Pediatric Annals

CME quiz

Abstract

INSTRUCTIONS

1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs.

2. Read the articles carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.

3. The following quiz questions have been designed to provide a useful link between the CME 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 published later.

4. Type or print your full name and address and your date of birth in the space provided on the CME REGISTRATION FORM.

5. Complete the Evaluation portion of the CME Registration Form. Forms and quizzes cannot be processed if the Evaluation portion is incomplete. The Evaluation portion of the CME Registration Form will be separated from the quiz upon receipt at PEDIATRIC ANNALS. Your evaluation of this activity will in no way affect the scoring of your quiz.

6. Send the completed form, with your $25 payment (check, money order, or credit card information) to: PEDlATRIC ANNALS CME Quiz, PO Box 36, Thorofare NJ 08086.

7. Your answers will be graded, and you will be advised whether you have passed or failed. Unanswered questions will be considered incorrect. A score of at least 80% is required to pass. Answers to the quiz will be published 3 months after the article appears. You should review your answers at that time, noting your incorrect answers, and referring to the article and its supplemental bibliography for additional information and clarification.

8. Be sure to mail the CME Registration Form on or before the deadline listed. After that date, the quiz will close and correct answers will appear in the Journal. CME Registration Forms received after the date listed will not be processed.

CME ACCREDITATION

SLACK Incorporated, publisher of PEDIATRIC ANNALS, is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. SLACK Incorporated designates this educational activity for a maximum of three (3) hours in category 1 toward the AMA Physician's Recognition Award. Each physician should only claim those hours of credit that he or she actually spent in the educational activity.

Questions 1 through 7 are taken from the article "Gastrointestinal Disorders Due to Cow's Milk Consumption" by John Barnard, MD.

1. Secondary lactase deficiency may be associated with all of the following disorders except:

A. Rotaviral gastroenteritis.

B. Allergic colitis.

C. Mild protein enteropathy.

D. Gluten enteropathy (celiac disease).

2. Lactase deficiency due to rotaviral gastroenteritis:

A. Results in lifelong lactose intolerance.

B. May persist for several weeks.

C. Both A and B.

D. Neither A nor B.

3. A 9- week-old infant on cow's milk formula develops failure to thrive, anemia, and hypoproteinemia, A small bowel biopsy reveals flattened mucosa. Which of the following formulas is best in this case:

A. Soy protein-based formula.

B. Casein hydrolysate formula without lactose.

C. Goat's milk.

D. Whole milk.

4. Pasteurized whole milk:

A. Is appropriate for infant feedings after 6 months of age.

B. Is acceptable for infant feedings after 1 2 months of age.

C. Delivers satisfactory levels of bioavailable iron.

D. Has reduced allergenicity due to pasteurization.

5. Genetic late-onset lactase deficiency is common in all of the following groups except:

A. African Americans.

B. Asians.

C. Eskimos.

D. Northern European Caucasians.

6. Which of the following tests is considered…

INSTRUCTIONS

1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs.

2. Read the articles carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.

3. The following quiz questions have been designed to provide a useful link between the CME 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 published later.

4. Type or print your full name and address and your date of birth in the space provided on the CME REGISTRATION FORM.

5. Complete the Evaluation portion of the CME Registration Form. Forms and quizzes cannot be processed if the Evaluation portion is incomplete. The Evaluation portion of the CME Registration Form will be separated from the quiz upon receipt at PEDIATRIC ANNALS. Your evaluation of this activity will in no way affect the scoring of your quiz.

6. Send the completed form, with your $25 payment (check, money order, or credit card information) to: PEDlATRIC ANNALS CME Quiz, PO Box 36, Thorofare NJ 08086.

7. Your answers will be graded, and you will be advised whether you have passed or failed. Unanswered questions will be considered incorrect. A score of at least 80% is required to pass. Answers to the quiz will be published 3 months after the article appears. You should review your answers at that time, noting your incorrect answers, and referring to the article and its supplemental bibliography for additional information and clarification.

8. Be sure to mail the CME Registration Form on or before the deadline listed. After that date, the quiz will close and correct answers will appear in the Journal. CME Registration Forms received after the date listed will not be processed.

CME ACCREDITATION

SLACK Incorporated, publisher of PEDIATRIC ANNALS, is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. SLACK Incorporated designates this educational activity for a maximum of three (3) hours in category 1 toward the AMA Physician's Recognition Award. Each physician should only claim those hours of credit that he or she actually spent in the educational activity.

Questions 1 through 7 are taken from the article "Gastrointestinal Disorders Due to Cow's Milk Consumption" by John Barnard, MD.

