Pediatric Annals

CME PRETEST 

CME PRETEST / CME QUIZ

Abstract

HOW TO OBTAIN CME CREDITS BY READING THIS ISSUE

Pediatricians can receive Category I credits for the Physician's Recognition Award of the American Medical Association by reading the following articles and successfully completing the quiz at the end of the issue. Complete instructions are given on the quiz pages.

The Pretest below has been prepared to assist you in studying the following material. It indicates some of the areas to be covered and will make it possible for you to challenge your present knowledge of the material before reading further.

EDUCATIONAL OBJECTIONS

Allergy season has arrived with clouds of pollen and patients suffering from allergic rhinitis and asthma. Although we are well prepared to handle each entity on its own, many times we fail to treat the two as a continuum between one part of a diseased airway and another. Over the years, this separation between allergic upper and lower airway disease has become more solidified as clinical pathways have evolved to handle each malady alone.

Although the link between allergic upper and lower airway disease is still controversial, it nonetheless poses a significant problem for the patient with allergic rhinosinusitis and asthma. This issue of Pediatric Annals presents several excellent reviews of this subject and will leave the participant better prepared to handle this challenging part of the year.

PRETEST

1. Antihistamines may worsen asthma by causing overdrying of respiratory secretions.

A. True.

B. False.

2. The acute phase of inflammation during an allergic response is due to the recruitment of eosinophils and Tlymphocytes to the target site.

A. True.

B. False.

3. Children with asthma are 4 to 5 times more likely to have abnormal results on sinus radiographs than are their healthy counterparts without asthma.

A. True.

B. False.

ANSWERS TO THE PRETEST:

1.B 2. B 3. A

CME PRETEST/CME QUIZ

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: PEDIATRIC 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…

HOW TO OBTAIN CME CREDITS BY READING THIS ISSUE

Pediatricians can receive Category I credits for the Physician's Recognition Award of the American Medical Association by reading the following articles and successfully completing the quiz at the end of the issue. Complete instructions are given on the quiz pages.

The Pretest below has been prepared to assist you in studying the following material. It indicates some of the areas to be covered and will make it possible for you to challenge your present knowledge of the material before reading further.

EDUCATIONAL OBJECTIONS

Allergy season has arrived with clouds of pollen and patients suffering from allergic rhinitis and asthma. Although we are well prepared to handle each entity on its own, many times we fail to treat the two as a continuum between one part of a diseased airway and another. Over the years, this separation between allergic upper and lower airway disease has become more solidified as clinical pathways have evolved to handle each malady alone.

Although the link between allergic upper and lower airway disease is still controversial, it nonetheless poses a significant problem for the patient with allergic rhinosinusitis and asthma. This issue of Pediatric Annals presents several excellent reviews of this subject and will leave the participant better prepared to handle this challenging part of the year.

PRETEST

1. Antihistamines may worsen asthma by causing overdrying of respiratory secretions.

A. True.

B. False.

2. The acute phase of inflammation during an allergic response is due to the recruitment of eosinophils and Tlymphocytes to the target site.

A. True.

B. False.

3. Children with asthma are 4 to 5 times more likely to have abnormal results on sinus radiographs than are their healthy counterparts without asthma.

A. True.

B. False.

ANSWERS TO THE PRETEST:

1.B 2. B 3. A

CME PRETEST/CME QUIZ

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: PEDIATRIC 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

This CME activity is primarily targeted to Pediatricians, Osteopathic Physicians, Pediatric Nurse Practitioners, and others allied to the field. There are no specific background requirements for participants taking this activity. SLACK Incorporated, publisher of PEDIATRIC ANNALS, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

SLACK Incorporated designates this educational activity for a maximum of three (3) hours in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

FULL DISCLOSURE POLICY

All authors participating in continuing medical education programs sponsored by SLACK Incorporated are expected to disclose to the readership authence any real or apparent conflict(s) of interest related to the content of their material. Full disclosure of author relationships will be made in the journal.

This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME) by SLACK Incorporated.

Questions 1 through 3 are taken from the article "The Association Between Allergic Rhinitis and Asthma In Children and Adolescents: Epidemiologic Considerations" by Jonathan Corren, MD.

1. The following is/are TRUE regarding the prevalence of allergic disease in the past two to three decades:

A. Allergic rhinitis has increased in prevalence, whereas the prevalence of asthma has remained unchanged.

B. Allergic rhinitis has remained stable in prevalence, whereas the prevalence of asthma has increased tenfold.

C. The prevalences of both allergic rhinitis and asthma have increased.

D. None of the above are TRUE.

2. Important risk factors for the subsequent development of asthma include which of the following:

A. Exposure to indoor tobacco smoke during infancy.

B. Exposure to dust mites.

C. Exposure to cockroaches.

D. All of the above.

3. All of the following statements are TRUE EXCEPT:

A. A patient's family history of a particular allergic disease does not limit the risk for allergic disease to only that condition.

B. The risk for subsequent development of seasonal allergic rhinitis is related to early life exposure to dust mites.

C. Maternal smoking is critical as a risk factor for the expression of asthma in young children.

D. High indoor humidity has been shown to be an important risk factor for the expression of asthma.

Questions 4 through 6 are taken from the article "A Pathophysiologic Unk Between Allergic Rhinitis and Asthma" by Phil Lieberman, MD.

