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 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 Avrard of the American Medical Association, provided it has been completed according to instructions.
1. In the most recent survey of US state public health laboratories:
A. The most common parasites encountered were Giardia lamblia and Enterobius vermicularis.
B. Rates of Giardia positivity had decreased since the last survey.
C. Ascaris was reported by all participating states.
D. The second most commonly reported protozoan infection was caused by Cn/piosporid/um.
2. All of the following drugs can be used for treating helminthic infections except:
B. Pyrantel pamoate.
3. Lariam (mefloqulne) malaria prophylaxis:
A. Should be started as soon as the traveler arrives in an area where malaria transmission occurs and continued for 4 weeks after return to a nonendemic area.
B. Is taken together with chloroquine.
C. Is the only drug available for use in areas where chloroquine- resistant Plasmodium falciparum occurs.
D. Is not approved for use in children under 30 lbs body weight or in pregnant women.
4. In malaria, the peak of parasitemia:
A. Usually precedes the fever spike.
B. Usually is at the same time as the fever spike.
C. Usually occurs immediately following fever defervescence.
D. Is unrelated to specific fever spike times.
5. The parasitic disease most frequently associated with the quartet of fever, myalgia, generalized weakness, and pain in the masseter and extraocular muscles Is:
6. All of the following parasitic diseases cause fever without significant eoslnophllia except:
7. Eoslnophilla Is generally defined as:
A. Having more than 40% eosinophils on a peripheral smear differential count.
B. Having more than 500 eosinophils per mm3 in the peripheral blood.
C. Finding significant eosinophils in tissue fluid collections.
D. When eosinophils demarginate and hence increase in number on a complete blood cell count.
8. The strongest stimulus for the eosinophilia associated with parasite Infections comes from:
A. Infection by protozoa! parasites.
B. Tissue migration of helminthic parasites.
C. Diarrhea due to parasite infection.
D. Fever due to parasite infection.
9. The sensitivity of eosinophilia for predicting parasite infection In expatriates and travelers returning from areas where parasites were prevalent approximates:
A. 10% to 20%.
B. 25% to 40%.
C. 45% to 60%.
D. 55% to 70%.
10. Eosinophilia is found in:
A. All patients with parasitic diseases.
B. All patients with intestinal helminthic infections.
C. Patients with invasive parasitic infections.
D. Patients with protozoan infections.
1 1 . Probably the most common parasitic cause of diarrhea In the developed world is:
A. Ingestion of Ascaris lumbricoides eggs.
B. Drinking water containing G lamblia cysts.
C. Contact with Strongyloides stercoralis larvae in soil.
D. Eating meat infected with Trichinella spiralis.
12. All of the following statements regarding parasitic causes of diarrhea are true except:
A. Diarrhea is a prominent feature of most helminthic infections.
B. Infestation with parasites are much less likely a cause of diarrhea in major developed countries than are rotovirus or shigella.
C. Dysentery is common in Entamoeba histolytica infections.
D. Parasitic diarrhea is rarely life threatening.
13. Toxoplasmosls is characterized by all of the following except:
A. Usually produces a heterophilenegative mononucleosis syndrome in healthy adolescents.
B. Can be acquired by ingestion of oocysts from cat litter or raw goat's milk.
C. Asymptomatic states are rare.
D. Central nervous system disease can clinically manifest as intracranial 'mass effect" with increased intracranial pressure.
14. The most common parasitic infection of the central nervous system is:
B. Visceral larva migrans.
D. Primary amebic meningoencephalitis.
1 5. With scabies in infants and small children:
A. Mites tend to be increased in numbers.
B. Vesiculopustules should make one consider another diagnosis.
C. Generalized skin involvement is unusual.
D. Bullae are typical lesions.
16. The current drug of choice for treatment of scabies Is:
A. Lindane (Kwell).
C. Crotamiton (Eurax).
D. Permethrin 5% (Elimite).
17. All of the following statements about pediculosis capftis [head lice) are true except:
A. Transmission is usually from head to head contact.
B. There is no individual acquired immunity from head lice and the phenomenon of herd immunity is not seen.
C. Nits are usually cemented at the base of the hair shaft close to the warm scalp surfaces.
D. Repeat treatment for head lice is always recommended, as is treatment of all close contacts.
18. A true statement about pediculosis pubis Is:
A. The finding of pubic lice on a child should initiate immediate referral to child protective services.
B. Pubic fice can be found in the scalp.
C. Lindane and permethrin are recommended agents to use for pubic lice involving the eyelashes.
D. Coexistent sexually transmitted infection in a sexually active adolescent with pubic lice is rare.
19. All of the following statements about respiratory symptoms and disease with parasites are true except:
A. Pneumocystis carinii is the parasitic organism most commonly associated with respiratory illness in immunocompromised patients.
B. Deep sputum specimens are usually adequate for detection of P carinii if present.
C. Mebendazole is the drug of choice for treatment of both ascariasis and Löfflerlike hookworm infestations.
D. Visceral larva migrans is most prevalent in children under age 6, and with exposure to a puppy.
20. All of the following parasites may cause respiratory symptoms associated with eoslnophllla except:
C. Visceral larva migrans.
D. Pneumocystis carinii.
Answers to the May Quiz Acute Surgical Conditions Il