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CME examination
376
Instructions
for
earning
INSTRUCTIONS
self-assessment
category
J. ALLERGY CLIN. IMMUNOL. FEBRUARY 1988
1 credit
FOR EARNING SELF-ASSESSMENT
Pleasenote. The answer sheets for receiving CME credit are no longer included with the self-assessment articles. The self-assessment questions and answers, however, are printed for those wishing to assess themselves. If CME credit is
CME examination
CATEGORY 1 CREDIT
required, participants can call the American Academy of Allergy and Immunology office (414/272-6071) for answer sheets that should be completed and returned for receipt of Category I credit.
Identification
No. 028835
Fisher SR, Newman CE. Surgical perspectives on allergic airway disease. J ALLERGYCLIN IMMUNOL 1988;81:361-
76. Questions l-28 Give the correct answers (a, b, c, d, or e) for each of the following questions: 1. At what age does the frontal sinus appear radiographically? a. Birth b. 2-3 yr c. 6-7 yr d. 12-13 yr e. Puberty 2. CT evaluation is indicated in evaluation of: a. Orbital cellulitis b. Chronic sinusitis c. Orbital proptosis d. All above e. None of the above 3. Polyps are commonly associated with: a. Aspirin sensitivity b. CF c. Asthma d. All of the above e. aandconly 4. Common findings in uncomplicated sinusitis include all except: a. Pain over the involved sinus b. AF level on x-ray film c. Elevated temperature >lOl” F d. Nasal discharge e. Pressure sensation 5. Which radiograph view best demonstrates the maxillary sinus? a. Caldwell b. Waters c. Latera d. Submental vertex e. None of the above
6. The most common fungus infection of the paranasal sinuses: a. Mucor b. Aspergillus c. Candida albicans d. Penicillum e. Corynibacterim 7. Clinically, the level of the cribiform plate can be estimated by all of the following anatomic landmarks except: a. Middle pupillary line b. Medial canthus c. Roof of the ethmoid sinus d. Frontoethmoid suture line e. Superior attachment of the middle turbinate 8. Which procedure involves obliteration of the frontal sinus? a. Osteoplastic flap b. Sewall-Boyden procedure c. Lynch procedure d. Trephination e. Caldwell-Luc 9. Which sinuses have their ostia within the middle meatus? a. Frontal b. Posterior ethmoid c. Maxillary d. All of the above e. aandc 10. The best initial procedure for surgical drainage of the frontal sinus for an acute infection would be: a. Frontoethmoidectomy b. Intranasal ethmoidectomy c. Maxillary antrostomy d. Trephination e. Caldwell-Luc
VOLUME 81 rYUMRER 2
11 Most common organism in acute sinusitis in adults: a. o-hemolytic Streptococcus b Pneumococcus c Staphlococcus d Klebsiella e. Anaerobic organisms 12 An integral step in the workup of all children with nasal polyps would be: a. Allergen skin testing b. CT scan c. Sweat test d. Polypectomy e. RAST 13. Radiographic evidence of sinusitis include all except: a. Mucosal thickening of 4 mm b. AF level on x-ray film c. Opacified sinus d. Loss or thinning of lamina e. Bone destruction 14. A serious complication of excessive turbinate reduction is: a. Rhinitis medicomentous b. Diplopia c. Atrophic rhinitis d. Maxillary sinusitis e. Eustachian tube dysfunction 15. Ablation of the frontal sinus is indicated for: a. Polypoid sinusitis b. Recurrent ethmoiditis c. Osteomyelitis d. Acute frontal sinusitis e. Frontal lobe abscess 16. The nasoantral window: a. Is generally part of the Lynch procedure b. Creates dependent drainage for the ethmoid sinus c. Is usually created in the middle meatus d. Is generally performed intranasally e. Usually disrupts the nasolacrimal duct 17. In the adult, the floor of the maxillary sinus is: a. Approximately 5 mm above the floor of the nose b. Generally at the same level as the floor of the nose c. Approximately 5 mm below the floor of the nose d. At the level of the inferior turbinate e. Horizontal 18. Turbinate reduction has been performed with all except: a. Electrocautery
