Pediatric Annals

CME QUIZ

Abstract

INSTRUCTIONS

Pediatricians may receive three credit hours in Category I for the Physician's Recognition Award of the American Medical Association by reading the material m 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 |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.

CERTIFYING INSTITUTION

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

CME Quiz

Pulmonary Diseases

1. The most significant risk factor for the development of bronchopulmonary dysplasia (BPD) is:

A. Prematurity.

B. Infection.

C. Maternal smoking.

D. Mechanical ventilation.

2. All of the following statements about BPD are true except:

A. The incidence of BPD has not declined despite the widespread use of surfactant replacement therapy.

B. Oxygen requirement at 36 weeks postconceptual age correlates directly with long-term pulmonary morbidity.

C. Bronchopulmonary dysplasia is an unusual cause of chronic lung disease in children.

D. Processes involved in the pathophysiology include damage from oxygen toxicity, inflammation, fibrosis, and smooth muscle hypertrophy.

3. All of the following factors must be met before infants with BPD may be discharged from the newborn intensive care unit except:

A. Primary caregivers have demonstrated their ability to give all medication correctly.

B. The patient no longer requires supplemental oxygen.

C. A primary care pediatrician has been identified and has agreed to provide ongoing care for the patient.

D. All support services have been contacted and follow-up arranged.

4. The most effective method to reduce the frequency of BPD would be to:

A. Give surfactant to all premature infants.

B. Treat premature infants who have respiratory distress syndrome (RDS) with corticosteroids.

C. Use very high frequency ventilation and jet ventilation for prematures with RDS.

D. Reduce obstetrical risk factors related to premature delivery.

5. In diagnosing cystic fibrosis:

A. Sweat chloride assay…

INSTRUCTIONS

Pediatricians may receive three credit hours in Category I for the Physician's Recognition Award of the American Medical Association by reading the material m 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 |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.

CERTIFYING INSTITUTION

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

CME Quiz

Pulmonary Diseases

1. The most significant risk factor for the development of bronchopulmonary dysplasia (BPD) is:

A. Prematurity.

B. Infection.

C. Maternal smoking.

D. Mechanical ventilation.

2. All of the following statements about BPD are true except:

A. The incidence of BPD has not declined despite the widespread use of surfactant replacement therapy.

B. Oxygen requirement at 36 weeks postconceptual age correlates directly with long-term pulmonary morbidity.

C. Bronchopulmonary dysplasia is an unusual cause of chronic lung disease in children.

D. Processes involved in the pathophysiology include damage from oxygen toxicity, inflammation, fibrosis, and smooth muscle hypertrophy.

3. All of the following factors must be met before infants with BPD may be discharged from the newborn intensive care unit except:

A. Primary caregivers have demonstrated their ability to give all medication correctly.

B. The patient no longer requires supplemental oxygen.

C. A primary care pediatrician has been identified and has agreed to provide ongoing care for the patient.

D. All support services have been contacted and follow-up arranged.

4. The most effective method to reduce the frequency of BPD would be to:

A. Give surfactant to all premature infants.

B. Treat premature infants who have respiratory distress syndrome (RDS) with corticosteroids.

C. Use very high frequency ventilation and jet ventilation for prematures with RDS.

D. Reduce obstetrical risk factors related to premature delivery.

5. In diagnosing cystic fibrosis:

A. Sweat chloride assay has been replaced by genetic analysis as the primary tool for diagnosing cystic fibrosis.

B. Genetic testing for carriers with cystic fibrosis is available and routinely used in the general population.

C. Prenatal detection by genetic marker analysis is currently available for families with a prior affected child.

D. Neonatal detection of cystic fibrosis by dried blood spot analysis is not yet a practical technology.

6. The precise biochemical abnormality in cystic fibrosis:

A. Has yet to be clarified.

B. Results in defective transport of chloride ions across epithelium.

C. Has yet to be linked to the observed genetic defect.

D. Is currently readily responsive to pharmacological therapy.

7. Potential avenues for future treatments of cystic fibrosis include all of the following except:

A. Using respiratory viruses as vectors for inserting recombinant DNA into airway epithelial cells.

B. Using recombinant DNAse enzyme, currently commercially produced, to help liquefy respiratory secretions.

C. Stem cell isolation with extracorporeal gene modification, and reinsertion of the modified stem cells to correct the underlying defect.

