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 $ 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.
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
Traumatic Brain Injury
1. Following head trauma, physiologic measurement scales such as the Glasgow Coma Scale (GCS) and the Children's Orientation and Amnesia Test are clinically useful for correlation with both eventual prognosis and future outcome.
2. Following injuries of all types, the most comon reason for a visit of a young child to an emergency room is:
A. Burn-related injuries.
B. Water-related injuries.
C. Motor vehicle- related injuries.
D. Fall-related injuries.
3. Traumatic brain injury (TBI):
A. Is as common in females as males.
B. Accounts for as many as 75% of pediatric trauma deaths in trauma center case series.
C. Has a higher incidence in infants and toddlers than in older adolescents.
D. Is less common among poor children.
4. All of the following are true of fall-related injuries in children except:
A. Falls account for a greater proportion of TBI in preschoolers than in adolescents.
B. In toddlers, most serious brain injuries from falls occur from heights less than 10 feet.
C. Baby walkers offer no developmental advantage to children who use them, and their use should be discouraged.
D. Maximum safe height for playground equipment is approximately 5 feet.
5. Bicycle-related TBI:
A. Accounts for less than 10% of all hospitalized peditric head trauma.
B. Usually occurs only when bicycles collide with motor vehicles.
C. Is more common in adults than in children.
D. Can be decreased by as much as 88% through the use of helmets.
6. All of the following statements are true except:
A. Trauma continues to be the leading cause of death and disability among children in the United States today.
B. Children have a better chance of surviving any given brain injury than do adults.
C. Children have a better chance of recovery from any given brain injury than do adults.
D. The presence of a skull fracture is associated with an increased risk of intracranial injury.
7. Components of the GCS include all of the following except:
A. Verbal response.
B. Eye opening.
C. Social behavioral response.
D. Motor response.
8. The child who has a closed head injury:
A. Is protected from severe injury if the fontanelle and sutures are open.
B. Is more likely to have a subdural than an epidural hematoma.
C. Can have a severe injury and not show signs of increased intracranial pressure such as bradycardia-hypertension or papilledema.
D. Will always do better than an adult with the same injury.
9. All of the following are considered part of the early treatment of severe closed head injury except:
A. Surgical evacuation of hematomas.
B. Osmotic diuresis.
C. Hyperventilation to pC02 <35 torr.
D. Barbiturate-induced coma.
10. In a child suffering from "whiplash shaken infant syndrome," the finding considered nearly pathomnemonic of the diagnosis is:
A. Retinal hemorrhages.
B. Subdural hematoma.
C. Skull fracture in the child less than 1 year old.
D. Deep white matter shear injury.
11. All of the following statements about computed tomography (CT) in childhood head injury are true except:
A. Computed tomography is able to accurately indentify intracranial hematomas easily.
B. Computed tomography scanning is more sensitive than magnetic resonance imaging in predicting deep shear injuries of the brain and brainstem.
C. Computed tomography is readily able to define cerebral contusions and shifting of brain structures.
D. Computed tomography is likely the single most responbile factor for the recent improved outcome of pediatric head-injured patients.
12. Brain injury deficits having the greatest impact on social, educational, and vocational outcome in children are:
A. Expressive language problems.
B. Receptive language problems.
C. Fine motor impairments.
D. Cognitive impairments.
13. Of the following sequelae of TBI, the one expected to have the earliest onset is:
A. Diabetes insipidus.
C. Growth retardation.
14. The least useful indicator of TBI severity in predicting late outcome after TBI is:
A. Admission GCS.
B. Admission CT scan finding.
C. Length of time to following commands.
D. Duration of posttraumatic amnesia.
15. Current research findings on family functioning following childhood TBI indicate that:
A. Preinjury family functioning is a better predictor of family functioning after 1 year than is injury severity.
B. Families report significant changes in family relationships and coping resources regardless of injury severity.
C. Families who are controlling (rigid) are more likely to have positive adaptation in the year following injury.
D. Cohesiveness and expressiveness are not important characteristics of positive family adaptation.
16. All of the following statements of parent reactions during the critical and acute care periods following TBI in children are true except:
A. Families often feel confused and may experience a state of high anxiety in the emergency room following injury.
B. When children recover rapidly, families usually adjust quickly and are cooperative with staff.
C. Most families of severely injured children are appropriately realistic about the prognosis.
D. Limited options for parent participation foster parental feeling of ineffectiveness.
17. Which of the following statements is often true during the rehabilitation period and first year of community reentry following severe TBI in childhood?
A. When setbacks occur, parents may vent their anger and frustration on hospital staff.
B. Siblings experience few adjustment reactions during the injured child's hospitalization and community reentry.
C. Following a comprehensive inpatient rehabilitation program, families are usually well equipped to handle subsequent problems on their own.
D. Parents have little difficulty separating TBI-related symptoms from the child's normal developmental course.
18. The definition of TBI includes all of the following except:
A. Brain injury caused by an external force.
B. Brain injury induced by birth trauma.
C. Brain injury resulting in total or partial functional disability that adversely affects a child's educational performance.
D. Brain injury applying to both open or closed head injuries resulting in impairment of cognition, reasoning, judgment, and speech.
19. Characteristics of severe TBI include all of the following except:
A. An initial GCS score of 8 or less.
B. A coma duration of greater than 6 hours.
C. A period of posttraumatic amnesia of greater than 7 days.
D. No more of an association with permenent cognitive and behavioral problems than patients with moderate TBI.
20. Both at initial assessment and at follow-up at 1 year, increased severity of TBI has a direct relationship to the magnitude of impairment on almost all neurobehavioral and functional measurements.
Answers to the October Quiz Tuberculosis