b Cryotherapy c. Submucous resection d. Laser e. Embolization 19. Clinical presentation of atrophic rhrnmi includes all except: a. Nasal mucosal drying b. Recurrent bleeding c. Offensive smell d. Enlarged turbinates e. Excessive crusting 20. Current belief about polypectomY include all except: a. A useful procedure in a child with CF and nasal polyps b. Frequently will result in the development of asthma c. May lead to improved medical therapy of subjects with asthma d. May precipitate an asthmatic attack e. Frequently will be followed by recurrence 21. Opacification of the paranasai sinuses in children with CF will occur in what percentage of patients’? a.90% 22. The antral choanal polyp is most successfully treated by: a. Simple intranasal polypectomy b . Ethmoidectomy c. Nasal steroids d. Caldwell-Luc procedure or polypectomy e. Transpalatal resection 23. Antral lavage: a. Is generally necessary to treat refractory acute sinusitis b. Will obtain a more accurate culture than a nasal culture of drainage c. Will hasten the resolution of acute sinusitis d. All of the above e. aandconly 24. Which of the following is not an indication for a maxillary sinus drainage procedure”? a. Antroal choanal polyp b. Turbinate hypertrophy c Recurrent sinusitis d. Antral cyst with obstruction e. Before radiation therapy of the nose 25. Nasal obstruction after continuous use of a topical nasoconstrictor is most likely caused by: a. Rhinitis medicamentosa
CME
J. ALLERGY CLIN. IMMUNOL. FEBRUARY 1999
examination
b. Nasal polyps c . Septal perforation d. Deviated septum e. Hypertrophic turbinates 26. Orbital cellulitis: a. Is frequently caused by maxillary sinusitis b. Requires immediate drainage of the orbit c. Is most commonly caused by ethmoiditis d. Is associated with loss of vision e. All of the above 27. Preoperative planning in allergic patients requires: a. Scheduling surgery so as to avoid the patient’s peak seasonal allergy
b. Attention to specific drug and food allergies c. Adequate medical therapy of any associated pulmonary disease d. Perioperative steroid coverage for steroiddependent patients e. All of the above 28. Initial treatment of acute sinusitis involves: a. Nasal or oral decongestant b. Sinus drainage procedure and lavage c . Appropriate antibiotics d. All of the above e. aandconly
Answers for December CME examination*
Identification
No. 128734
Platts-Miis TAE, Chapman MD. Dust mites: Immunology, allergic disease, and environmental control. J ALLERGYCLIN IMMUNOL 1987;80:755-75.
Answers 1. b (p. c (p. d (p. c (p. a (p.
2. 3. 4. 5.
1-5 756) 756) 756) 756) 756)
Answers 8-9 6. b (pp. 756-7) 7. d (pp. 756-7) 8. a (pp. 756-7) 9. c (pp. 756-7) The terminology accepted by WHO is based on the first three letters of the genus name followed by the first letter of the species name. The roman numeral I indicates that this was the first major allergen purified from this source. Answers lo-13 10. b (p. 757) 11. a (p. 757) 12. a (pp. 757-8) 13. b (p. 757) Mite allergens are rapidly denatured at 212” F and are denatured within hours at 140” F. There is extensive homology between the three group I allergens and between group II allergens, but the *Page numbers refer to journal pages.
