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 article« carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.
2. Th* following questione 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, 117 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 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 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 6 are taken from the article, "Management of Pediatrie Wounds," by Kenneth Jackimczyk, MD. and Emily Pollack, MD.
1. Which of the following is considered a low-risk wound:
A. A dog bite to the leg.
B. A scalp laceration in a 6-year-old child.
C. A through-and-through lip laceration.
D. A laceration in the axilla.
2. Which of the following does not require specialty consultation:
A. An eyelid margin laceration.
B. A crushed fingertip with germinal matrix damage.
C. A laceration to the pinnae with exposed cartilage.
D. A cheek laceration with blood noted at Stenson's duct.
3. Wound prep of a highly contaminated wound should Include all of the following except
A. Scrub peripherey of wound with betadine scrub.
B. Judiciously debride nonviable tissue.
C. Scrub wound with normal saline.
D. Irrigate wound with saline using a bulb syringe.
4. Radiographs are useful in assessing a wound for all of the following except
A. Presence of glass.
B. Presence of gravel.
C. Presence of wood splinter.
D. Detection of fractures.
5. The pain of local anesthetic injection can be reduced by all of the following except
A. Buffering the anesthetic solution with sodium bicarbonate.
B. Using anesthetic solution that contains epinephrine.
C. Slowing the injection rate.
D. Warming the anesthetic solution.
6. Which of the following Is a true statement:
A. Most simple lacerations <6 hours old can be closed primarily.
B. All wounds >6 hours old must be left to heal by secondary intention.
C. Wounds on the face and scalp only can be closed by delayed primary closure.
D. All wounds >24 hours old must be closed by delayed primary closure.
Questions 7 through 13 are taken from the article, "Pediatrie Abdominal Surgical Emergencies." by Emily S. Pollack, MD.
7. The following are true of Meckel's diverticulum except:
A. Meckel's diverticulum occurs in about 2% of the population and becomes symptomatic in 2% of those who have it.
B. Ultrasound is the imaging technique of choice for this disorder.
C. Meckel's diverticulum most often presents with massive, painless rectal bleeding.
D. There may be both gastric and pancreatic tissue present in a Meckel's diverticulum.
8. A newborn presents with poor perfusion, lethargy, and a history of green emesis. Your examination reveals no overt abnormalities. Abdominal radiographs show colonie gas in the right upper abdomen. The likely diagnosis is which of the following:
A. Incarcerated inguinal hernia.
B. lleocecal intussusception.
C. Malrotation with intestinal incarceration.
D. Duodenal atresia.
9. Which metabolic derangement Is most commonly associated with hypertrophie pyloric stenosis:
A. Hypochloremic, hypokalemic, metabolic alkalosis.
B. Hypochloremic, hypokalemic, metabolic acidosis.
C. Hypochloremic, hyperkalemic, metabolic alkalosis.
D. Hypochloremic, hyperkalemic, metabolic acidosis.
10. Which of the following is not true of intussusception:
A. It is the most common abdominal surgical emergency in children up to 2 years of age.
B. It is typically ileocolic.
C. In the majority of cases, presentation is that of vomiting, intermittent crying, and bloody stools.
D. Under 2 years of age, there is typically no obvious lead point.
11. All of the following statements are true regarding acute appendicitis except
A. It is the most common nontraumatic pediatrie surgical emergency.
B. The majority of cases appear in children older than 10 years.
C. Progression to perforation is less rapid in young children.
D. Fever usually develops after the onset of other symptoms.
12. Which of the following Is true of inguinal hernias In children:
A. Most are bilateral.
B. The left side is involved more often than the right.
C. Girls have a higher rate of incarceration.
D. There is a slight male to female predominance.
13. Which of the following imaging studies Is best suited to demonstrate a Meckel's diverticulum:
A. Technetium pertechnetate scan.
B. Double contrast barium enema.
C. Upper gastrointestinal series with small bowel follow through.
Questions 14 through 20 are taken from the article, ''Genitourinary Surgical Emergencies" by Marianne Gausche, MO.
14. Which of the following conditions Is the most common cause of priapism In children:
A. Sickle cell disease.
C. Sexual abuse.
15. A 1 3-year-old adolescent male presents to the emergency room 2 hours after the onset of right testicular pain that began during participation in a soccer tournament. You highly suspect testicular torsion. Which of the following is the most appropriate in the management of this patient:
A. Urinalysis and testicular scan followed by a urology consult if necessary
B. Urinalysis and color-flow doppler ultrasonography followed by urology consult if necessary.
C. Urinalysis and urine culture followed by admission for observation.
D. Immediate urology consult for surgical repair.
16. Which of the following signs and symptoms Is not commonly found In testicular torsion:
A. Acute pain.
D. Horizontally oriented testis.
17. A 6-month-old black male presents to your office fussy and Inconsolable. Your examination reveals a tender erect penis with a flaccid glans and corpus sponglosum. Initial workup of this child should Include which of the following:
A. Hemoglobin electrophoresis.
B. Complete blood cell count.
C. Both A and 6.
D. Neither A nor B.
18. Which of the following Is true regarding the diagnosis and management of meaial stenosis:
A. The diagnosis is made simply oy visual inspection of the urethral meatus.
B. Dilatation is indicated when there is marked deflection of the urinary stream.
C. Diagnosis is only possible by invasive imaging studies.
D. Dilatation is only performed under general anesthesia by skilled urologists.
19. Indications for surgical Intervention for renal Injury Include all of the following except
A. Renal pedicle injury.
B. Expanding or pulsatile hematoma.
C. Fractured kidney.
D. Contusion of the kidney
20. All of the following signs and symptoms are commonly found In torsion of the appendix testis except
A. Normal testicular position.
B. Blue dot sign.
C. Age of onset less than 16 years.
Answers to the May Quiz