Pediatricians may receive up to 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 $25 made payable to PEDIATRIC ANNALS CME CENTER, 1 17 Old Alumni Ctr, DCO 345.00, Columbia, MO 652 12.
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 swarded. (After that date, the quiz will close, and correct answers will appear in the journal.) Unanswered questions will be considered incorrect and so scored. A minimum score of 70 must be obtained in order for credits to be awarded.
The office of Continuing Education. School of Medicine. University of Missouri-Columbia is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME programs for physicians. This activity is designated for up to 3 hours of credit for the Physician's Recognition Award.
1. Prior to puberty, recurrent pediatric headache:
A. Occurs more often in girls than boys.
B. Occurs equally in both sexes.
C. Occurs more often in boys than girls.
D. Is associated with premature adrenarche.
2. Tension headache:
A. Is common in prepubertal girls.
B. Is less likely than migraine to have psychological précipitants.
C. Is less likely than migraine to occur prior to puberty.
D. Is often associated with nausea and vomiting.
3. Indications for neurolmaging in recurrent pediatric headache include all of the following except:
A. Reduced visual acuity.
B. Onset prior to age 10 years.
C. Increasing frequency and severity.
D. Frequent awakening.
A. Is a common cause of tension-type headaches in children and adolescents.
B. May be found radiographically in as many as 40% of recurrent pediatric headache cases.
C. Should be sought for with routine radiographs or computed tomography in all cases of frequent recurrent pediatric headache.
D. May be associated with frontal headache and positional change in pain intensity.
5. All of the following are true about migraine headaches except.
A. They are always associated with nausea and vomiting.
B. They are associated with desire to sleep.
C. They may increase in severity over time.
D. They are separated by pain-free intervals.
6. All of the following structures in the head are sensitive to pain except:
B. Ependymal lining and choroid plexus.
D. Mucous membranes.
7. Potent S-HT2 antagonists effective for migraine prophylaxis Include all of the following except:
8. Migraine is:
A. More common in adolescent boys then girls.
B. Inherited in an autosomal dominant fashion with variable penetrance.
C. Thought to be precipitated by emotional causes with no organic substrate.
D. Always unilateral.
9. Children and adolescents with recurrent headache:
A. Are at increased risk for suicide.
B. Commonly meet clinical criteria for depression.
C. Endorse more depressive symptoms than controls.
D. Are at increased risk for obsessive compulsive disorder.
10. The frequency and severity of recurrent pediatric headache:
A. Is inversely related to levels of anxiety.
B. Is increased in panic disorder.
C. is unassocjated with anxiety level.
D. Is closely related to anxiety level.
11. Parents of children and adolescents with recurrent pediatric headache:
A. Commonly have high performance expectations for their children.
B. Focus less on achievement than parents of children without recurrent pediatric headache.
C. Have a higher incidence of psychiatric disorders than controls.
D. Are more likely to have marital dissatisfaction than controls.
12. When compared to controls, children and adolescents with recurrent pediatric headache:
A. Report increased numbers of negative life events.
B. Report more somatic symptoms.
C. Are more socially competent.
D. Have higher thresholds tor pain.
13. Intravenous dihydroergotamine:
A. Has greater peripheral vasoconstrictive effects than ergotamine.
B. Should be preceded by antinauseant treatment.
C. Often leads to dependence with frequent use.
D. May only be given at the onset of the migraine attack.
A. Is a 5-hydroxytrypatirne (5-HT) antagonist.
B. Is available in oral and subcutaneous forms in the United States.
C. May lead to the symptom of chest tightness and disorientation.
D. Has a long half-life.
15. Side effects of medications used for migraine prophylaxis Include all of the following except:
A. Cardiac arrhythmia in the use of tricyclic antidepressants.
B. Decreased appetite in the use of cyproheptadine.
C. Hypoglycemia in the use of propranolol.
D. Bradycardia in the use of propranolol.
16. All of the following are types of behavioral techniques that can be used in treating headache In children except:
17. In terms of parental Involvement In headache treatment, which of the following statements is correct?
A. Parents should always be included in the treatment.
B. The child's perception of parental feedback should be minimized.
C. The degree of parental involvement should be considered carefully.
D. Parents are often very helpful in teaching biofeedback to children with headache.
18. Stress coping treatments for headache consist of the following steps:
A. Identifying stressors, recognizing, challenging, and replacing negative thoughts, and self-reward.
B. Education of causes of headache, relaxation instruction, and specific practice instructions.
C. Gradual induction, imagery and/or relaxation, and suggestion.
D. Distraction, ignoring or nonreinforcement, and reward.
19. The us* of biofeedback in headache treatment:
A. Always requires costly equipment.
B. Is not appropriate for migraine.
C. Requires advanced training.
D. Has proven efficacy.
20. If parents begin using ignoring in response to pain behaviors, they should expect:
A. An immediate decrease in these behaviors.
B. An escalation in these behaviors.
C. A slow but steady decrease in these behaviors.
D. Little change.
Answers to the June Quiz
Adolescent Medicine II