D. Pharmacologic manipulation of existing chloride channels.

8. All of the following statements about cystic fibrosis are true except:

A. The lungs in newborns with cystic fibrosis are structurally abnormal at birth.

B. The locus for the cystic fibrosis mutation is on the long arm of chromosome 7.

C. Cystic fibrosis is inherited on an autosomal recessive basis, with 5% of the Caucasian population being carriers.

D. In utero obstruction of the pancreatic ducts results in pancreatic fibrosis in 85% of the cases.

9. All of the following groups currently are considered to be at increased risk for tuberculosis in the United States except:

A. Children exposed to adults with human immunodeficiency virus infection.

B. Foreign-born children from Southeast Asia.

C. Children living in rural counties.

D. Current or former residents of correctional institutions.

10. All of the following statements about multiple puncture tuberculin skin tests are true except:

A. They have both more false positives and more false negatives compared with the Mantoux skin test.

B. The dose of administered antigen cannot be controlled precisely.

C. They should never be used to test a child who has been exposed to a case of tuberculosis.

D. Applying the test will cause development of delayed hypersensitivity in the child.

11. All of the following children should be started on isoniazid preventive therapy except:

A. A newborn infant whose mother has isoniazid-susceptible pulmonary tuberculosis.

B. A newborn infant whose mother has a positive Mantoux tuberculin skin test, but neither she nor other members of the household have infectious tuberculosis.

C. A 1 -year-old child with an 8-mm reaction to a Mantoux tuberculin skin test whose father has pulmonary tuberculosis.

D. A 2-year-old child with a 1 9-mm reaction to a Mantoux tuberculin skin test, a negative chest radiograph, and a normal physical examination.

12. All of the following statements about the Mantoux tuberculin skin test using five tuberculin units of purified protein derivative are true except:

A. It continues to be the gold standard of tuberculosis testing.

B. For children with no risk factors, it is acceptable to use 1 5 mm as the cutoff point for a positive test.

C. In most children, tuberculin reactivity does not first appear until 3 to 8 weeks after initial infection.

D. About 60% of the positive cases in children occur in children 5 years of age or older.

13. In children referred for recurrent or persistent pneumonia in the United States, asthma was the only etiology found in about:

A. 60% of the cases.

B. 40% of the cases.

C. 20% of the cases.

D. 10% of the cases.

14. All of the following are consistent with the diagnosis of asthma except:

A. Digital clubbing.

B. family history of allergy, hay fever, or asthma.

C. Wheezes and crackles on chest auscultation.

D. Awakening from sleep, especially with coughing.

15. The diagnostic test likely to be of most value for a normally nourished 2-year-old child who has a persistent infiltrate of one lobe and a 5-year-old sibling who likes to feed him is:

A. Quantitative immunoglobulin concentrations.

B. Sweat chloride concentration.

C. Barium swallow for recurrent aspiration.

D. Rigid bronchoscopy for foreign body.

16. A child with recurrent infiltrates in the right middle lobe and lingula of the left upper lobe with scattered crackles and wheezes throughout both lung fields initially requires all of the following evaluations except:

A. Quantitative immunoglobulin concentrations.

B. Sweat chloride concentration.

C. Barium swallow for recurrent aspiration.

D. Rigid bronchoscopy for foreign body.

17. All of the following play important roles in the pathogenesis of asthma except:

A. Genetic factors.

B. Environmental exposure.

C. Decreased airway responsiveness to stimuli.

D. Airway inflammation.

18. The most dominant particulate matter to eliminate in the homes of asthmatic children is:

A. Cigarette smoke.

B. Cat and dog dander.

C. Dust mites.

D. Cockroaches.

19. A true statement about a child who normally has a peak flow rate of 250 IVm in and whose current peak flow rate is now 210 L/min is:

A. This value is within the child's "green" range. No further therapy is necessary at this time.

B. This value is in the child's "yellow" zone. The child's asthma is worsening and he or she needs additional asthma therapy now.

C. This value is in the child's "red" zone. He or she should come to the emergency room immediately.

D. This is an impossible number. The child should stop measuring peak flows at home.

20. Essential components of an asthma therapy plan must include all of the following except:

A. Continual patient and parent education.

B. In-off ice or emergency room evaluation for all respiratory illnesses.

C. Use of environmental controls.

D. Use of anti-inflammatory agents.

Answers to the June Quiz Ocular Infections

1. B

2. D

3. A

4. C

5. C

6. D

7. C

8. A

9. B

10. D

11. B

12. A

13. C

14. C

15. A

16. B

17. D

18. D

19. A

20. D

10.3928/0090-4481-19930901-10

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