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, 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.
Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits"*. Physicians should only daim 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 authence 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 authence is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-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 "New Immunization Strategies for Preventing Infectious Diseases in Adolescents" by Erin M, Bennett, MD; and Joseph B. Domachowske,MD (pages 327-335).
1 . Which of the following is true?
A. Polysaccharide vaccine is associated with more adverse reactions than the conjugate vaccine.
B. Polysaccharide vaccine is processed in a T-cell independent manner.
C. Conjugate vaccine is processed in a B-cell independent manner.
D. Conjugate vaccine induces immune tolerance.
2. Both the conjugate and the polysaccharide meningococcal vaccine available for use in the United States provide protection against which capsular types?
3. In the United States, the currently licensed human papillomavirus vaccine is approved for use in which patients?
A. Females between 9 and 26 years.
B. Females between 1 6 and 26 years.
C. Males and females between 9 and 26 years.
D. Males and females between 1 6 and 26 years.
4. The Advisory Committee on Immunization Practices (ACIP) now recommends which of the following groups receive pertussis-containing booster vaccine?
A. Adolescents only.
B. Health care workers only.
C. Teenage parents only.
D. All adolescents and all adults.
5. Bordetella pertussis infection remains endemic in the United States because:
A. Vaccine efficacy is less than 60%.
B. Vaccine protects against only one strain of B. pertussis.
C. An animal reservoir (dogs) allows the organism to be reintroduced to humans on a periodic basis.
D. An ongoing human reservoir exists because of waning immunity.
Questions 6 through 10 are taken from the article "Pediatric Uses of Fluoroquinolone Antibiotics" by Thomas 5. Murray, MD, PhD; and Robert S. Baltimore, MD (pages 336342).
6. The antimicrobial effect of fluoroquinolones is because of:
A. Inhibition of protein synthesis by binding the ribosome.
B. Inhibition of cell wall synthesis.
C. Inhibition of DNA synthesis by inhibiting the DNA topoisomerase and/or DNA gyrase.
D. Generation of pores in the bacterial cell membrane resulting in cell death.
7. Which statement best describes the safety data of fluoroquinolones in animals and children?
A. Irreversible cartilage toxicity has been demonstrated in both juvenile animals and children.
B. Cartilage toxicity in animals has only been observed in beagles.
C. The cartilage toxicity consistently observed in animals has not been reported in children.
D. Prospective blinded studies in a large number of patients have demonstrated that fluoroquinolone administration in children is safe.
8. The most common mechanism of fluoroquinolone resistance is:
A. Selection of genetic mutations that alter the binding affinity of the drug for its target.
B. Acquisition of plasmids that confer high-level resistance.
C. Up-regulation of drug efflux pumps.
D. Changes in the bacterial cell wall that limit drug entry into the cell.
9. Which of the following statements accurately describes the epidemiology of fluoroquinolone-resistant bacteria?
A. Fluoroquinolone resistance has not developed, even in areas of frequent administration.
B. Fluoroquinolone-resistant bacteria have only been isolated from patients prescribed this class of drugs.
C. Older patients are not at increased risk for harboring fluoroquinolone-resistant organisms.
D. Pneumococcal resistance to ciprofloxacin has been steadily increasing in areas where it is commonly prescribed.
10. Which of the following clinical situations would not be an appropriate indication for a fluoroquinolone?
A. Bacteremia with a multi-drug resistant gram-negative organism.
B. Acute otitis media.
C. Urinary tract infection due to Pseudomonas aeruginosa.
D. Severe gram-negative infection in a patient with allergies to cephalosporins and sulfa drugs.
Questions 11 through 15 are taken from the article "Germs on a Plane - Infectious Issues and the Pediatric International Traveler: A Primer for Pediatricians" by Paul J. Lee, MD; and Leonard R. Krilov, MD (pages 344351).
11. Which of the following is the most common illness that affects international travelers?
A. Traveler's diarrhea.
D. Airplane-acquired respiratory infections.
12. Which of the following statements about pediatric traveler's diarrhea is true?
A. Boys are affected more often by it than girls.
B. It usually resolves spontaneously within 48 hours.
C. It frequently results in severe dehydration and the need for emergent medical care.
D. Its resulting immune response prevents recurrence.
13. When counseling a family considering travel to a Plasmodium falciparum endemic area, all of the following recommendations would apply except:
A. Travel with infants and children is not recommended because of the rapid and life threatening sequelae of P. falciparum infection.
B. Insect repellants, in particular DEET, should be used daily.
C. If sleeping areas have windows, doors, and walls that can keep mosquitoes out, the bed netting is not necessary.
D. Malaria chemoprophylaxis is more important for children than for parents, provided parents were born in the country in question and have pre-existing immunity.
14. What would be the most appropriate recommendation for malaria chemoprophylaxis for a 10 year old traveling to a malaria endemic area in Africa?
A. Mefloquine or atovaqone/proguanil or doxycycline.
B. Chloroquine or hydroxychloroquine.
C. Mefloquine or atovaquone/proguanil or chloroquine.
D. Malaria chemoprophylaxis is not necessary for this trip.
15. Which of the following is true about typhoid vaccine?
A. It should be recommended for all travelers to typhoid endemic areas.
B. Protection is lifelong after immunization.
C. Protection from oral typhoid vaccine lasts longer than with the intramuscular vaccine.
D. Adverse reactions to the oral vaccine are very different from reactions to the intramuscular vaccine.
Questions ? 1 through 1 5 are taken from the article "Bioterrorism: A Clinical Reality" by Robert J. Leggiadro, MD (pages 352-358).
16. The mortality rate associated with inhalational anthrax in the attacks of fall 2001 in the United States was:
1 7. The most likely clinical form of tularemia to result from an intentional release would be:
18. Epidemiologic clues to an intentional release of Clostridium botulinum include:
A. Common geographic exposure without a common dietary history.
B. Rodent exposure.
C. Sick contacts.
D. Disorientation as a clinical feature.
19. Marburg and Ebola viruses are associated with:
A. High mortality.
B. Susceptibility for ribavirin.
D. Known reservoir and vector.
20. The rash of smallpox may be differentiated from that of varicella by:
A. Lesions in the same stage of development in any area of the body.
B. Centripetal distribution.
C. Superficial lesions.
D. Lack of scarring.