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 Ehe 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 HrII Hospital of New York designates this continuing medics! education activily 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. All of the following statements about urinary tract infections (UTIs) in children are true except.
A. 1% to 2% of prepuberta! children will have bacteriuria on screening urinalyses.
B. The prevalence of asymptomatic bacteriuria in preschool-aged and early school-aged children is equally divided between females and males.
C. Up to 80% of UTIs in children are caused by Escherichia coli bacteria.
D. Gram-positive bacteria such as Staphyiococcus au/eus and Siaphyfococcus epidermidis often are found in patients with indwelling catheters and stents.
2. A true statement about vesicoureteral reflux (VUR) is:
A. UTI is the most common clinical feature of VUR and serves as the primary marker indicating that further work-up is necessary.
B. No greater than one quarter (25%) of children with UTI will have VUR.
C. Demonstrated VUR resolves spontaneously in 50% of patients per every 2-year period.
D. The likelihood of demonstrating VUR in association with UTI increases with increasing age through the teenage years.
3. All of the following statements about treatment of UTIs are true except:
A. Repeat urine culture at 48 to 96 hours of therapy is essential to ensure that adequate treatment is achieved.
B. For long-term prophylaxis of recurrent UTIs and reflux, the prophylactic dose of appropriate drugs is one half of the therapeutic dose.
C. The only absolute indication for surgical intervention in patients with reflux is failure of medical therapy.
D. If prophylaxis has failed once, then a different prophylactic agent should be used.
4. The most common cause of hematuria in childhood, either gross or microscopic, is:
D, Urinary tract infection.
5. All of the following foods and drugs can make the urine red except.
6. The dipstick for blood can show a positive result for:
A. Red blood cells only.
B. Red blood cells and hemoglobin.
C. Red blood cells and myoglobin.
D. Red blood cells, hemoglobin, and myoglobin.
7. When school-aged children are screened for blood in the urine, significant hematuria in one specimen is found in:
A. 0.5% to 1%.
B. 2% Io 3%.
C. 4% to 6%,
D. Greater than 10%.
8. When evaluating a child with persistent microscopic hematuria whose father and grandfather both had a history for kidney stones, it would be most important to obtain:
A. Urinary Ca/Cr.
B. Serum calcium level. .
C. Serum uric acid.
D. C3, C4.
9. Important clues localizing hematuria to a glomerular etiology rather than a nonglomerular one include all of the following except:
A. Brown or "tea-colored" urine.
B. Red blood cells and cellular casts.
C. Proteinuria s=2+ by dipstick.
D. Normal morphology of the erythrocytes in the urine.
10. Known mechanisms for proteinuria include all of the following except:
A. Glomerular proteinuria.
B. Vascular malformations.
C. Hemodynamic alterations of glomerular blood flow.
D. Tubular proteinuria.
11. The percentage of children who initially test positive for proteinuria and who persist with proteinuria after 8 to 1 2 months of appropriate followup approximates:
12. All of the following statements about proteinuria in the pediatrie population are true except.
A. A urine specimen is considered positive for protein if it registers 1 + (30 mg/dL) or greater in a urine whose specific gravity is =£1015.
B. Proteinuria continuing or increasing over several years merits renal biopsy,
C. Alkaline urine pH (>7.0) may cause a false-negative dipstick reaction for urinary protein.
D. A timed urine collection for protein quantitation is essential to establish the presence and degree of proteinuria.
13. Orthostatic proteinuria:
A. Is defined as an abnormal high protein excretion after a prolonged recumbent position.
B. Is always fixed and reproducible.
C. Accounts for approximately 60% of all proteinuria seen in children and an even higher figure in adolescents.
D. Is generally associated with hypertension when persisting for many years.
14. All of the following infectious etiologies have been associated with the nephrotJc syndrome except:
B. Hepatitis A virus.
C. Human immunodeficiency virus.
15. The simplest accurate method to quantitate urine protein excretion in a child Is to measure:
A. Random urine protein concentration.
B. Random urine protein/creatinine ratio.
C. 24-hour urine protein excretion.
D. 24-hour urine protein/creatinine ratio.
16. The use of corticosterolds for minima I change nephrotic syndrome:
A. Should be considered palliative and not curative.
B. Should be continued on a daily basis for 6 months.
C. Should be continued on a daily basis for 3 months.
D. Is probably more harmful than helpful.
17. All of the following statements about the nephrotic syndrome in children are true except.
A. The long-term prognosis is rarely very favorable.
B. Remission is diagnosed only when urinary protein excretion normalizes.
C. Mosteases will be steroid responsive.
D. Minimal lesion nephrotic syndrome accounts for about 75% of all children with primary nephrotic syndrome.
18. A true statement about the evaluation and prognosis of 2-year-old and 4-year-old children from the same family who develop hemolytic uremie syndrome (HUS) over the course of a 2week period is:
A. The prognosis is poor because this is familial HUS.
B. The patients should be treated with infusions of fresh frozen plasma and plasmapheresis.
C. The children have the same prognosis as other patients with the epidemic form.
D. Other family members should be treated with antibiotics and antimotility agents to prevent HUS.
19. The management of an 1 8-fnonthold female presenting with irritability, pallor, and edema during an episode of bloody diarrhea and whose parents assure you of good urine output because the diapers are wet should Include all of the following except:
A. Insertion of a Foley catheter to monitor urine output.
B. Restricting fluids.
C, Obtaining a complete blood cell count and electrolytes.
D. Treatment with antibiotics and antimotility agents.
20. All of the following statements about HUS In children are true except-,
A. Children who sustain permanent renal failure are good candidates for kidney transplantation.
B. There is currently specific therapy for the acute phase of the disease process and preventative therapy for the disease itself.
C. Plasmapheresis is helpful in patients with nonepidemic HUS, but not in patients with epidemic HUS.
D. Death and disability due to central nervous system involvement and multisystem disease is still common.
Answers to the June Quiz Diabetes