378
proteins of the two groups appear to be completely distinct. Answer 14 14. c (pp. 756-7, 769-70) (i) is incorrect because Der p I is present in extracts made from mite bodies. (iii) is incorrect because current evidence demonstrates that D . pceronyssinus is prevalent in many parts of the United States. (iv) is incorrect because all commercially available extracts in the United States are made from mites grown on media other than human skin scales. Answer
15
15. c (p. 758) Currently, no specific allergen measurements are made on house dust extracts. There are no controlled trials of house dust versus mite extract demonstrating that house dust is less effective. Most companies avoid collecting house dust during the local pollen seasons. The Allergenic Products Advisory Committee has recommended that house dust be declared category II, but no regulatory action has been taken yet. Answer
18
16. b (pp. 763, 765) (i) is incorrect because fecal particles are similar in size to pollen grains. (iv) is incorrect because
Instructions
for
earning
INSTRUCTIONS
self-assessment
category
J. ALLERGY CLIN. IMMUNOL. FEBRUARY 1988
1 credit
FOR EARNING SELF-ASSESSMENT
Pleasenote. The answer sheets for receiving CME credit are no longer included with the self-assessment articles. The self-assessment questions and answers, however, are printed for those wishing to assess themselves. If CME credit is
CME examination
CATEGORY 1 CREDIT
required, participants can call the American Academy of Allergy and Immunology office (414/272-6071) for answer sheets that should be completed and returned for receipt of Category I credit.
Identification
No. 028835
Fisher SR, Newman CE. Surgical perspectives on allergic airway disease. J ALLERGYCLIN IMMUNOL 1988;81:361-
76. Questions l-28 Give the correct answers (a, b, c, d, or e) for each of the following questions: 1. At what age does the frontal sinus appear radiographically? a. Birth b. 2-3 yr c. 6-7 yr d. 12-13 yr e. Puberty 2. CT evaluation is indicated in evaluation of: a. Orbital cellulitis b. Chronic sinusitis c. Orbital proptosis d. All above e. None of the above 3. Polyps are commonly associated with: a. Aspirin sensitivity b. CF c. Asthma d. All of the above e. aandconly 4. Common findings in uncomplicated sinusitis include all except: a. Pain over the involved sinus b. AF level on x-ray film c. Elevated temperature >lOl” F d. Nasal discharge e. Pressure sensation 5. Which radiograph view best demonstrates the maxillary sinus? a. Caldwell b. Waters c. Latera d. Submental vertex e. None of the above
6. The most common fungus infection of the paranasal sinuses: a. Mucor b. Aspergillus c. Candida albicans d. Penicillum e. Corynibacterim 7. Clinically, the level of the cribiform plate can be estimated by all of the following anatomic landmarks except: a. Middle pupillary line b. Medial canthus c. Roof of the ethmoid sinus d. Frontoethmoid suture line e. Superior attachment of the middle turbinate 8. Which procedure involves obliteration of the frontal sinus? a. Osteoplastic flap b. Sewall-Boyden procedure c. Lynch procedure d. Trephination e. Caldwell-Luc 9. Which sinuses have their ostia within the middle meatus? a. Frontal b. Posterior ethmoid c. Maxillary d. All of the above e. aandc 10. The best initial procedure for surgical drainage of the frontal sinus for an acute infection would be: a. Frontoethmoidectomy b. Intranasal ethmoidectomy c. Maxillary antrostomy d. Trephination e. Caldwell-Luc
VOLUME 81 rYUMRER 2
11 Most common organism in acute sinusitis in adults: a. o-hemolytic Streptococcus b Pneumococcus c Staphlococcus d Klebsiella e. Anaerobic organisms 12 An integral step in the workup of all children with nasal polyps would be: a. Allergen skin testing b. CT scan c. Sweat test d. Polypectomy e. RAST 13. Radiographic evidence of sinusitis include all except: a. Mucosal thickening of 4 mm b. AF level on x-ray film c. Opacified sinus d. Loss or thinning of lamina e. Bone destruction 14. A serious complication of excessive turbinate reduction is: a. Rhinitis medicomentous b. Diplopia c. Atrophic rhinitis d. Maxillary sinusitis e. Eustachian tube dysfunction 15. Ablation of the frontal