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Volume 20, Number 5—May 2014

CME ACTIVITY

Outbreaks of Kingella kingae Infections in Daycare Facilities

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title: Outbreaks of Kingella kingae Infections in Daycare Facilities

CME Questions

1. You are seeing a 3-year-old boy who was just diagnosed with osteomyelitis of the left tibia. The child attends day care 5 times per week. You consider whether this patient might have a hematogenous infection with Kingella kingae. Besides the bones, this organism displays a tropism for what other anatomic site?

A. Esophagus

B. Kidneys

C. Brain

D. Heart

2. What should you consider regarding the clinical presentation of invasive infection with K. kingae?

A. Most children with invasive infection have multiple chronic medical conditions

B. Nearly all children have fever

C. A normal serum C-reactive protein level rules out the possibility of K. kingae osteomyelitis

D. The typical presentation of K. kingae bacteremia makes the diagnosis easy to miss

3. You initiate laboratory work to identify possible K. kingae infection for this patient. Which of the following statements regarding the diagnostic process for K. kingae infections is most accurate?

A. Less than 1% of children between 12 and 24 months old harbor the K. kingae bacterium

B. Bone exudates in particular grow well on routine solid culture media

C. Medium consisting of blood-agar with added 2 mg/mL of vancomycin should be avoided in respiratory cultures

D. Nucleic acid amplification assays have improved the sensitivity of detection of K. kingae and reduce the time needed for diagnosis

4. The patient is diagnosed with K. kingae osteomyelitis. What should you consider regarding a possible outbreak of infection in his day care class?

A. Previous data suggest that the risk for another K. kingae infection within 1 month exceeds 10%

B. Isoniazid is the drug of choice as prophylaxis

C. Azithromycin is the drug of choice as prophylaxis

D. Multiple antibiotic prescriptions are associated with 100% eradication of K. kingae

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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