4. Which of the following are currently proposed theories regarding a link between upper and lower airway disease:

A. Neural reflex mechanisms.

B. Aspiration of nasal and sinus drainage.

C. Poor air conditioning function of the upper airway.

D. All of the above.

5. The efferent limb of the reflex mechanism of airway hyperreactivity due to upper airway stimulation is carried by which of the following:

A. Vagus nerve.

B. Glossopharyngeal nerve.

C. Trigeminal nerve.

D. Facial nerve.

6. The nose processes air for the lower airway by which of the following methods:

A. Humidification.

B. Filtration.

C. Warming.

D. All of the above.

Questions 7 through 9 are taken from the article "Treatment of Allergie RhInHb With Antihistamines and Decongestants and Its Effect on the Lower Airway" by Martin E. Hurwitz, MD.

7. All of the following statements regarding allergic rhinitis and asthma are TRUE EXCEPT:

A. The prevalence of allergic rhinitis and asthma is increasing.

B. Histamine is not as important an inflammatory mediator in the lower airway as it is in the nose and sinuses.

C. Allergic sensitization forms the basis for inflammatory activity in both the nose and the lower airway.

D. Repeated exposure to an allergen primes bronchial and nasal mucosa to react with lower subsequent allergen exposures.

8. TRUE statements about antihistamines include all of the following EXCEPT:

A. Second-generation antihistamines have a longer half-life than do first-generation antihistamines.

B. Antihistamines possess some decongestant activity.

C. Antihistamines are best used pro phy tactical Iy before allergen exposure.

D. First-generation antihistamines are known to interfere with cognitive activity in children.

9. Beneficial effects of antihistamines on the lower respiratory tract in patients with allergic rhinitis and concomitant asthma may involve which of the following mechanisms:

A. Reduction of bronchomotor tone through direct action on smooth muscle.

B. Reduction of inflammatory activity in the upper airway.

C. Reduction of inflammatory activity in the lower airway by histamine antagonism.

D. All of the above.

Questions 10 and 11 are taken from the article "Treatment of Allergic Rhinitis With Intranasal Steroids and Its Effects on the Lower Airway" by Eric J. Schenkel, MD, and William E. Berger, MD.

10. Reasons for the artificial separation between the treatment of asthma and allergic rhinitis include which of the following:

A. Effective topical medications for both conditions have been developed, leading to a tendency to treat one condition and not the other.

B. Current CPT nomenclature creates an artificial separation of the two entities.

C. Practice parameters have been developed to treat each individual disease, with little mention of treating both concomitantly.

D. All of the above are TRUE.

11. Which of the following topical nasal steroids has the lowest absolute bioavailability:

A. Mometasone furoate.

B. Beclomethasone dipropionate.

C. Fluticasone propionate.

D. None of the above.

Questions 12 through 14 are taken from the article "Specific Allergen Immunotherapy for Allergic Rhinitis and Asthma" by Ricardo Z. Vinuya, MD.

12. Which of the following is/are postulated mechanisms by which immunotherapy exerts its effects in respiratory allergies:

A. Decreasing inflammatory mediators and effector cells.

B. Production of "blocking" antibodies.

C. Immune deviation from Th2- to ThI -type lymphocytic response.

D. All of the above.

13. All of the following are established indications for immunotherapy in the pediatric population EXCEPT:

A. Allergic rhinoconjunctivitis.

B. Food allergies.

C. Insect sting hypersensitivity.

D. Allergic asthma.

14. All of the following are TRUE regarding the safe administration of allergy immunotherapy EXCEPT:

A. Shots should be administered under the supervision of a physician well trained in their use and indications.

B. Personnel administering the shots should be skilled in the recognition and treatment of anaphylaxis.

C. With proper training, patients can administer allergy shots at home.

D. Shots should be administered only in an office equipped to handle life-threatening emergencies.

Questions 15 through 18 are taken from the article "Sinusitis and Pediatric Asthma" by Frank S. Virant, MD.

15. Which of the following eosinophil products has been implicated in the pathogenesis of acute bacterial sinusitis and nasal hyperresponsiveness:

A. Eotaxin.

B. Major basic protein.

C. lnterleukin-9 (IL-9).

D. None of the above.

16. The evaluation of a child with chronic asthma should consider the possibility of which of the following diagnoses:

A. Allergic rhinitis.

B. Sinusitis.

C. Gastroesophageal reflux disease.

D. All of the above.

17. Which of the following antibiotics is the best choice for monotherapy for childhood acute sinusitis:

A. Penicillin.

B. Amoxicillin.

C. Trimethoprim-sulfamethoxazole.

D. Clindamycin.

18. The best technique for imaging the sinuses of a child whose clinical course has not improved after 10 weeks of treatment is which of the following:

A. Positron emission tomography scan.

B. Dual-mode ultrasound.

C. Coronal sinus computed tomography scan.

D. Gallium scan.

Questions Ï9 and 20 are taken from the article "QuaHty-of-Ufe Outcomes Measures of Asthma and Allergic Rhinitis" by D. Melissa Graham, MD, and Michael S. Blahs, MD.

19. The Child Health Questionnaire is an example of what type of quality-of-life outcomes instrument:

A. Generic quality-of-life questionnaire.

B. Specific quality-of-life questionnaire.

C. Patient satisfaction questionnaire.

D. None of the above.

20. Which of the following is NOT a domain of function used to evaluate the different aspects of healthrelated quality of life:

A. Physical status and functional abilities.

B. Environmental status.

C. Social and role interactions.

D. Psychological status and well-being.

Answers to the April Quiz

INTERNATIONAL ADOPTIONS

1. D

2. C

3. C

4. C

5. D

6. D

7. B

8. B

9. B

10. C

11. A

12. D

13. D

14. C

15. D

16. A

17. D

18. D

19. B

20. D

10.3928/0090-4481-20000701-14

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