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 mateial 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 cor-rect 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 25 made payable to PEDIATRIC ANNALS CME CENTER.! 1 7 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 as- pect of the subject listed in the references in this issue.
6. Be sure to mall 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 ob~tained 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.
Medical Emergencies I
1. Hyperkalemia may occur with which of the following neuromuscular blocking agents:
2. As you prepare for rapid sequence Induction and intubation of a child with Increased intracranial pressure due to meningitis, which of the following analgesics/amnesties would you absolutely avoid:
3. Which endotracheal tube size Is most appropriate for a 4 year old:
A. 4.0 mm.
B. 4.5 mm.
C 5.0 mm.
D. 6.0 mm.
4. Of the following maneuvers to relieve airway obstruction, which Is the most appropriate for a combative or semiconscious patient:
A. Jaw thrust.
B. Oral airway.
C Head tilt.
D. None of the above.
5. Which of the following anesthetic agents Is most appropriate for management of the airway In a child with normal Intracranial pressure but abnormal cardiovascular function:
6. All of the following metabolic derangements may be seen In the child with shock except:
7. The cardiovascular changes Induced by dobutamine Include:
A. Increased inotropy, vasoconstriction.
B. Increased inotropy, vasodilatation.
C. Increased chronotropy, vasoconstriction.
D. Increased chronotropy, vasodialation.
8. You have been called to resuscitate a child with known congenital heart disease. The patient displays signs of cardiogenic shock. Which of the following Inotropic agents is the most appropriate In this setting:
9. Which of the following descriptions of shock states Is the most accurate:
A. Hypovolemic: decreased preload, decreased afterload, normal contractility.
B. Distributive: decreased preload, decreased afterload, decreased contractility.
C. Cardiogenic: increased preload, increased afterload, decreased contractility.
D. Early septic: decreased preload, increased afterload, increased contractility.
10. A patient enters your office in frank anaphylaxis after suffering several bee stings while disturbing a hive near his house. Which of the following shock states best describes his condition:
A. Late septic shock.
B. Cardiogenic shock.
C. Hypovolemic shock.
D. Distributive shock.
11. Which of the following crystalloid solutions has the most physiologic concentration of sodium:
A. Normal saline.
B. Ringer's lactate.
D. None of the above.
12 Initial management of patients with left-sided obstruction of the heart Includes all of the following except:
A. Establishment of a reliable airway.
B. Rapid venous access.
C. Establishment of circulatory stability
D. Administration of prostaglandin E after echocardiographic confirmation of the obstruction.
13. Which of the following Is true in the mangement of a patient with left-sided cardiac obstruction:
A. An oxygen saturation of 100% should be maintained at all times.
B. Ventilation with room air to achieve a saturation of 75% to 80% may be necessary.
C. Inotropic support should be avoided.
D. Metabolic alkalosis is common and should be controlled with hyperventilation.
14. Treatment of a "Tet spell" Includes which of the following:
A. Calming the child and pressing the knees against the chest while administering oxygen.
B. Intravenous phenylephrine.
C. Intravenous propranolol.
D. All of the above.
15. At a 2-month well child examination, you note a history of difficulty feeding and poor weight gain. Your examination Is positive for a murmur and an enlarged liver. Which of the following diagnoses Is the most likely:
A. Ventricular septal defect with congestive heart failure.
B. Tricuspid atresia with acute decompensation.
C. Complete transposition of the greate vessels.
D. None of the above.
16. A patient with poor capillary refill, weak pulses, hepatomegaly, and a stable heart rate of 220 beats/minute presents to your emergency center. You are unable to establish Intravenous access. Which course of action Is most prudent:
A. Unilateral carotid massage.
B. Iced towel to the face.
C. Synchronized cardioversion.
D. Gag the patient.
17. All of the following statements about neonatal sepsis are true except:
A. Early-onset disease carries a lower mortality rate than late-onset disease.
B. The etiologic agent is usually acquired from the maternal genital or gastrointestinal tract.
C. There is often a history of obstetrical complications.
D. Fever is not a reliable sign of neonatal sepsis.
18. A 7 -day-old jaundiced IMICU graduate presents to your office with poor feeding, irritability, and weight loss. Your gestalt is that the child Is septic. Which of the following antibiotic regimens would be the most appropriate:
A. Ampicillin and gentamicin.
B. Ampicillin and ceftriaxone.
C. Ampicillin, gentamicin, and vancomycin.
D. Ampicillin and vancomycin.
19. The most common potential pathogen to consider in a septic 5 month old include all of the following except:
A. Streptococcus pneumoniae.
B. Group B streptococcus.
C. Neisseria meningitidis.
D. Hemophilus influenzae.
20 A 10-year-old child with fever, headache, myalgias, and a petechial rash on the palms and soles presents to your office. Which of the following antiobiotlc regimens Is the most appropriate:
Answers to the March Quiz