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 succesfully 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 65212.
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 within 3 to 4 weeks of the quiz deadline. 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 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.
Questions 1 through 8 are taken from the article, "The Management of Common Infections in Ambulatory Children," by Wilbert H. Mason, MD, MPH.
1. Which of the following antibiotics has the longest half-life:
2. In selecting an antimicrobial agent, which of the following factors should be considered:
A. Clinical effectiveness.
B. Dosing frequency.
D. All of the above.
3. Which of the following antimicrobials constitutes the highest cost for a 10-day course:
D. Cefpodoxime proxetil.
4. Which of the following antimicrobials constitutes the least cost for a 10-day course:
A. Erythromycin ethyl succinate.
B. Penicillin V.
D. Sulfamethoxazole/trimethoprim .
5. Which of the following Is not a common bacterial pathogen in acute otitis media:
A. Streptococcus pneumoniae.
B. Moraxella catarrhalis.
C. Hemophilus influenzae type b.
6. When managing a case of acute otitis media in a community with low prevalence of penicillinresistant pneumococci, what is the recommended step to be taken after a failed second course of antimicrobial therapy using a beta-lactamase stable drug:
A. Pursue myringotomy and culture.
B. Pursue pressure equalization tubes.
C. Begin third-generation therapy without myringotomy and culture.
D. None of the above.
7. Which of the following symptoms is more consistant with sinusitis in a child than a simple upper respiratory tract infection:
A. Early fever.
B. Watery rhinnorhea.
C. Persistant cough, worse at night.
8. Increasing antimicrobial resistance has been observed for which of the following common pediatric pathogens:
A. Hemophilus influenzae.
B. Streptococcus pneumoniae.
C. Moraxella catarrhalis.
D. All of the above.
Questions 9 through 14 are taken from the article, "Presumptive Antibiotic Therapy for Hospitalized Children With Sepsis and Meningitis: CostEffective Analysis and Antibiotic Restriction Guidelines," by Richard F. Jacobs, MD, and J. MeI Stimson, PharmD.
9. Which of the following is the most likely bacterial pathogen to cause meningitis in an otherwise healthy 2-year-old male who Is up to date on his immunizations:
A. Group B streptococcus.
B. Escherichia coli.
C. Streptococcus pneumoniae.
D. Hemophilus influenzae type b.
10. The most appropriate presumptive antibiotic regimen for a 6 week old with clinical sepsis with no evidence of bone, Joint, or skin infection includes:
A. Ampicillin plus cefotaxime.
B. Cefotaxime plus gentamicin.
C. Vancomycin plus ceftriaxone.
11. Which of the following is not a common pathogen in the septic neonate:
A. Ecsherichia coli.
B. Listeria moncytogenes.
C. Neisseria meningitidis.
D. Group B streptococcus.
12. The recommended therapy for preseptal cellulitis includes all of the following except
13. A 5-year-old unimmunized male presents to the emergency room with toxic appearance, high fever, drooling, and severe inspiratory stridor. The preferred presumptive therapy Includes which of the following:
14. Antibiotic levels are recommended during the first 72 hours of therapy for all of the following cases except
A. Six-month-old male with cellulitis.
B. One month old with meningitis.
C. Two year old with renal insufficiency.
D. Five year old in the intensive care unit.
Questions 15 through 20 are taken from the article, "Continuation of Antibiotic Therapy for Serious Bacterial Infections Outside of the Hospital," by Kathleen Gutierrez, MD.
15. Sequential Intravenous to oral antibiotic therapy is not recommended for which of the following Infections:
16. Each of the following criteria must be met for successful transition from intravenous to oral antibiotic therapy except
A. Improvement in signs and symptoms.
B. Good oral intake for food and medication.
C. Normal sedimentation rate.
D. Reliable parents.
17. The serum level of which of the following oral antibiotics most approximates that of Its intravenous counterpart when given in standard recommended doses.
A. Cefuroxime axetil.
18. Options for the outpatient management of meningitis after Initial inpatient parenteral therapy include all of the following except
A. Oral Cefixime to complete a 10-day course of antibiotics.
B. Daily home intramuscular ceftriaxone.
C. Daily intravenous ceftriaxone.
D. Daily office intramuscular/intravenous ceftriaxone.
19. Early hospital discharge on home intravenous antibiotics for bacterial endocarditis most likely is with:
A. Staphylococcus aureus.
B. Gram-negative species.
C. Streptococcal species.
20. All of the following antibiotics may be increased two to three times above their standard dose to achieve better serum levels without serious side effects except
A. Penicillin V.
D. Amoxicillin with clavulanic acid.
Answers to the August Quiz