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 SLACK Incorporated. 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 i 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 INVESTIGATlONAL 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 "Understanding Stress in Children" by Joshua D, Sparrow, MD (see pages 187-1 94).
1. In times of disaster, which of the following does not predict a likely serious stress reaction in the child?
A. Separation from parents.
B. Gender of the child.
C. Close geographic proximity.
D. Immediate physical consequences.
2. Which of the following is a stress-response brain structure shared by humans and other primates?
C. Pre-frontal cortex.
D. Pituitary gland.
3. Physiologic stress reactions can affect all of the following except:
A. Cardiovascular system.
B. Immune system
C. Brain function.
D. Ophthalmologic system.
4. In times of crisis and disaster, children have the least longterm psychopathological sequelae if:
A. They remain in proximity to their parents.
B. They are younger.
C. They reenact the disaster repeatedly.
D. They relocate to safety even if separated from their parents.
5. Prolonged exposure to stress can produce all of the following changes in an individual's mental health except:
A. Posttraumatic stress disorder.
C. Improved attention.
D. Motor hyperactivity.
Questions 6 through 10 are taken from the article "Maternal Depression and Childhood Outcomes" by Patti L Johnson, PhD; and Eric M. Flake, MD (see pages 196-202).
6. Offspring of a parent with depression are this much more likely to develop depression when compared to those of parents without depression:
A. 3 times more likely.
B. 5 times more likely.
C. 10 times more likely.
D. 15 times more likely.
7. What percentage of women experience transient postpartum"blues"?
8. School-aged children of depressed mothers are more prone to all except:
C Conduct disorder.
D. Attention-deficit hyperactivity disorder.
9. In diagnosing depression, core symptoms include a persistent sadness and/or loss of pleasure in activities lasting for;
A. 2 or more weeks.
B. 4 or more weeks.
C. 8 or more weeks.
D. At least 12 weeks.
10. Protective factors against the child's effects of maternal depression include:
A. One healthy parent.
B. Good sibling relationship.
C. Good coping and social skills.
D. All of the above.
Questions 11 through 15 are taken from the article ''The Impact of Trauma: A Developmental Framework for infancy and Early Childhood" by Alicia F. Lieberman, PhD; and Kathleen Knorr, LICSW1 (see pages 209-215).
11. What percentage of fatal abuse occurs in children under 6 years of age?
12. Children who witness violence in the home are how many times more likely to experience abuse?
A. 15 times more likely.
B. 10 times more likely.
C 5 times more likely.
D. 2.5 times more likely.
13. Primary motivations that shape how infants and young children respond to their environment are:
A. Temperature and fear.
B. Attachment and exploration.
C. Hunger and control.
D. Angerand ownership.
14. Reparation anxiety refers to:
A. Inability to feed.
B. Lack of boundaries.
C. Fear of loss of the parent.
D. Anxiety with acquisition of ambulation.
15. Hyperarousal in young children is manifested as:
A. Increased feeding.
B. Increased irritability.
C. Regression in developmental milestones.
D. Deep sleeping.
Questions 16 through 20 are taken from the article "Recognizing and Responding to Child and Adolescent Stress: The Critical Role of the Pediatrician" by Keith M. Lemmon, MD1 FAAP; and Elisabeth M. Stafford, MD, FAAP, FSAM (see pages 225-23 V:
16. The 7 "Cs" of resiliency include all except:
17. Pediatricians can address issues of childhood stress by implementing all of the following except:
A. Pro-active screening for stress during clinical encounters.
B. Utilizing brief screening questionnaires.
C. Reminding parents stress is"just a phase."
D. Educating parents on signs and symptoms of stress in childhood.
18. Common Stressors impacting military families include:
A. Frequent relocations.
B. Lack of proximity to extended family support.
C Intermittent, extended military parent absence.
D. All of the above.
19. Emotional intelligence includes all of the following features except:
A. Perception of emotions.
B. Creation of emotional responses.
C. Assimilation of emotions.
D. Management of emotions.
20. "New morbidities" in pediatrics include all except:
A. Childhood cancer.
B. Firearms in the home.
C. School violence.
D. Sexual activity.