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 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 $18 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 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.
Laparoscopy and Thoracoscopy
1. All of the following are significant risk factors for the development of cholelithiasis in Infants and children except:
A. Total parenteral nutrition.
C. Sickle cell disease.
D. Previous abdominal surgery.
2. The most likely cause for the increased cost of any laparoscopic procedure is:
A. Length of procedure.
B. Length of hospitalization.
C. The use of disposable equipment.
D. Anesthesia for the procedure.
3. The current recommended treatment for cholelithiasis in teenagers is:
A. Oral dissolution therapy.
B. Extracorporeal Shockwave lithotripsy.
D. Cholecystotomy and extraction of stones.
4. All of the following are advantages of laparoscopic cholecystectomy and laparoscopic appendectomy over an open surgical procedure except:
A. Reduced hospitalization time.
B. Less trauma, though more muscle disruption to abdomen.
C. Faster return to routine activities.
D. Decreased discomfort.
5. The age group at highest risk for the development of acute appendicitis remains:
A. Less than 10 years of age.
B. 10 to 19 years of age.
C. 20 to 30 years of age.
D. Over 30 years of age.
6. All of the following statements about laparoscopic appendectomy are true except:
A. If during a laparoscopic procedure a normal appendix is found, one should immediately convert to an open procedure.
B. If the appendix is found to be perforated at laparoscopy, the procedure can still be performed as long as the base of the appendix is still viable.
C. If during a laparoscopic procedure the anatomy is ill defined or the inflammatory reaction is too intense, one should convert to an open procedure.
D. Laparoscopy gives much better visualization for irrigating the abdomen with perforated appendicitis.
7. In comparing laparoscopic appendectomy to open appendectomy, all of the following are true except:
A. Infectious complications are similar following both laparoscopic and open appendectomies.
B. Hospital costs are comparable for both laparoscopic and open appendectomies.
C. Recovery from a laparoscopic appendectomy is quicker than from an open appendectomy.
D. A distinct disadvantage to the laparoscopic procedure is the inability to directly palpate the involved structure.
8. When the diagnosis of acute appendicitis in an ill child is initially uncertain, a laparoscopic approach rather than an open procedure offers the surgeon better visibility and a better opportunity to explore the abdomen.
9. Advantages of laparoscopic splenectomy over an open operation include all of the following except:
A. Less postoperative discomfort.
B. Less narcotic administration.
C. Less operative time.
D. Reduced ileus.
10. The major complication of splenectomy in children Is:
B. Postoperative prolonged ileus.
C. Chronic pulmonary atelectasis.
D. Postsplenectomy fulminating sepsis.
11. All of the following statements about laparoscopic splenectomy are true except:
A. Laparoscopic splenectomy appears to be a safe procedure for children.
B. At the time of laparoscopic splenectomy, a concomitant laparoscopic cholecystectomy should not be performed even if gallstones are noted on preoperative evaluation.
C. Pneumococcal and Hemophilus influenzae type b immunizations should be completed prior to elective splenectomy.
D. The spleen is removed from the peritoneal cavity using an endoscopic bag, and the tissue is morcellated into small pieces.
12. Indications for splenectomy In children include all of the following except:
A. Splenic trauma.
B. Chronic idiopathic thrombocytopenia purpura (ITP).
C. Sickle cell disease with recurrent splenic sequestration.
D. Hereditary spherocytosis with persistent anemia.
13. Which of the following statements is false?
A. The concept of routine bilateral inguinal hem torrhaphy was initiated in the 1 950s.
B. In most reports, physical examination can reliably predict a contralateral hernia.
C. Inguinal herniorrhaphy is the most common general surgical procedure performed by pediatric surgeons.
D. The incidence of a contralateral hernia on routine bttnd exploration is approximately 50%.
14. All of the following may account for the finding of a nonpalpable testis in a young boy except:
A. The testis may have undergone torsion during its descent into the scrotum.
B. There may have been improper development of the testis due to hormonal reasons.
C. There may have been a large hydrocele postpartum that occluded the testicular blood supply causing the testis to atrophy.
D. The testis may have descended into the lower abdominal cavity but not through the inguinal canal.
15. All of the following statements about nonpalpable testis in boys are true except:
A. Approximately 25% of boys with an undescended testis will have a gonad that is not palpable at all.
B. Diagnostic peritoneoscopy is a very helpful adjunct to plan the surgical management of a boy with a nonpalpable gonad.
C. Standard orchiopexy is usually not possible in boys with an intraabdominal testis.
D. The first stage of a two-stage Fowler-Stephens orchiopexy now can be performed laparoscopically with a secondstage standard orchiopexy performed 6 to 9 months later.
16. Advantages for exploration of the opposite side at the time of repair of a known inguinal hernia include all of the following except.
A. A large number of children will be found to have a contralateral hernia on blind contralateral exploration.
B. A second operation and associated anxiety will have been prevented.
C. The substantial increase in cost both to the family and third-party payers for a second operation will have been avoided.
D. There is less chance of injury to the vas deferens with routine bilateral exploration.
17. Thoracoscopy may be indicated for evaluation of all of the following except:
A. Isolated posterior lung lesion.
B. Recurrent pneumothorax.
C. Diffuse interstitial disease.
D. Penetrating trauma.
18. All of the following are advantages of thoracoscopy over open thoracotomy except.
A. Smaller, less painful incisions.
B. Decreased operative time.
C. Decreased blood loss.
D. Ability to use local anesthesia in small infants.
19. A contraindication for thoracoscopy Is:
A. Age younger than 2 years.
B. Complete pleural symphysis.
C. Posterior mediastinal lesions.
D. Previous thoracotomy.
20. Observed complications of thoracoscopy have included all of the following except.
A. Recurrent pneumothorax.
B. Tension pneumothorax.
C. Air or CO2 embolism.
D. Rib fracture.
Answers to the August Quiz Management of Febrile Infants and Children