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Our Services :: Post-Adoption Evaluation :: CME QUIZ

Medical Evaluation at Arrival
as written by Dr. Jane Aronson
for Pediatric Annals, Vol. 29, No 4, April 2000

Pretest Questions

1.  Rickets is caused by vitamin C deficiency: True or False?
False; Rickets is caused by vitamin D and calcium deficiency

2.  A PPD should not be performed on a child with a history of prior BCG vaccination: True or False?
False; PPD should be performed on all children adopted from abroad regardless of BCG vaccination unless the skin area of the BCG is infected and draining

3.  Failure to Thrive is common in children adopted from abroad: True or False?
True; Greater than 50% of children living in orphanages are failing to thrive

CME Quiz (answers at bottom)
1. When a PPD is read as greater than or equal to 10 mm in a child adopted from abroad, the following should be done:
a.
b.
c.

d.
Nothing
A chest x-ray should be performed
A chest x-ray should be performed and if it is normal, 9 months of isoniazid should be recommended as preventive therapy
A chest x-ray should be performed and if it is negative, no therapy should be recommended if the child has had the BCG vaccine
 
2. When a child adopted from abroad arrives in the U.S., the following hepatitis serology should be performed:
a.
b.
c.

d.
Hepatitis A IgM and IgG
Hepatitis B surface antigen only
Hepatitis B surface antibody, Hepatitis B surface antigen, and Hepatitis B core antibody (IgG)
Hepatitis B surface antibody, Hepatitis B surface antigen, Hepatitis B core antibody (IgG), Hepatitis C antibody
 
3. Lead poisoning in children adopted from abroad is most commonly found in which country:

a.
b.
c.
d.
e.

Russia
Guatemala
China
Vietnam
Romania
 
4. The classic features of Fetal Alcohol Syndrome are:

a.
b.
c.
d.

large ears, mid-facial hypoplasia, and skeletal anomalies
large eyes, micrognathia, failure to thrive, and microcephaly
small palpebral fissures, long flat philtrum, thin upper lip, and microcephaly
heart murmur, kidney anomalies, small palpebral fissures, and microcephaly
 
 

Bibliography

1. American Academy of Pediatrics. Appendix I. In Peter G. ed.1997 Redbook: Report of the Committee on Infectious Diseases. 24th ed. . Elk Grove Village, IL: American Academy of Pediatrics, 1997: 667.

2. American Academy of Pediatrics. Medical Evaluation of Internationally Adopted Children. In Peter G. ed. 1997 Redbook: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics, 1997:116-120.

3. Aronson J E. Rickets in Chinese Children. Families with Children from China/San Francisco Bay Newsletter. 1998; 3: 34,36.

4. Jenista J A. Rickets in the 1990's. Adoption/Medical News. 1997; III, no.6, 1-4.

5. Blizzard R M, Bulatovic A. Syndromes of Psychosocial Short Stature. In Lipshitz F. ed. Pediatric Endocrinology. New York: Marcel Dekker, inc.1996:

6. Bakwin H. Emotional Deprivation in Infants. J Pediatr. 1949; 35: 512-521.

7. Hostetter M K, Johnson D E.Immunization Status of Adoptees from China, Russia, and Eastern Europe. Society for Pediatric Research. Abstract #851, New Orleans, LA. May 1-4.

8. Shen X, Rosen J F, Guo D, Wu S. Childhood Lead Poisoning in China. The Science of the Total Environment. 1996; 181: 101-109.

9. Aronson J E. Why is Lead a Problem? International Adoption and Health. The Yale-China Review. 1998; 6: no. 1, 30-31.

10. Aronson J E, Johnson D E, Hostetter M K, Traister M, Smith A M, Kothari V, Alonso M. Lead Poisoning in Children Adopted from China. Ambulatory Pediatric Association, Abstract #45, May 1999.

11. Report of the Working Group on Tuberculosis Among Foreign-Born Persons. MMWR. 1998; 47: 1-29.

12. American Academy of Pediatrics. Tuberculosis. In Peter G. ed.1997 Redbook: Report of the Committee on Infectious Diseases. 24th ed. . Elk Grove Village, IL: American Academy of Pediatrics, 1997: 541-562.

13. Miller L C, Kiernan M T, Mathers M I, Klein-Gitelman M. Developmental and Nutritional Status of Internationally Adopted Children. Arch Pediatr Adolesc Med. 1995; 149: 40-44.

14. Hostetter M K, Johnson D E. Medical Examination of the Internationally Adopted Child. Postgrad Med. 1996; 99: 70-82.

15. Hendrie N. Adoptmed@u.washington.edu. Personal Communication. January 14, 1999.

16. Centers for Disease Control and Prevention.Tuberculin Skin Test Survey in a Pediatric Population with High BCG Vaccination Coverage-Botswana, 1996. MMWR. 1997; 46: 846-851.

17. Lifschitz M. The Value of the Tuberculin Skin Test as a Screening Test for Tuberculosis among BCG-Vaccinated Children. Pediatrics. 1965;36: 624-627.

18. Nemir R L , Teichner A. Management of Tuberculin Reactors in Children and Adolescents Previously Vaccinated with BCG. Pediatr Infect Dis J. 1983; 2: 446-451.

19. Otten J. International Adoptions Pose Extra TB Problems. TB Monitor. 1997; 4: 91-93.

20. Johnson D E, Traister M. Micronutrient Deficiencies, Growth Failure and Developmental Delays are More Prevalent then Infectious Diseases in US Adopted Chinese Orphans. Pediatr Res. #735, May 1999.

21. Jenista J A. Is There Life After Hepaititis B? Families with Children from China Newsletter/Greater New York, Connnecticut, New Jersey. 1997; 4: 22.

22. Miller L C, Kiernan M T, Mathers M I, Klein-Gitelman M. Developmental and Nutritional Status of Internationally Adopted Children. Arch Pediatr Adolesc Med. 1995; 149: 40-44.

23. Traister M, Aronson, J E. Personal communication regarding Hepatitis C. 1998.

24. Johnson D E. Personal communication regarding Hepatitis C on Adoptmed@u.washington.edu.December10, 1998.

25. Chen X C, Wang W G, Yan H C, Yin T A, Xu Q M. Studies on Iron Deficiency Anemia, Rickets, and Zinc Deficiency and their Prevention among Chinese Preschool Children. Progress in Food and Nutrition Science. 1992; 16: 263-277.

26. Glader B E, Look K A. Hematologic Disorders in Children from Southeast Asia. Pediatric Clinics of North America. 1996; 43: 665-681.

27. Aronson J E Iodine Deficiency: How Concerned Should You Be?. Families with Children from China newsletter. 1997; 4: 10.

28. Miller L et al. Developmental Findings in Chinese Adoptees. Joint Council on international children's services. April 14, 1999.

29. Johnson D E, Traister M. Micronutrient Deficiencies, Growth Failure and Developmental Delays are More Prevalent then Infectious Diseases in US Adopted Chinese Orphans. Pediatr Res. #735, May 1999.

30. Streissguth A P. Fetal Alcohol Syndrome/A Guide for Families and Communities. Maryland: Paul H. Brookes Publishing, 1997.

 
 
Answer Key:
1. c
2. d
3. c
4. c
 
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  This page last updated July 31, 2007 5:01 PM EST