September JPGN Article
 
1 - Based on this study, which of the following apply to diagnostic testing for CMPA and its gastrointestinal manifestations?
A   - The DBPCFC is the gold?standard test, but impractical in the clinical setting.
B   - Confounding factors causing placebo symptoms are easy to recognize and accounted for when analyzing results in open challenges.
C   - Placebo reactions occur in nearly all patients during the DBPCFC.
D   - Parental perceptions of the etiology of their child’s symptoms may be misinterpreted, and furthermore, parental anxiety plays a role in the management of infants with gastrointestinally manifested CMPA.
2 - Which of the following statements regarding the diagnostic tests for CMPA is true based on this study?
A   - Levels of cow’s milk specific IgE are elevated in CMPA, regardless of presenting symptoms.
B   - Gastrointestinal manifestations of CMPA have various etiologies (most of which are still unproven), but IgE is nearly always negative.
C   - Positive skin prick tests always make performing the DBPCFC unnecessary.
D   - Elevated levels of cow’s milk specific IgG and IgA could indicate CMPA.
3 - The suspicion of gastrointestinally manifested CMPA is often based on unspecific symptoms. Which of the following is true based on this study?
A   - Vomiting and reflux symptoms can be reliably interpreted even when performing an open food challenge.
B   - Constipation is a typical CMPA symptom.
C   - Excessive crying and fussing, when connected to feeding as perceived by the parents, is a likely to be caused by CMPA.
D   - Diarrhea is a typical CMPA symptom.
4 - Which statement regarding the management of gastrointestinally manifested CMPA is true, according to reviewed literature and present study findings?
A   - Non?IgE CMPA patients are generally all tolerant of cow’s milk by age one year, as opposed to 80% of IgE?positive by age five.
B   - One third of patients with gastrointestinally manifested CMPA tolerate small amounts of cow’s milk protein six months after the positive DBPCFC.
C   - Extensively hydrolyzed formulas are well tolerated in gastrointestinally manifested (DBPCFC proven) non-IgE mediated CMPA.
D   - Gastrointestinally manifested CMPA in infancy carries a much higher risk of becoming lactose intolerant in older age.
5 - he most helpful radiology modality to help evaluate and plan appropriate perianal disease management is:
A   - CT scan of the Pelvis
B   - Fistulography
C   - MRI of the Pelvis
D   - Endoscopic Anorectal Ultrasound
6 - Which of the following is the recommended primary surgical procedure for patients with complex perianal fistulae?
A   - Exam under anesthesia and placement of non?cutting setons
B   - Exam under anesthesia and placement of cutting setons
C   - Exam under anesthesia and fistulectomy.
D   - Exam under anesthesia and injection with fibrin glue.
7 - Which class of therapy is not effective in closing or maintaining closure of pediatric perianal fistula?
A   - Immunomodulators
B   - Antibiotics
C   - Corticosteroids
D   - Biologics (infliximab)
E   - Enteral Therapy
8 - What is the primary role of anti?TNF agents in treatment of pediatric perianal Crohn’s disease?
A   - Induction of fistula closure
B   - Maintenance of fistula closure
C   - Adjuvant to surgery
D   - All of the above