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 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, 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 mall 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 tis 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.
CME Quiz Immunization Update
1. The US record for age-appropriate immunization of children by age 2 years remains one of the best in the world.
2. The Children's Vaccine Initiative (CVI) alms to:
A. Increase the number of doses required for infant immunization.
B. Continue the use of pertussis wholecell vaccine.
C. Decrease the use of heat-stable vaccines.
D. Add new vaccines to prevent acute respiratory and enteric infections.
3. All of the following new vaccines are close to Imminent availability in 1994 except:
D. Hepatitis A.
4. All of the following statements regarding combination vaccines are true except:
A. Diphtheria/tetanus toxoids/pertussis (DTP) with Hemophilus influenzae, type b conjugate is currently licensed in this country.
B. A potential live virus combination would add varicella-zoster virus to measles, mumps, rubella (MMR)- resulting in an MMR tetravalent.
C. DTP is the "core" trivalent product to which other inactivated antigens will be added.
D. A potential live virus combination would add respiratory syncytial virus (RSV) to current trivalent polio vaccine.
5. The most frequently named vaccine in cases previously filed under the Vaccine Injury Compensation Program Is:
A. Pertussis vaccine,
B. Oral polio vaccine (OPV).
C. Rubella vaccine.
D. Hemophilus influenzae, type b vaccine.
6. Basic Immunizations included In the Expanded Program on Immunizations (EPI) of the World Health Organization Include all of the following except:
A. OPV trivalent.
C. Hemophilus influenzae, type B.
D. Measles monovalent.
7. All of the following statements about herpes simplex virus (HSV) Infections and vaccine development are true except:
A. Over 100 million individuals in the United States alone are infected by HSV-1.
B. A unique biologic property of HSV is its ability to recur in the presence of humoral antibodies.
C. Overt clinical recurrences are apparent in more than 50% of individuals infected by HSV.
D. By preventing the primary infection, an ideal HSV vaccine also should prevent the colonization on sensory ganglion.
8. The currently accepted approach to the development of an HSV vaccine includes the use of:
A. Wild-type virus vaccine.
B. Live virus vaccine.
C. Inactivated virus vaccine.
D. Killed virus vaccine.
9. All of the following statements about infants with RSV Infection are true except:
A. Approximately 3% to 4% of all infants bom in the United States will be hospitalized with RSV infection in the first year of life.
B. RSV infection is a substantial cause of infant morbidity with some definite mortality, not only in the United States but also in all geographic and climatic regions of the world.
C. Mortality rates exceed 3% in infants with underlying heart or lung disease, even with the best supportive care.
D. Once RSV infection occurs in previously healthy children, there is fairly little that practitioners can offer in terms of treatment.
10. The proportion of all Infants growing up In developed countries that have acquired RSV Infection by 2 years of age Is approximately:
A. One quarter (25%).
B. One half (50%).
C. Two thirds (67%).
D. Nearly all (greater than 90%).
11. Each of the following statements concerning potential Ihre attenuated RSV vaccine is true except:
A. Live attenuated strains produced poor antibody responses in individuals who were seropositive for RSV.
B. Attenuated RSV vaccines induced rhinitis and otitis media in many individuals who were initially seronegative for RSV.
C. RSV attenuated vaccines induced wheezing in both initially seropositive and seronegative infants.
D. A minor fraction of temperaturesensitive RSV vaccine strains reverted to temperature insensitivity following infection.
12. The component of the human Immune system that appears to correlate best with protection against RSV Infection Is:
A. Neutralizing antibody in serum.
B. Antibody present in respiratory secretions.
C. Cell-mediated immunity.
D. Antifusion antibody present in serum or secretions.
13. All of the following characteristics pertain to the live typhoid vaccine TY21a except:
A. It has specific, molecularly engineered, deletion mutations.
B. It is an attenuated, oral vaccine.
C. The recommended schedule of administration is one dose every other day for three to four doses.
D. Its duration of efficacy is approximately 3 years.
14. All of the following statements concerning the typhoid vaccine Vl polysaccharlde are true except:
A. It is a parenteral, single-dose immunization.
B. It is well tolerated.
C. Vi polysaccharide is a virulencerelated antigen found on the surface of Salmonella typhi.
D. Multiple field trials have yielded a vaccine efficacy of 95% with a duration of efficacy lasting 3 years.
15. Atrue statement with respect to vaccines against cholera is:
A. The inactivated whole-cell parenteral vaccine confers high levels of protection (approximately 75%) to young children less than 5 years of age.
B. The inactivated whole-cell oral vaccine exclusively consists of Vibriocholerae01 El Tor Ogawa in combination with the B subunit of cholera toxin.
C. CVD 103-HgR is an oral, single-dose, attenuated vaccine candidate that has proven to be both safe and highly immunogenic in all settings.
D. CVD 103-HgR has a recommended administration schedule of one dose every other day for three to four doses.
16. Several candidate vaccines against SMgella Sonnet and enterotoxigenic Escherlchla coll (ETECJ are now In clinical trial.
17. Risk factors for early-onsetgroup B streptococcal (GBS) infections in the newborn Include all of the following except:
A. Maternal labor prior to 37 weeks gestation.
B. Maternal diabetes.
C. Maternal rupture of membranes greater than 20 hours.
D. Maternal choiroamnionitis infection.
18. Individuals who might benefit directly from a vaccine to prevent group B streptococcal infection Include all except:
A. Newborn infants.
B. School-aged children.
C. Pregnant women.
D. Immunocompromised adults.
19. Immunogenicity of group B streptococcal polysaccharldes has been Improved In animal testing by which of the following:
A. Increasing the dose given.
B. Providing booster doses of vaccine.
C. Conjugating the polysaccharide to tetanus toxoid.
D. Elongating the polysaccharide chain length.
20. The feasibility of preventing group B streptococcal Infections by vaccine development Is dependent on which of the following assumptions:
A. Sufficient IgG antibody directed to capsular polysaccharides of group B streptococci is protective.
B. IgM antibodies to capsular polysaccharide antigens will confer protection to newborn infants.
C. Vaccine will prevent early - but nof late - onset infections.
D. A vaccine using group B antigen might prevent infection from all group B streptococcal serotypes.
Answers to the September Quiz Pulmonary Diseases