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 $ 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 for 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 . By best current estimates, the number of children in the United States currently infected with human immunodeficiency virus type 1 (HIV-I) is:
A. Less than 5000 children.
B. 5000 to 10 000 children.
C. 10 000 to 20 000 children.
D. Greater than 25 000 children.
2. The largest pediatric group at risk of acquired immunodeficiency syndrome (AIDS) is:
A. Infants born to HIV-infected women.
B. Children who received infected blood products prior to 1 985.
C. Children who are victims of sexual abuse.
D. Adolescent drug users.
3. In the early 1990s, the greatest rate of increase of AIDS in American women and heterosexual men has occurred in the US regions of:
A. The East and West coasts.
B. The South and Midwest.
C. The Northeast and Southeast.
D. The Northeast and Southwest.
4. HIV transmission to infants and children has been reported by all of the following except:
B. Sexual abuse.
C. Intravenous drug use.
D. Transfusion of heat-mediated coagulation factors.
5. The most common AIDS-defining event in women is:
A. vaginal candidiasis.
B. Esophageal candidiasis.
D. Pneumocystis carinii pneumonia.
6. Currently, children over 2 years old at the time of acquiring HIV infection have a mean survival rate that is:
A. Shorter than that of perinatally infected children.
B. About the same as that of perinatally infected children.
C. Significantly longer than that of perinatally infected children.
7. Prenatal screening of women in high-risk categories, such as intravenous drug users, sexual partners of intravenous drug users, sexual partners of bisexual men, etc, will fail to identify as many as:
A. 10% of HIV-infected pregnant women.
B. 25% of HIV-infected pregnant women.
C. 50% of HIV-infected pregnant women.
D. 70% of HIV-infected pregnant women.
8. Of the following, the least predictor of a poor pregnancy outcome is:
A. Maternal drug use.
B. Maternal alcohol abuse.
C. Maternal tobacco abuse.
D. Maternal HIV infection.
9. Recent studies on twin pregnancies reveal the following:
A. The presenting twin is more likely to acquire HIV than the second twin.
B. Infants bom by cesarean section are more likely to acquire HIV than those bom by vaginal delivery.
C. The second-born twin is more likely to be infected than the first-bom twin.
D. Female twins are more likely to acquire HIV infection than males.
10. Maternal factors associated with increased risks of vertical HIV transmission include all of the following except:
B. Low CD4 lymphocyte counts.
C. Asymptomatic HIV infection.
D. Positive p24 antigenemia.
11. Based on recent prospective studies, the rate of vertical HIV transmission to infants born to HIV-infected women is:
A. Less than 30%.
B. 35% to 50%.
C. 51% to 67%.
D. Greater than 70%.
12. Clinical manifestations of H IV i nfection in children frequently include all of the following except:
A. Diabetes mellitus.
B. Failure to thrive.
C. Interstitial pneumonia.
D. Chronic/recurrent otitis media.
13. Clinical laboratory features of pediatric HIV infection frequently include all of the following except:
A. Elevated immunoglobulin levels.
C. Decreased CD4 + helper T-cells.
14. All of the following statements about HIV-infected children are true except:
A. A positive anti-HIV antibody test is a reliable indicator of HIV infection in a child over 2 years of age.
B. A positive anti-HIV antibody test is a reliable indicator of HIV infection in a newborn infant.
C. Up to 80% of anti-HIV antibodypositive newborn infants will eventually lose all signs of HIV Infection.
D. In the health-care setting, bloodcontaminated "sharps" comprise the greatest risk with regard to HIV transmission.
15. The major side effects of zidovudine (2DV) in children are:
A. Fever and weight loss.
B. Nausea and vomiting.
C. Anemia and neutropenia.
D. Pancreatitis and peripheral neuropathy.
16. All of the following are correct except:
A. Zidovudine and didanosine (DDI) are currently the only two antiretroviral agents approved by the Food and Drug Administration for use in children.
B. Both ZDV and DDI are approved as first-line therapy for both symptomatic and asymptomatic HIV-infected children and either can be used for initial management.
C. Zidovudine is well tolerated overall by pediatric patients, although up to one third may require dose reduction due to side effects.
D. Didanosine may be dosed every 12 hours due to its prolonged intracellular half-life.
17. The low prevalence of AIDS in adolescents (less than 1% of the total diagnoses to date) indicates that:
A. Adolescents are not being infected with HIV.
B. Sex education is working and most adolescents are now practicing safe sex.
C. The long latency period of HIV results in most HIV-infected adolescents not developing AIDS until young adulthood.
D. The sexual activity rate in adolescents has lowered over the past few years, thus preventing the spread of HIV.
18. Parents and teenagers both generally agree that:
A. Pediatricians should wait for teenagers to bring up the issues of sexuality or contraception before discussing them.
B. Pediatricians should only discuss sexuality and contraception with adolescents after obtaining parental permission.
C. Pediatricians should avoid discussions of contraception and sexuality because it will alienate parents and teens.
D. Pediatricians should routinely discuss sexuality and contraception with their adolescent patients.
19. All of the following are true about HIV testing procedures in adolescents except:
A. A positive HIV, ELISA, and confirmatory test should be repeated if the adolescent has no known risk factors for HIV.
B. In most states, adolescents over age 12 may consent to HIV testing.
C. Physicians may discuss HIV test results with parents without the adolescent patient's permission.
D. An indeterminate Western blot in lowrisk individuals may indicate a disease other than HIV
20. The initial medical evaluation of an adolescent who tests HP/ positive includes all of the following except:
A. A complete sexual and sexually transmitted disease history.
B. Update of immunizations including oral polio vaccine.
C. C D4 T lymphocyte count.
D. Purified protein derivative of tuberculin placement with controls.
Answers to the April Quiz Skin & Soft Tissue Infections