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 2 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 2 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.

NOTE: The full text of AFP is available online (www.aafp.org/afp), including each issue’s Clinical Quiz. The table of contents for each online issue will link you to the Clinical Quiz. Just follow the online directions to take the quiz and, if you’re an AAFP member, you can submit your answers for CME credit.

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.

* Mail the Clinical Quiz answer card within one year (by June 30, 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

Acute Abdominal Pain in Children (p. 2321)

Q1. Which one of the following conditions is the most common

cause of abdominal pain in children?

[] A. Appendicitis.

[] B. Mesenteric lymphadenitis.

[] C. Constipation.

[] D. Gastroenteritis.

Q2. Which one of the following conditions is the most common surgical

condition in children with abdominal pain?

[] A. Blunt abdominal trauma.

[] B. Volvulus.

[] C. Appendicitis.

[] D. Intussusception.

The Basic Z-Plasty (p. 2329)

Q3. Which one of the following statements about lengthening a scar

with z-plasty is correct?

[] A. Increased lengthening occurs with smaller lateral arm angles.

[] B. Arm angles of 30 degrees produce a lengthening of about 50

percent.

[] C. Lengthening is always less than the theoretic amount because

of wound tension.

[] D. Lengthening can be accomplished without wound reorientation.

Use of Atypical Antipsychotic Drugs in Patients with Dementia (p. 2335)

Q4. Which one of the following screening measures is

recommended for patients taking an atypical antipsychotic agent?

[] A. Determination of the serum blood level of the medication

twice a year.

[] B. Serum liver function tests twice a year.

[] C. Screening for cataract formation annually.

[] D. Fasting serum blood glucose test twice a year.

[] E. Fasting lipid profile twice a year.

Q5. If it is decided that an atypical antipsychotic agent is needed

in a patient with dementia and Parkinson’s disease, which one of the

following would be the best choice?

[] A. Risperidone (Risperdal).

[] B. Olanzapine (Zyprexa).

[] C. Quetiapine (Seroquel).

[] D. Ziprasidone (Geodon).

[] E. Clozapine (Clozaril).

Q6. Which one of the following is the most effective agent for the

treatment of drug-induced psychosis in patients with Parkinson’s

disease?

[] A. Ziprasidone.

[] B. Clozapine.

[] C. Quetiapine.

[] D. Olanzapine.

[] E. Risperidone.

Automated Ambulatory Blood Pressure Monitoring: Clinical Utility

in the Family Practice Setting (p. 2343)

Q7. As many as 30 percent of patients who are hypertensive have

been noted to have which one of the following?

[] A. End-organ damage.

[] B. White coat hypertension

[] C. Resistant hypertension.

[] D. Postural hypertension.

Q8. Pseudohypertension is caused by which one of the following?

[] A. Anxiety.

[] B. Calcification of the brachial artery.

[] C. Drug side effects.

[] D. Excessive sodium intake.

Clinical Evidence Concise

Helicobacter pylori Infection (p. 2359)

Q9. Eradication of Helicobacter pylori is unlikely to be beneficial

in patients with which one of the following conditions?

[] A. Gastroesophageal reflux.

[] B. Gastric B-cell lymphoma.

[] C. Duodenal ulcers.

[] D. Gastric ulcers.

[] E. Nonulcer dyspepsia.

Cochrane for Clinicians:

Putting Evidence into Practice

Does Long-Term Anticoagulation Improve Function After Stroke? (p. 2317)

Q10. Which one of the following statements about long-term

anticoagulation for prevention of recurrent presumed non-cardioembolic

ischemic stroke or transient ischemic attack is correct?

[] A. Anticoagulation is safe and effective.

[] B. Antiplatelet therapy is a better choice than anticoagulation.

[] C. Anticoagulation reduces the risk of ischemic stroke.

[] D. Warfarin should be used but not heparin.

The Basic Z-Plasty (p. 2329)

Q11. Typical indications for basic z-plasty include which of the

following?

[] A. Removal of keloid scar.

[] B. Lengthening of a contracted scar across a flexor crease.

[] C. Improving functionality of a burn scar contracture.

[] D. Reorientation of a scar into a natural skin fold or lines of

least skin tension.

Q12. Which of the following statements about z-plasty is/are

correct?

[] A. The length of each lateral arm should exactly equal the central

incision over the original scar.

[] B. Each lateral arm must be at precisely the same angle to the

central incision.

[] C. Use of lateral arm angles greater than 60 degrees is recommended

to decrease wound tension.

[] D. Tissue undermining is necessary to properly mobilize the flaps.

Automated Ambulatory Blood Pressure Monitoring: Clinical Utility in

the Family Practice Setting (p. 2343)

Q13. Which of the following is/are indications for use of

ambulatory blood pressure monitoring?

[] A. White coat hypertension.

[] B. Borderline hypertension.

[] C. Well-established, stable hypertension.

[] D. Hypertension that is resistant to drug therapy.

Clinical Evidence Concise

Helicobacter pylori Infection (p. 2359)

Q14. Eradication of Helicobacter pylori is beneficial in patients

with which of the following conditions?

[] A. Duodenal ulcers.

[] B. Gastroesophageal reflux.

[] C. Gastric ulcers.

[] D. Gastric cancer.

Cochrane for Clinicians:

Putting Evidence into Practice

Does Long-Term Anticoagulation Improve Function After Stroke? (p. 2317)

Q15. Which of the following outcomes is/are effects of

anticoagulant therapy in patients who have had a stroke or

transient ischemic attack deriving from a non-cardioembolic source?

[] A. Decreased risk of death from all causes

[] B. Decreased risk of nonfatal stroke.

[] C. Increased risk of fatal intracranial hemorrhage.

[] D. Increased risk of major extracranial hemorrhage.

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. Acute Abdominal Pain in Children (p. 2321).

[] B. The Basic Z-Plasty (p. 2329).

[] C. Use of Atypical Antipsychotic Drugs in Patients with Dementia

(p. 2335).

[] D. Automated Ambulatory Blood Pressure Monitoring: Clinical Utility

in the Family Practice Setting (p. 2343).

[] E. Helicobacter pylori Infection (p. 2359).

[] F. Does Long-Term Anticoagulation Improve Function After Stroke?

(p. 2317).

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.)

To help ensure that the number of CME hours we offer in the future

reflects the time readers invest in reading our CME articles and

departments and taking the quiz, please write in the space provided

on the answer card roughly how long it took you to read the CME

featured in this issue, answer the quiz questions, and review any

sections you needed to. Thank you for your help!

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 2241.

Answers to This Issue’s Clinical Quiz

Q1. D

Q2. C

Q3. C

Q4. D

Q5. C

Q6. B

Q7. B

Q8. B

Q9. A

Q10. B

Q11. B,D

Q12. A,B,D

Q13. A,B,D

Q14. A,C

Q15. C,D

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group