Clinical quiz

Clinical Quiz questions are based on selected articles in this issue. Answers appear in this issue.

American Family Physician has been approved by the American Academy of Family Physicians as having educational content acceptable for Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of January 2003. This issue has been reviewed and is acceptable for up to 4 Prescribed credit hours. Credit may be claimed for one year from the date of this issue. When reporting CME credit hours, AAFP members should report total Prescribed credit hours earned for this activity. It is not necessary for members to label credit hours as evidence-based or Prescribed for CME reporting purposes.

The American Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AAFP designates this educational activity for a maximum of 4 hours in Category 1 credit toward the American Medical Association Physician’s Recognition Award. Each physician should claim only those hours of credit that he or she actually spent in the educational activity.

AAFP Credit

Each copy of AFP contains a Clinical Quiz answer card. AAFP members may use this card to obtain the designated number of Prescribed credit hours for the year in which the card is postmarked.

AMA/PRA Category 1 Credit

AAFP members who satisfy the Academy’s continuing medical education requirements are automatically eligible for the AMA/PRA.

Physicians who are not members of the AAFP are eligible to receive the designated number of credit hours in Category 1 of the AMA/PRA on completion and return of the Clinical Quiz answer card. AFP keeps a record of AMA/PRA Category 1 credit hours for nonmember physicians. This record will be provided on request; however, nonmembers are responsible for reporting their own Category 1 CME credits when applying for the AMA/PRA or other certificates or credentials.

For health care professionals who are not physicians and are AFP subscribers, a record of CME credit is kept by AAFP and will be provided to you on written request. You are responsible for reporting CME hours to your professional organization.

Instructions

Read each article, answer all questions on the quiz pages, and transfer your answers to the Clinical Quiz answer card (bound into your copy of AFP). This will help you avoid errors and permit you to check your answers against the correct answers.

E Mail the Clinical Quiz answer card within one year (by January 31, 2004). The bar code on the answer card contains your identification for CME credit hours.

Before beginning the test, please note:

Each Clinical Quiz includes two types of questions: Type A and Type X.

Type A questions have only one correct answer and may have four or five choices. Here is a typical Type A question:

Q1. Most allergic reactions to foods are:

[] A. Due to IgA deficiency.

[] B. Due to IgG and IgM antibodies.

[check] C. IgE-mediated.

[] D. Due to enzyme deficiencies.

[] E. Due to toxins.

Type X questions may have one or more correct answers. They are

multiple true-false questions with four options. Here

is a typical Type X question:

Q2. Causes of varicosities in pregnancy

include:

[check] A. Hormonal changes.

[check] B. Venous compression.

[check] C. Familial tendency.

[check] D. Prolonged sitting and standing.

Clinical Quiz questions are written by the associate and assistant

editors of AFP.

Type A Questions

Each question has only one correct answer.

Articles

Diagnosis of Eating Disorders in Primary Care (p. 297)

Q1. Which one of the following laboratory abnormalities is most likely

to be found in patients with anorexia nervosa or bulimia nervosa?

[] A. Leukocytosis.

[] B. Elevated thyroid-stimulating hormone level.

[] C. Metabolic acidosis.

[] D. Hypokalemia.

[] E. Hypernatremia.

Acute Respiratory Distress Syndrome (p. 315)

Q2. Which one of the following is the most common risk factor for acute

respiratory distress syndrome?

[] A. Near drowning.

[] B. Pulmonary contusion.

[] C. Severe trauma.

[] D. Sepsis syndrome.

[] E. Pneumonia.

Q3. Which one the following describes the initial auscultatory findings

in a dyspneic patient developing acute respiratory distress syndrome?

[] A. Normal.

[] B. Diffuse bronchi.

[] C. Coarse rales.

[] D. Fine crepitations.

[] E. Coarse crepitations.

Seizure Disorders in the Elderly (p. 325)

Q4. Which one of the following statements about seizures in elderly

patients is correct?

[] A. Patients who have a first seizure must be started on

antiepileptic drug therapy as soon as possible after the initial

seizure is controlled.

[] B. Lifelong treatment is always needed after a seizure.

[] C. In older patients, generalized epilepsy is more common than

partial epilepsy.

[] D. Older patients with seizures appear to be more responsive to

antiepileptic drugs than younger patients.

Alternative Therapies for Traditional Disease States: Osteoarthritis

(p. 339)

Q5. In the treatment of osteoarthritis, chondroitin has been shown to

have which one of the following results?

[] A. It promotes cartilage regeneration.

[] B. It improves symptoms of osteoarthritis.

[] C. It provides long-term improvement of osteoarthritis.

[] D. It has a faster onset of action than nonsteroidal

anti-inflammatory drugs (NSAIDSs).

[] E. It causes more gastrointestinal side effects than NSAIDs.

Q6. Glucosamine has been shown to have which one of the following

effects?

[] A. It makes arthroscopically-confirmed improvements in arthritic

cartilage.

[] B. It provides relief of arthritis pain within one week.

[] C. It can cause severe stomach ulcers.

[] D. It reduces the amount of proteoglycans produced by cartilage.

[] E. It has some efficacy in decreasing the pain of osteoarthritis.

Chronic Illness and Sexual Functioning (p. 347)

Q7. Which one of the following medication classes is least likely to

have a negative effect on sexual functioning?

