Pediatricians may receive three credit hours in Category I for the Physician's Recognition Award of the American Medical Association by reading the material in this issue and successful/y 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, ¿is 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. Retama 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 08080.
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 an organization a r credi ted for continuing medical educalion, the Lenox Hill Hospital of New York designates this continuing medical education activity as meeting the entena for three credit hours in Category I tor Educational Matertals tor the Physician's Recognition Aw.-ird of the American Medical Association, provided it has been completed according Io instructions
CME Quiz Thyroid Disease
1. Congenital hypothyroidism:
A. Can be easily detected by clinical symptoms.
B. Often leads to severe mental retardation, even when the treatment is started within the first three weeks of life.
C. Is diagnosed reliably only by newborn screening programs.
D. Is confirmed by thyroid ultrasound.
2. The greatest problem in newborn screening programs to identify congenital hypothyroidism is:
A. Poor precision and sensitivity of TSH assays.
B. Too many specimens for regional laboratories to handle in order to obtain accurate results.
C. Poor quality of the filter paper that is used for screening.
D. Delay from the time the infant is born until the time the affected infant is treated.
3. All of the following are true statements about the epidemiology of hypothyroidism except:
A. The incidence of congential hypothyroidism detected by newborn screening programs is 1 :3000-4000.
B. The incidence of transient hypothyroidism is 1:2000.
C. Sporadic congenital hypothyroidism is more frequent in girls than boys.
D. The most frequent cause for congenital hypothyroidism world-wide continues to be iodine deficiency.
4. The most frequent cause for permanent congenital hypothyroidism is:
A. Maternal antithyroid drugs.
B. Iodine excess.
D. Thyroid dysgenesis.
5. Transient congenital hypothyroidism is caused by:
A. Maternal use of povidone iodine for vaginal douches.
B. TSH or TRH deficiency.
C. Ectopie thyroid glands.
6. All of the following statements regarding the fetal thyroid development are true except:
A. Iodine organisation starts within the fetal thyroid gland between the 10th and 12th week of gestation.
B. Fetal T4 levels are low until about week 20 of gestation and then increase throughout the latter half of gestation.
C. TSH levels are very low during the first 20 weeks of gestation and then increase throughout the latter half of gestation.
D. T4 is able to cross the placenta in limited amounts.
7. The recommended drug and initial dosage for treatment of newborn* with congenital hypothyroidism is:
A. Triiodothyronine 20 µg/m2/day.
B. Potassium iodide 1 drop/kg/day.
C. TRH 200 µg/day.
D. L-thyroxine 10-15 µg/kg/day.
8. A common clinical presentation of chronic lymphocytic thryoiditis in children is:
A. Asymptomatic goiter.
B. Painful swelling in the neck.
9. The laboratory features diagnostic of compensated hypothyroidism are:
A. Low serum T4, elevated TSH concentration.
B. Low serum T4, normal TSH concentration.
C. Normal serum T4, elevated TSH concentration.
D. Elevated serum T4, subnormal TSH concentration.
10. All of the following statements about chronic lymphocytic thryoiditis (CLT) are true except:
A. During childhood, CLT most commonly affects adolescent females.
B. A family history of some type of thyroid disorder has been reported in greater than 50% of affected children.
C. CLT is uncommon before 3 years of age.
D. Both immunologie and environmental factors may play a role in the development of CLT in pediatrie patients.
1 1 . Chronic lymphocytic thyroiditis is seen with a higher frequency in all of the following disorders except:
A. Type Il polyglandular syndrome (Schmidt's syndrome).
B. Prader-Willi syndrome.
C. Turner syndrome.
D. Down syndrome.
12. All of the following statements about thyrotoxicosis during the first two decades of life are true except:
A. This disorder is relatively uncommon in childhood and adolescence.
B. It is usually not a difficult disease to diagnose.
C. It is usually not a difficult disease to manage.
D. The cause of the disorder is usuaily autoimmune.
13. All of the following clinical symptoms and signs are usually present in children with Graves' disease and thyrotoxicosis except:
A. Narrow pulse pressure.
D. Disturbed sleeping habits.
14. AH of the following are true statementx about childhood thyrotoxicosis except:
A. Autoimmune thyrotoxicosis (Graves' disease) is the most common cause in childhood.
B. Greater than 90% ot children with Graves' disease have exophthalmos.
C. Goiter, or thromegaly, is almost invariably present in children with untreated Graves' disease who are clinically thyrotoxic.
D. In otherwise healthy children with thryotox icosts, the total T3 will be increased.
15. The serum thyroid function test that is the first to become abnormal in a child with symptoms suggestive of thryotoxicosis is:
B. Free thyroxine.
16. Thyromegaly occurs in each of the following clinical causes of thyrotoxicosis except.
A. Thyrotoxic phase of Hashimoto's (chronic lymphocytic) thyroiditis.
B. TSH-secreting pituitary adenoma.
C. Graves' disease, active, untreated.
D. Ingestion of beef that is contaminated with thyroid gland tissue.
17. The most common cause of a solitary thyroid nodule in a child is:
A. Follicular adenoma.
D. Chronic fymphocytic thyroiditis.
18. The highest incidence of thyroid carcinoma occurs in a:
A. Hot toxic nodule.
B. Cold solid nodule.
C. Cystic nodule.
D. Hot nontoxic nodule.
19. Medullary thyroid carcinoma may occur in association with all of the following except:
B. Multiple mucosal neuromas.
D. Congenital heart disease.
20. All of the following have been used extensively in the therapy of thyroid cancer in pediatrie patients except:
C. Thyroid hormone replacement.
D. Radioactive iodine.
ANSWERS TO THE OCTOBER QUIZ SUBSTANCEABUSE DURING PREGNANCY