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 questions in the quiz 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 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 $18 made out to PEDATRIC 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 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 1 for Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions.
1. The World Health Organization recently estimated the percentage of the world's population currently infected with Mycobacterium tuberculosis to be:
2. The most important factor in the resurgence of tuberculosis in the United States has been:
A. Poor housing.
B. Lack of access to health care.
D. Co-infection with human immunodeficiency virus (HIV).
3. The pediatric population at greatest risk for developing both mild and serious tuberculous disease is:
A. Children under 4 years of age.
B. Young schoolaged children 5 to 10 years of age.
C. Adolescents and young teenagers.
D. Older teenagers and college-aged students.
4. A sentinel health care event signifying ongoing transmission of tuberculosis in a community is:
A. A case of tuberculosis in an adult.
B. A case of tuberculosis in a child.
C. A case of tuberculosis in a foreignborn person.
D. Increasing case rates, overall.
5. The presence of tuberculous disease in an individual means: A. Positive tuberculin skin test only.
B. The presence of signs and symptoms of tuberculous illness.
C. Latent infection with mycobacteria.
D. Positive sputum culture.
6. Tuberculosis may be transmitted by all of the following except:
A. Young children with tuberculosis.
B. Airborne droplet nuclei from an infectious adult.
C. A physician with pulmonary tuberculosis who is not on treatment.
D. An adult patient in the hospital with drug-resistant pulmonary tuberculosis.
7 . The most effective method of finding children with tuberculosis is:
A. A thorough skin testing program in the public schools.
B. Associate investigation of the contacts of infected individuals.
C. Contact investigation of infectious adult cases.
D. Evaluation of children with symptoms of tuberculosis.
8. All of the following statements about prevention and public health aspects of tuberculosis in children are true except:
A. Infection occurs when a susceptible child inhales Mycobacterium organisms into his or her lungs.
B. Most public health laws require thatl physicians report tuberculosis at the earliest suspicion of disease.
C. Patient adherence to a recommended treatment regimen is the major barrier to the control and elimination of tuberculosis in the United States today.
D. BCG vaccination is currently recommended for health-care workers in high-risk areas of the United States.
9. A child with a positive Mantoux tuberculin skin test reaction, a normal chest radiograph and a normal physical examination has:
A. Tuberculous disease.
C. Tuberculous infection.
D. Pulmonary tuberculosis.
10. A properly applied Mantoux tu-l berculin skin test is now considered positive by:
A. A 4-mm reaction in a low-risk child.
B. A 7-mm reaction in a child whose father has pulmonary tuberculosis.
C. An 8-mm reaction in a healthy child born in Mexico.
D. A 7-mm reaction in a 13 year old who received BCG vaccine in Ecuador.
11. The most potent argument! against mass skin testing of children at low risk for tuberculosis is:
B. Inaccuracy of the test in low-risk populations.
C. Adverse reactions to the test.
D. Lack of availability of skin test materials.
12. The risk of developing active tu-| berculous disease in a person c« infected with Mycobacterium tubercu^ losis and HIV is approximately:
A. 10% to 20% over a lifetime.
B. 2% per year.
C. 10% per year.
D. 20% per year.
13. In children with pulmonary! tuberculosis, cavity formation is most commonly associated with:
A. Asymptomatic primary tuberculosis.
B. Chronic pulmonary tuberculosis.
C. Progressive primary pulmonary tuber-| culosis.
D. Miliary tuberculosis.
14. The most common consequence of hilar lymphadenopathy in children] is:
A. Superior vena cava syndrome.
D. Bronchial obstruction.
15. All of the following statements regarding children with miliary tuberculosis are true except:
A. Chest roentgenography reveals a diffuse distribution of tuberculosis over the entire lung fields.
B. Choroidal tubercles on ophthalmic examination are seen in some patients.
C. The severity of the presentation is often dependent upon the number of tubercle bacilli discharged into the blood.
D. Tuberculous meningitis is not commonly associated with miliary disease.
16. AJI of the following statements regarding tuberculous meningitis are true except:
A. Onset of tuberculous meningitis is slow, usually over a 3- to 4-month period after an asymptomatic primary infection.
B. It is the most common cause of death in children with tuberculosis.
C. Children do not develop neurologic findings until stage 2 disease.
D. Patients in stage 3 disease have evidence of severe extensive cerebral dysfunction.
17. The current recommended treatment of pulmonary tuberculosis in children is:
A. Two months of isoniazid, rifampin, and pyrazinamide followed by 4 months of isoniazid and rifampin.
B. Three months of isoniazid, rifampin, and streptomycin followed by 9 months of isoniazid and pyrazinamide.
C. Three months of isoniazid, rifampin, and ethambutol followed by 3 months of isoniazid and rifampin.
D. One year of isoniazid and rifampin.
18. Drug-resistant tuberculosis in children:
A. ls not a problem in the United States.
B. Can be treated with the same regimen as drug-susceptible tuberculosis, but for a longer period of time.
C. Should always be considered if the children being treated are living with adults who have immigrated from highrisk regions.
D. Should be treated with multiple-drug therapy, plus corticosteroids for a 3month period.
19. All of the following statements about therapy for children with tuberculous disease are true except:
A. Unlike adults, children do not typically develop cavitary lesions as part of the primary infection.
B. Isoniazid is the most widely used and most ideal antituberculous medication.
C. Corticosteroid therapy has been demonstrated to decrease both mortality rates and long-term neurologic sequelae in patients with tuberculous meningitis.
D. A normal chest radiograph is a necessary criteria for stopping therapy in children with pulmonary tuberculosis.
20. All of the following statements regarding patient adherence to therapy are true except:
A. The major problem with long-term drug therapy of any type is adherence to the treatment plan.
B. Routine follow-up appointments are not required in childhood tuberculosis.
C. The local health department should be notified and become involved with patients who do not adhere to therapy.
D. Directly observed therapy should be encouraged in most cases.
Answers to the July Quiz AIDS