sinus is indicated for: a. Polypoid sinusitis b. Recurrent ethmoiditis c. Osteomyelitis d. Acute frontal sinusitis e. Frontal lobe abscess 16. The nasoantral window: a. Is generally part of the Lynch procedure b. Creates dependent drainage for the ethmoid sinus c. Is usually created in the middle meatus d. Is generally performed intranasally e. Usually disrupts the nasolacrimal duct 17. In the adult, the floor of the maxillary sinus is: a. Approximately 5 mm above the floor of the nose b. Generally at the same level as the floor of the nose c. Approximately 5 mm below the floor of the nose d. At the level of the inferior turbinate e. Horizontal 18. Turbinate reduction has been performed with all except: a. Electrocautery
b Cryotherapy c. Submucous resection d. Laser e. Embolization 19. Clinical presentation of atrophic rhrnmi includes all except: a. Nasal mucosal drying b. Recurrent bleeding c. Offensive smell d. Enlarged turbinates e. Excessive crusting 20. Current belief about polypectomY include all except: a. A useful procedure in a child with CF and nasal polyps b. Frequently will result in the development of asthma c. May lead to improved medical therapy of subjects with asthma d. May precipitate an asthmatic attack e. Frequently will be followed by recurrence 21. Opacification of the paranasai sinuses in children with CF will occur in what percentage of patients’? a.
CME
J. ALLERGY CLIN. IMMUNOL. FEBRUARY 1999
examination
b. Nasal polyps c . Septal perforation d. Deviated septum e. Hypertrophic turbinates 26. Orbital cellulitis: a. Is frequently caused by maxillary sinusitis b. Requires immediate drainage of the orbit c. Is most commonly caused by ethmoiditis d. Is associated with loss of vision e. All of the above 27. Preoperative planning in allergic patients requires: a. Scheduling surgery so as to avoid the patient’s peak seasonal allergy
b. Attention to specific drug and food allergies c. Adequate medical therapy of any associated pulmonary disease d. Perioperative steroid coverage for steroiddependent patients e. All of the above 28. Initial treatment of acute sinusitis involves: a. Nasal or oral decongestant b. Sinus drainage procedure and lavage c . Appropriate antibiotics d. All of the above e. aandconly
Answers for December CME examination*
Identification
No. 128734
Platts-Miis TAE, Chapman MD. Dust mites: Immunology, allergic disease, and environmental control. J ALLERGYCLIN IMMUNOL 1987;80:755-75.
Answers 1. b (p. c (p. d (p. c (p. a (p.
2. 3. 4. 5.
1-5 756) 756) 756) 756) 756)
Answers 8-9 6. b (pp. 756-7) 7. d (pp. 756-7) 8. a (pp. 756-7) 9. c (pp. 756-7) The terminology accepted by WHO is based on the first three letters of the genus name followed by the first letter of the species name. The roman numeral I indicates that this was the first major allergen purified from this source. Answers lo-13 10. b (p. 757) 11. a (p. 757) 12. a (pp. 757-8) 13. b (p. 757) Mite allergens are rapidly denatured at 212” F and are denatured within hours at 140” F. There is extensive homology between the three group I allergens and between group II allergens, but the *Page numbers refer to journal pages.
378
proteins of the two groups appear to be completely distinct. Answer 14 14. c (pp. 756-7, 769-70) (i) is incorrect because Der p I is present in extracts made from mite bodies. (iii) is incorrect because current evidence demonstrates that D . pceronyssinus is prevalent in many parts of the United States. (iv) is incorrect because all commercially available extracts in the United States are made from mites grown on media other than human skin scales. Answer
15
15. c (p. 758) Currently, no specific allergen measurements are made on house dust extracts. There are no controlled trials of house dust versus mite extract demonstrating that house dust is less effective. Most companies avoid collecting house dust during the local pollen seasons. The Allergenic Products Advisory Committee has recommended that house dust be declared category II, but no regulatory action has been taken yet. Answer
18
16. b (pp. 763, 765) (i) is incorrect because fecal particles are similar in size to pollen grains. (iv) is incorrect because