[] A. Anticholinergics.

[] B. Angiotensin-converting enzyme inhibitors.

[] C. Diuretics.

[] D. Narcotics.

[] E. Protease inhibitors.

Q8. In patients who have undergone radical prostatectomy, sexual

functioning may improve with the administration of which one of the

following?

[] A. Leuprolide (Lupron).

[] B. Tamoxifen (Nolvadex).

[] C. Sildenafil.

[] D. Additional radiation therapy.

U.S. Preventive Services Task Force: Recommendations and Rationale

Postmenopausal Hormone Replacement Therapy for the Primary Prevention

of Chronic Conditions: Recommendations and Rationale (p. 359)

Q9. Which one of the following statements best characterizes the

conclusions drawn by the U.S. Preventive Services Task Force

regarding the combined use of estrogen and progestin to prevent

chronic conditions?

[] A. Harms include decreased bone mineral density.

[] B. The harmful effects are likely to exceed the benefits in most

women.

[] C. There is no effect on the risk of colorectal cancer.

[] D. Benefits include a reduction in the incidence of cholecystitis.

[] E. Combined use of estrogen and progestin increases all-cause

mortality.

Type X Questions

Each question has one or more correct answers.

Diagnosis of Eating Disorders in Primary Care (p. 297)

Q10. Which of the following statements about the outcome of eating

disorders is/are correct?

[] A. About one half of patients with anorexia have good outcomes.

[] B. Older age at diagnosis carries a more favorable prognosis.

[] C. About 10 percent of patients with anorexia have poor outcomes.

[] D. Social and family relationships influence prognosis.

Acute Respiratory Distress Syndrome (p. 315)

Q11. Which of the following pharmacologic agents has/have been shown

to be clinically efficacious in the treatment of acute respiratory

distress syndrome?

[] A. Prophylactic antibiotics.

[] B. N-acetylcysteine (Mucomyst).

[] C. Beta agonists.

[] D. Nitroprusside (Nipride).

Seizure Disorders in the Elderly (p. 325)

Q12. Which of the following statements about the diagnostic evaluation

of seizures in elderly patients is/are correct?

[] A. Every patient should have echocardiography, Holter monitoring,

and carotid Doppler ultrasonography.

[] B. Lumbar puncture is required in all elderly patients with

new-onset seizure.

[] C. Magnetic resonance imaging is the neuroimaging examination of

choice.

[] D. Electroencephalography can help to classify the seizure type.

Chronic Illness and Sexual Functioning (p. 347)

Q13. Which of the following may interfere with sexual functioning in

patients who have spinal cord injury or other conditions that impair

the neurologic system?

[] A. Muscle spasticity.

[] B. Lack of sensation.

[] C. Ejaculatory dysfunction.

[] D. Loss of sphincter control.

U.S. Preventive Services Task Force: Recommendations and Rationale

Postmenopausal Hormone Replacement Therapy for the Primary Prevention

of Chronic Conditions: Recommendations and Rationale (p. 359)

Q14. Which of the following statements best characterizes the

recommendations of the U.S. Preventive Services Task Force (USPSTF)

regarding hormone replacement therapy in postmenopausal women?

[] A. The USPSTF recommends prescribing combined estrogen and

progestin for the prevention of chronic conditions.

[] B. The USPSTF recommends against the use of either unopposed

estrogen or combined estrogen and progestin for the prevention of

chronic conditions.

[] C. The USPSTF recommends against the use of combined estrogen and

progestin for the prevention of chronic conditions.

[] D. The USPSTF recommends prescribing unopposed estrogen for the

prevention of chronic conditions in women who have had a

hysterectomy.

CME Quality Survey

Please answer the following questions to help us monitor the quality of AFP’s CME material on an ongoing basis. Mark your answers on this issue’s quiz card. We would appreciate hearing any suggestions you have for improving the CME experience offered through AFP. See the directory on page 226.

Q1. Which of the following articles covered in this quiz provide

information that you find useful? (On the answer card, please circle

all that apply.)

[] A. Diagnosis of Eating Disorders in Primary Care (p. 297).

[] B. Acute Respiratory Distress Syndrome (p. 315).

[] C. Seizure Disorders in the Elderly (p. 325).

[] D. Alternative Therapies for Traditional Disease States:

Osteoarthritis (p. 339).

[] E. Chronic Illness and Sexual Functioning (p. 347).

[] F. Postmenopausal Hormone Replacement Therapy for the Primary

Prevention of Chronic Conditions (p. 359).

Q2. In general, how clear was the presentation of the information in

these articles? (On the answer card, please circle one number: 5 =

extremely clear; 0 = extremely unclear.)

Q3. Thinking of all the issues of AFP that you’ve seen recently,

please rate the overall quality of AFP as a vehicle for continuing

medical education in the clinical aspects of practice. (On the answer

card, please circle one number: 5

= excellent; 0 = poor.)

Answers to This Issue’s Clinical Quiz

Q1. D

Q2. D

Q3. A

Q4. D

Q5. B

Q6. E

Q7. B

Q8. C

Q9. B

Q10. A,D

Q11. C

Q12. C,D

Q13. A,B,C,D

Q14. C

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group