1. Secondary lactase deficiency may be associated with all of the following disorders except:

A. Rotaviral gastroenteritis.

B. Allergic colitis.

C. Mild protein enteropathy.

D. Gluten enteropathy (celiac disease).

2. Lactase deficiency due to rotaviral gastroenteritis:

A. Results in lifelong lactose intolerance.

B. May persist for several weeks.

C. Both A and B.

D. Neither A nor B.

3. A 9- week-old infant on cow's milk formula develops failure to thrive, anemia, and hypoproteinemia, A small bowel biopsy reveals flattened mucosa. Which of the following formulas is best in this case:

A. Soy protein-based formula.

B. Casein hydrolysate formula without lactose.

C. Goat's milk.

D. Whole milk.

4. Pasteurized whole milk:

A. Is appropriate for infant feedings after 6 months of age.

B. Is acceptable for infant feedings after 1 2 months of age.

C. Delivers satisfactory levels of bioavailable iron.

D. Has reduced allergenicity due to pasteurization.

5. Genetic late-onset lactase deficiency is common in all of the following groups except:

A. African Americans.

B. Asians.

C. Eskimos.

D. Northern European Caucasians.

6. Which of the following tests is considered the test of choice to detect lactase deficiency:

A. Stool pH.

B. Breath hydrogen analysis.

C. Ctinitest for reducing sugars.

D. None of the above.

7. A healthy-appearing 2-month-old breast-fed infant presents to your clinic with streaky, brightred rectal bleeding while passing loose mucoid stools. Laboratory studies are normal. Appropriate management includes which of the following:

A. Continued breast feeding with elimination of soy and cow's milk protein in the maternal diet.

B. Complete cessation of breast feeding and use of goat's milk supplement.

C. Replacement of breast feeding with a casein hydrolyzed formula.

D. Continued breast feeding with no changes in the maternal diet.

Questions 8 through 14 are taken from the article "Evaluation of Dyspepsia" by David A. Gremse, MD, and Alan I. Sacks, MD.

8. Which of the following pathophysiologic mechanisms are associated with gastroesophageal reflux:

A. Increased resting lower esophageal sphincter tone.

B. Abnormal episodes of transient lower esophageal sphincter relaxation.

C. Increased rate of gastric emptying.

D. Achlorhydria.

9. Which of the following stimulate gastric acid secretion?

A. Histamine.

B. Gastrin.

C. Acetylcholine.

D. All of the above.

10. Which of the following symptoms is not suggestive of acid-peptic disease in children?

A. Waterbrash.

B. Flatulence.

C. Dysphagia.

D. Hematemesis.

11. All of the following are H2-receptor antagonists except:

A. Cimetidine.

B. Ranitidine.

C. Omeprazole.

D. Nizatidine.

12. Which of the following agents is a prokinetic agent?

A. Cisapride.

B. Cimetidine.

C. Sucralfate.

D. Ranitidine.

13. For which of the following patients would esophagogastroduodenoscopy be the next most appropriate diagnostic test:

A. A 10 month old with regurgitation and normal growth velocity.

B. A 12 year old with a normal upper Gl series and epigastric pain relieved with Cimetidine.

C. An 8 year old with occult fecal blood and dyspepsia unresponsive to ranitidine.

D. A 9 year old with cramping periumbilical pain unresponsive to antacids.

14. Which of the following signs and/or symptoms is commonly seen in infants and toddlers with dyspepsia:

A. Vomiting.

B. Feeding resistance.

C. Postprandial fussiness.

D. All of the above.

Questions 15 through 20 are taken from the article "Practical Approach to Defecation Disorders in Children" by L Glen Lewis, MD, and Colin D. Rudolph, MD, PhD.

15. Which of the following is not characteristically associated with Hirschsprung disease:

A. Absence of ganglion cells in the mysenteric and submucosal plexi on rectal biopsy.

B. Failure to pass meconium in the first 24 hours of life.

C. Fecal soiling.

D. Absence of internal and sphincter relaxation following rectal distension.

16. Anorectal manometry is indicated in all of the following cases except:

A. Teaching external and sphincter relaxation in a child with rectosphincteric dyssynergia.

B. As part of the initial investigation of fecal soiling.

C. As biofeedback training in a child with myelomeningocele and some preservation of sensorimotor function in the perineal region.

D. To differentiate between functional constipation and Hirschsprung disease in a child with severe refractory constipation.

17. The initial goal in the management of a child with longstanding fecal soiling (following family education) should be:

A. Psychological evaluation.

B. Biofeedback training.

C. Disimpaction of the fecal mass by enemas or cathartic therapy.

D. Increased fiber diet.

18. Which of the following has no place in the therapy of a child who has failed medical management of encopresis:

A. Reinitiating rectal clean out followed by daily laxative therapy and positive reward system.

B. Psychological evaluation.

C. Initiating a system of punishment for soiling.

D. Anorectal manometry with biofeedback.

19. Which of the following laxative is recommended for use in children under 6 months:

A. Karyo syrup.

B. Milk of Magnesia.

C. Mineral oil.

D. Lactulose.

20. AH of the following are true regarding constipation except:

A. A breast-fed infant passing soft stools every 4 days has significant constipation.

B. Encopresis is more common in school-aged boys than girls.

C. Constipation is more common in postpubertal females than males.

D. The most common etiology of constipation in all ages is functional.

10.3928/0090-4481-19970401-11

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