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.
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This CME activity is primarily targeted to pediatricians, osteopathic physicians, pediatrie 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 SLACKIncorporated.Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.
Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
FULL DISCLOSURE POLICY
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.
UNLABELED AND INVESTIGATIONAL USAGE
The audience is advised that this continuing medical education activity may contain references to un labe led uses of PDA-approved products or to 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 "Epidemiology of Pediatric Obesity" by Michael Rosenbaum, MD (see pages 89-95).
1. Which geographic region of the United States has the highest prevalence of obesity?
2. The "catch-up growth" view of the contribution of prenatal undernutrition to obesity includes all of the following except:
A. Intrauterine undernutrition provokes neuroendocrinechanges in the form of insulin resistance.
B. Intrauterine undernutrition provokes decreased insulin production.
C. Intrauterine undernutrition provokes decreased insulin-like growth factor production.
D. During the calorie-rich, post-natal, catch-up growth phase, tissues respond by becoming insulin resistant to protect against hypoglycemia.
3. Predominantly breastfeeding for at least 6 months is associated with which of the following?
A. An approximately 20% to 30% reduction in the prevalence of obesity through early adolescence.
B. A 50% reduction in obesity in adulthood.
C. An 80% reduction in risk for metabolic syndrome.
D. A 75% reduction in risk for adult hypertension.
4. While discussing the association between television viewing and obesity during a routine 8-year-old well child exam, you would appropriately include all of the following except:
A. Less than 30% of television commercials during children's programs are food-related.
B. Television watching promotes inactivity.
C. Television watching promotes increased caloric intake.
D. More than 60% of television commercials during children's programs are food- related.
5. The primary risk factor for type 2 diabetes in children is:
A. Family history.
B. History of small for gestational age.
D. History of large for gestational age.
Questions 6 through 10 are taken from the article "Complications of Obesity in Childhood" by Sreenivas Dutt Gunturu, MD; and Svettano Ten, MD (see pages 96-101).
6. The currently estimated percentage of obese children and adolescents in the United States is:
7. Hyperinsulinemia increases blood pressure by:
A. Increasing renal sodium absorption.
B. Increasing sympathetic nervous system activity.
C. Enhancing free fatty acid induced sensitivity to adrenergic stimuli.
D. All of the above.
8. Obese adolescent girls may also present with any of the following except:
A. Menstrual irregularity.
B. Persistent acne.
9. Common sites of involvement with acanthosis nigricans would include all except:
A. Nasolabial folds.
B. Posterior region of the neck.
C. Antecubital fossae.
D. Axillary folds.
10. Psychosocial consequences of obesity in adulthood include:
A. Higher family income.
B. Higher poverty rates.
C. Higher marriage rates.
D. Increased years of education.
Questions 11 through 75 are taken from the article "Comprehensive Behavioral Treatment of Overweight and the Pediatrie Practice" by Deborah De Santis-Moniaci, PhD; and Lisa Altshulerf PhD (seepages 102-108).
11. Children who have a body mass index (BMI) > 85th percentile by ages 3 to 5 are likely to be overweight as adults:
A. 24% of the time.
B. 36% of the time.
C. 48% of the time.
D. More than 60% of the time.
12. The most effective approach to treating overweight in the pediatrie population includes:
C. Family participation.
D. All of the above.
13. Which of the following descriptions is most consistent with stimulus control techniques:
A. External environment is altered to enhance the likelihood that an individual will engage in eating and exercise behaviors that support weight loss.
B. Individuals gain awareness of eating and physical activity habits that contribute to weight gain through daily records.
C. Specific, measurable, and realistic goals are set on a weekly basis.
D. None of the above.
14. Weight maintenance as part of a comprehensive treatment plan for overweight is recommended for:
A. Children 7 and under with no medical complications and for children over 7 whose BMI is between the 85th and 95th percentile.
B. Children 7 and under with a BMI over the 95th percentile experiencing medical co morbidities.
C. Children over 7 with a BMI between the 85th and 95th percentile with medical co morbidities.
D. Children over 7 with a BMI greater than the 95th percentile.
15. A medical evaluation is indicated for all children and adolescents:
A. Whose BMI is greater than the 95th percentile.
B. Who have a BMI between the 85th and 95th percentile and who are experiencing complications.
C. Who have shown large increases in BMI over time.
D. All of the above.
Questions 1 6 through 20 are taken from the article "Type 2 Diabetes in Children and Adolescents" by Chayim Y. Newmark, MD; and Henry Anhalt, DO, FAAP, FACOP, FACE, CDE (pages 109-113).
16. Which of the following minority groups has the highest incidence of type 2 diabetes in children:
C. American Indians.
D. Asian-Pacific Islanders.
17. For overweight individuals with positive risk factors for type 2 diabetes, screening in the office should begin at:
A. 10 years of age or at onset of puberty if puberty occurs earlier.
B. 12 years of age.
C. 8 years of age.
D. 15 years of age in all children regardless of risk factors.
18. Compared to type 1 diabetes, which of the following is less common in type 2 diabetes:
B. Lipid abnormalities.
D. Peripheral neuropathy.
19. All of the following statements regarding hyperosmolar hyperglycémie state are true except:
A. Bicarbonate is usually greater than 15 mEq/mL
B. Patients usually have some alteration in state of consciousness.
C. In more than 70% of cases, this is the initial presentation of a patient's diabetes.
D. Effective serum osmolalrty is 320 mOsm/kg or greater.
20. The main limiting factor in the use of metformin is:
B. Gastrointestinal distress.