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 (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.
Sexually Transmitted Diseases
1. A pregnant mother with untreated syphilis in the primary or secondary stage has approximately what percentage chance of infecting her newborn?
A. Near 50%.
B. Near 67%.
C. Near 85%.
D. Near 100%.
2. The RPR (rapid plasma reagin) test is a:
A. Treponemal test.
B. Nontreponemal test.
C. Direct visualization test.
D. Fluorescent antibody test.
3. Acquired syphilis in children is:
A. Usually transmitted by casual contact with adults.
B. Always associated with an easily identifiable chancre.
C. Usually a late manifestation of congenital syphilis.
D. Usually transmitted by sexual abuse.
4. All of the following statements about syphilis in infants and young children are true except.
A. Neither treponemal antigen tests nor antitreponemal antigen tests are specific for syphilis or completely sensitive.
B. Snuffles usually appear in the first week of life, but can occur as late as 3 months.
C. Radiographs are helpful in differentiating late congenital syphilis from acquired syphilis.
D. The most common finding seen with late congenital syphilis is interstitial keratitis.
5. Specific identification of Nelsseira gonorrhoeae is made by:
A. An appropriate and accurate Gram stain.
B. A rapid test such as a deoxyribonucleic acid (DNA) probe or an enzyme immunoassay test.
C. Culture, Gram stain, and oxidase positivity.
D. Culture, colony morphology, Gram stain, and oxidase positivity followed by two tests that involve different principles.
6. Unless the child is allergic to the antibiotic, gonococcal infections in children should be treated with:
7. The most common gonococcal infection in children is:
8. If a child has gonococcal vaginitis:
A. She should be treated without further cultures.
B. She will always have a vaginal discharge.
C. Oropharyngeal and rectal gonococcal cultures should always be obtained before treatment.
D. The gonococcal isolate need not be saved for confirmation.
9. Chlamydia trachomatis has been implicated as a cause of all the following except:
A. Neonatal conjunctivitis.
B. Neonatal hepatitis.
C. Infantile pneumonia.
D. Asymptomatic rectal and vaginal infection in infants.
10. Infants acquire C trachomatis infection:
A. Vertically from mother at delivery.
B. By respiratory droplets from other infants.
C. Horizontally from mother after birth.
D. Horizontally from other family members or contacts after birth.
11. In evaluating a 3-year-old girl for suspected sexual abuse, C trachomatis is isolated from a vaginal culture. The child may have acquired the infection:
A. From her mother at delivery.
B. By sexual contact.
C. Both of the above.
12. All of the following statements regarding anogenital human papillomavirus (HPV) infection in children are true except.
A. Type 2 always indicates "innocent" or nonsexual transmission.
B. Types 6 and 11 are found in the majority of childhood condyloma acuminata.
C. Types 16 and 18 may lead to anogenital cancers.
D. Viral typing is not helpful in documenting the mode of transmission of the virus.
13. Transmission of HPV to children:
A. Can occur through sexual abuse.
B. Is always vertically transmitted in children younger than 2 years of age.
C. Has been proven to be transmitted on contaminated objects.
D. Has a fixed latency period from inoculation to development of lesions.
14. In evaluating a child with condyloma acuminata:
A. Biopsy should always be done to confirm the diagnosis.
B. Viral typing should be performed in all circumstances to confirm the presence of nononcogenic type.
C. The lesions may be confused with molluscum contagiosum in the anogenital area.
D. Screening for other sexually transmitted diseases should be performed only in those cases where the child's history confirms sexual contact.
15. All of the following statements about diagnosing syphilis are true except:
A. A positive dark-field microscopic exam for Treponema pallidum in a specimen from a genital lesion will definitively diagnose syphilis.
B. A positive serum Venereal Disease Research Laboratory test or RPR will definitively diagnose syphilis.
C. Specific treponemal tests should be used to confirm a positive nontreponemal test before the diagnosis of syphilis is made.
D. A negative fluorescent treponemal antibody absorbed immunoglobulin M test is inadequate to rule out congenital syphilis.
16. In diagnosing sexually transmitted diseases (STDs):
A. False-negative, false-positive, and indeterminate Western blot test for human immunodeficiency virus (HIV) are commonly encountered.
B. When HPV DNA is recovered from the female cervix, the Pap smear will always be abnormal.
C The diagnosis of herpes simplex virus (HSV) genital infections in children can be made with recovery of the organism from cell culture or by detection of the virus by direct antigen methods.
D. Molluscum contagiosum in the anogenital area of a child indicates that the child has been sexually abused.
17. The most acceptable method of C trachomatis diagnosis that is currently in use for genital specimen evaluation in children is:
A. Direct fluorescent antibody.
B. Enzyme immunoassay.
C. Polymerase chain reaction.
D. Cell culture.
18. All of the following statements about testing sexually abused children for STD are true except.
A. Penile cultures for N gonorrhoeae and C trachomatis should be obtained in every case.
B. Trichomonas vaginalis can be found in the nasopharynx or vagina of newborn infants bom to infected mothers.
C. Vaginal or rectal ulcers or vesicles should be cultured for herpes.
D. Large multicenter studies of normal vaginal flora in children have not been performed.
19. Of the following, the only true statement regarding acquired immunodeficiency syndrome (AIDS) and sexually abused children is:
A. There have not been documented cases of pediatric AIDS in which HIV was transmitted by sexual abuse.
B. Parental anxiety about AIDS is not an indication for testing a sexually abused child.
C. The Centers for Disease Control and Prevention has accurate data on the number of pediatric AIDS cases that are a result of sexual abuse.
D. Sexual contact that is physically traumatic to oral, genital, or vaginal mucosa is a risk factor for HIV transmission.
20. Of the following, the only true statement about STD is:
A. The incidence of syphilis in sexually abused children is very high.
B. Transmission of gonorrhea by fomites is a common occurrence in children.
C. Positive Gardnerella vaginalis culture is diagnostic for sexual abuse.
D. Children can autoinoculate HSV I from oral lesions to the genital area.
Answers to the April Quiz
Acute Surgical Conditions I