Pediatric Annals

CME Pretest

Abstract

HOW TO OBTAIN CME CREDITS BY READING THIS ISSUE

Pediatricians can receive Category 1 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 current knowledge of the material before reading further.

In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

EDUCATIONAL OBJECTIVES

Abdominal complaints are perhaps some of the most common issues presenting to the practicing pediatrician and account for a large portion of missed school days in American children. When faced with the child complaining of chronic recurrent abdominal pain, the pediatrician must balance the benefit of multiple studies against the possibility of reinforcing the fears of the child and the parents with too much investigation. The Rome ? criteria provide a simple yet effective classification of functional disorders of the gastrointestinal tract and allow clinical diagnosis without unnecessary and at times invasive studies.

When investigation is warranted newer serological assays allow earlier and more effective diagnosis of inflammatory bowel disease and celiac disease in children assuring a better long-term quality of life. It is clear that with early intervention these children can achieve normal growth and development and lead normal lives. Indeed, even in the smallest of our patients liver disease has become an entity that can be more accurately diagnosed and successfully treated when addressed early. Improved diagnostic criteria and treatment modalities have made the management of GER straightforward and accessible to all pediatric practitioners.

This issue of Pediatric Annals provides focused reviews on each of these areas as well as excellent guidelines for evaluation and management. This month's collection affords the participant the opportunity to more thoroughly evaluate and manage children with suspected inflammatory bowel disease, gastroesophageal reflux, and celiac disease, as well as neonates with prolonged or late-onset jaundice.

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 should you choose to request them.

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…

HOW TO OBTAIN CME CREDITS BY READING THIS ISSUE

Pediatricians can receive Category 1 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 current knowledge of the material before reading further.

In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

EDUCATIONAL OBJECTIVES

Abdominal complaints are perhaps some of the most common issues presenting to the practicing pediatrician and account for a large portion of missed school days in American children. When faced with the child complaining of chronic recurrent abdominal pain, the pediatrician must balance the benefit of multiple studies against the possibility of reinforcing the fears of the child and the parents with too much investigation. The Rome ? criteria provide a simple yet effective classification of functional disorders of the gastrointestinal tract and allow clinical diagnosis without unnecessary and at times invasive studies.

When investigation is warranted newer serological assays allow earlier and more effective diagnosis of inflammatory bowel disease and celiac disease in children assuring a better long-term quality of life. It is clear that with early intervention these children can achieve normal growth and development and lead normal lives. Indeed, even in the smallest of our patients liver disease has become an entity that can be more accurately diagnosed and successfully treated when addressed early. Improved diagnostic criteria and treatment modalities have made the management of GER straightforward and accessible to all pediatric practitioners.

This issue of Pediatric Annals provides focused reviews on each of these areas as well as excellent guidelines for evaluation and management. This month's collection affords the participant the opportunity to more thoroughly evaluate and manage children with suspected inflammatory bowel disease, gastroesophageal reflux, and celiac disease, as well as neonates with prolonged or late-onset jaundice.

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 should you choose to request them.

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: VINDICO MEDICAL EDUCATION, PO Box 36, Thorofare NJ 08086. Payment should be made in US dollars drawn on a US bank.

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. Upon receiving your grade, you may request quiz answers. Contact our customer service department at (856) 994-9400.

8. Be sure to mail the CME registration form on or before the deadline listed. After that date, the quiz will close. 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. Learning objectives are found at the beginning of each CME article.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Vindico Medical Education and SLACK Incorporated. Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

CME activities formerly sponsored by SLACK Incorporated will be sponsored by Vindico Medical Education, a part of the SLACK Group. CME credits will be issued by Vindico Medical Education.

Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™1. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FULL DISCLOSURE POLICY

In accordance with the Accreditation Council forContinuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

UNLABELED AND INVESTIGATIONAL USAGE

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products orto products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.

Questions 1 through 5 are taken from the article "Gastroesophageal Reflux in Infancy and Childhood" by Eugene Suwandhi, MD; Mimi N. Ton, MD; and Steven M. Schwarz, MD (see pages 259-266).

1. By age 4 months, what percentage of infants demonstrate gastroesophageal reflux (GER)?:

A. 20%.

B. 40%.

C. 70%.

D. 90%.

2. A 6-week-old breastfed infant presents with feeding-associated irritability, arching while nursing, and nonbilious post-prandial emesis. Growth has been adequate, but the baby's nursing seems reduced. Your first therapeutic decision includes which of the following in this case?:

A. Starting a hypoa Merge nie formula.

B. Introducing thickened feeds.

C. Prescribing an H2 receptor antagonist.

D. Using prone positioning after feeding.

3. You are treating a 14-year-old girl for heartburn that appears to be worse in the morning and after a large meal. Despite treatment with ranitidine at a dose of 1 50 mg twice a day, she develops breakthrough symptoms. You suggest dietary changes and recommend which of the following therapies?:

A. Metoclopramide, 10 mg three times per day, taken 30 minutes before meals.

B. Lansoprazole, 30 mg every morning.

C. Omeprazole, 20 mg twice per day.

D. Increase ranitidine to 300 mg in the morning and 1 50 mg in the evening.

4. The most accurate and reliable method of diagnosing GER in children is:

A. 24-hour intraesophageal pH monitoring.

B. Upper gastroinstestinal (Gl) endoscopy.

C. Esophageal electrical impedance.

D. Technetium-labeled "milk" scintigraphy.

5. Anti-reflux surgery should be considered in which of the following conditions:

A. Initial evaluation demonstrated erosive esophagitis on endoscopic biopsy.

B. Barium swallow demonstrates severe Gl reflux.

C. Barrett's esophagitis.

D. Poor clinical response to H2 receptor antagonists.

Questions 6 through 70 are taken from the article "Inflammatory Bowel Diseases" by Ari Silbermintz, MD; and James Markowitz, MD (see pages 268-274).

6. Which of the following statements regarding the NOD2/ CARDI 5 gene is true?:

10.3928/0090-4481-20060401-09

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