disease symptoms.
C. A vaccine is currently available for CMV but not for parvovirus B19.
D. Testing female day-care workers for antibody to CMV can be very valuable for those women who could become pregnant, as those who test seropositive can be strongly reassured.
13. True statements about the five distinct viruses causing viral hepatitis in children and adults include all of the following except:
A. Hepatitis types A and E are enterically transmitted viruses.
B. Hepatitis types C, D, and E are predominantly transmitted through percutaneous exposure to blood and by sexual contacts.
C. Hepatitis B outbreaks are the most important type of hepatitis observed in day-care settings.
D. Hepatitis types C and D occur primarily in adults, and transmission has not been documented in day-care sellings.
14. Day-care center outbreaks of hepatitis A are most often recognized when:
A. Clinical cases of hepatitis A occur among child attendees.
B. Clinical cases of hepatitis A occur among center staff.
C. Clinical cases of hepatitis A occur among adult family members of child attendees.
D. Increased rates of hepatitis A are observed in the community where day-care centers are located.
15. Immune globulin should be given to all children and staff at a day-care center that has children in diapers if:
A. A child in diapers at the center is diagnosed with hepatitis A.
B. A family member of an IgM anti-HAV negative child attendee is diagnosed with hepatitis A.
C. An older child at the center not in diapers is diagnosed with hepatitis A.
D. An employee at the center acquires hepatitis A while traveling abroad.
16. All of the following are aspects of control of HBV transmission in daycare centers except:
A. Hepatitis B screening of potential attendees.
B. Making provisions that toothbrushes are not shared.
C. Cleansing of blood-contaminated surfaces wilh dilute bleach solution.
D. Future universal immunization of ail children in the United Slates with hepatitis B vaccine as a routine childhood immunization.
1 7. The percentage of diarrhea! ill· nesses in children younger than 3 years of age who attend day care that can be attributed to acquisition of the infection at the day-care setting is:
A. Less than 25%.
1 8. The incidence of diarrhea! disease among children attending day care:
A. Is significantly greater among preschool-aged children than among infants.
B. Is, at all ages, not significantly higher than among children in home care.
C. Is significantly greater among children in the first 4 weeks after enrollment in care than in subsequent weeks.
D. Can only be minimally affected by a policy of frequent handwashing by staff and children.
19. AJI of the following statements about enteric infections associated with child day care are true except:
A. Asymptomatic infections are common.
B. Enteric infections in day care may be of viral, bacterial, or parasitic etiology.
C. Enteric infections in day care are usually transmitted person to person.
D. Enteric infections in day care tend to cause moderate to severe disease and usually require specific therapy.
20. Accepted recommended measures to prevent or control enteric infection in day-care settings include all of the following except:
A. Having written policies for managing illness, practicing hygiene, and maintaining environmental sanitation.
B. Removal of asymptomatic carriers during an outbreak.
C. Frequent washing of staff and children's hands.
D. Daily cleaning of frequently handled toys and diaper changing areas.
ANSWERS TO THE MAY QUIZ BEHAVIORAL PEDIATRICS