Clinical Quiz – continuing medical education examinations and problems

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. This issue has been approved for up to 5 Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of March 2001. Credit may be claimed for one year from the date of this issue.

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 5 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 (, 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.


(1) 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.

(2) Mail the Clinical Quiz answer card within one year (by March 31, 2002). 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.

[ ] C. IgE-mediated.

[check] 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


[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.

Antimicrobial Resistance: A Plan of Action for Community Practice (p. 1087)

Q1. Emergence of which one of the following resistant organisms in

community-acquired infections in Minnesota and North Dakota has led

to heightened concern about resistance to antibiotics?

[ ] A. Escherichia coli.

[ ] B. Streptococcus pneumoniae.

[ ] C. Methicillin-resistant Staphylococcus aureus.

[ ] D. Pseudomonas.

[ ] E. Moraxella catarrhalis.

Q2. The authors believe that prescribing an antibiotic is

unnecessary in up to what percentage of patients in the

community setting?

[ ] A. 10.

[ ] B. 50.

[ ] C. 70.

[ ] D. 90.

Cancer Screening Guidelines (p. 1101)

Q3. Which one of the following statements about cancer

screening is correct?

[ ] A. Evidence supports screening mammography in women between

50 and 80 years of age.

[ ] B. Performing Papanicolaou (Pap) tests every one or two years,

rather than every three years, improves the effectiveness of

screening by 20 percent.

[ ] C. Pap tests should be performed every three years in women who

have had a hysterectomy for a benign condition.

[ ] D. The U.S. Preventive Services Task Force does not recommend

screening for prostate cancer in asymptomatic men.

Acute and Chronic Paronychia (p. 1113)

Q4. Which one of the following is the most common infecting organism in

a case of acute paronychia?

[ ] A. Streptococci.

[ ] B. Pseudomonas species.

[ ] C. Herpes simplex virus.

[ ] D. Staphylococcus aureus.

[ ] E. Candida species.

Q5. Which one of the following organisms is found on culture in 95 percent

of cases of chronic paronychia?

[ ] A. Atypical Mycobacteria.

[ ] B. Gram-negative rods.

[ ] C. Gram-negative cocci.

[ ] D. Candida albicans.

Osteoporosis: Part II. Nonpharmacologic and

Pharmacologic Treatment (p. 1121)

Q6. Which one of the following agents is recommended for

treatment of bone loss associated with glucocorticoid treatment?

[ ] A. Calcitonin (Calcimar).

[ ] B. Bisphosphonates.

[ ] C. Selective estrogen receptor modulators.

[ ] D. Estrogen replacement therapy.

Endometrial Biopsy (p. 1131)

Q7. Which one of the following statements about endometrial biopsy

is correct?

[ ] A. Postoperative cramping is an infrequent side effect.

[ ] B. In all patients with the potential for pregnancy, pregnancy

testing should be considered before the performance of the


[ ] C. The procedure is generally more easily performed on the

perimenopausal patient.

[ ] D. Topical anesthesia is of little help in reducing patient

discomfort from placement of the tenaculum on the cervix.

[ ] E. A second pass with the suction catheter rarely helps in preventing

an insufficient sample.

Q8. Which one of the following conditions represents an absolute

contraindication to endometrial biopsy?

[ ] A. Acute pelvic inflammatory disease.

[ ] B. Morbid obesity.

[ ] C. Severe cervical stenosis.

[ ] D. Severe pelvic relaxation with uterine descensus.

Asymptomatic Microscopic Hematuria in Adults: Summary of the AUA Best

Practice Policy Recommendations (p. 1145)

Q9. Which one of the following best describes the advantage of computed

tomography over intravenous urography and ultrasonography in evaluation

of the urinary tract?

[ ] A. Excellent characterization of renal cysts.

[ ] B. Best modality for evaluating stones and renal and perirenal


[ ] C. Least expensive study in most centers.

[ ] D. Best study for detecting transitional cell carcinoma.

[ ] E. Traditionally, the modality of choice for evaluation of the

urinary tract.

Q10. Which one of the following should prompt evaluation for primary renal

disease in a patient with microhematuria?

[ ] A. Dysmorphic red blood cells or red cell casts.

[ ] B. One red blood cell per high-power field in two of three properly

collected urine specimens.

[ ] C. Urinary tract infection resolving after treatment.

[ ] D. Protein excretion of greater than 200 mg per 24 hours

(0.2 g per day).

[ ] E. White blood cells on urinary sediment.

Insulin Resistance Syndrome (p. 1159)

Q11. Type 2 diabetes mellitus (formerly known as non-insulin-dependent

diabetes) is associated with which one of the following?

[ ] A. Increased high-density lipoprotein cholesterol levels.

[ ] B. Increased serum very-low-density lipoprotein levels.

[ ] C. Decreased total serum cholesterol levels.

[ ] D. Decreased serum triglyceride levels.

Q12. Insulin resistance syndrome should be suspected in patients with

which one of the following conditions?

[ ] A. History of gestational diabetes.

[ ] B. Body mass index of 25 kg per m2.

[ ] C. Hip-to-waist ratio of greater than 1 (in men).

[ ] D. Waist-to-hip ratio of less than 1 (in women).

Antimicrobial Resistance: A Plan of Action for Community Practice (p. 1087)

Type X Questions

Each question has one or more correct answer.

Q13. In which of the following cases should antibiotic therapy be


[ ] A. Otitis media with persistent effusion following treatment.

[ ] B. Acute bronchitis.

[ ] C. Acute exacerbation of chronic bronchitis.

[ ] D. Acute urinary tract infection.

Cancer Screening Guidelines (p. 1101)

Q14. Which of the following screening tests is/are recommended by

most medical organizations for a healthy 60-year-old woman with no

risk factors for cancer?

[ ] A. Mammography.

[ ] B. Papanicolaou smear.

[ ] C. Fecal occult blood testing

[ ] D. Transvaginal sonogram.

Acute and Chronic Paronychia (p. 1113)

Q15. Which of the following antibiotics does the author

recommend for the treatment of acute paronychia?

[ ] A. Penicillin.

[ ] B. Ampicillin.

[ ] C. Clindamycin (Cleocin).

[ ] D. Amoxicillin-clavulanate potassium (Augmentin).

Osteoporosis: Part II. Nonpharmacologic and

Pharmacologic Treatment (p. 1121)

Q16. Which of the following should a physician actively

discourage when counseling women about prevention of


[ ] A. Tobacco use.

[ ] B. Excessive alcohol consumption.

[ ] C. Obesity.

[ ] D. Excessive caffeine intake.

Endometrial Biopsy (p. 1131)

Q17. Which of the following steps is/are part of an endometrial biopsy?

[ ] A. Bimanual examination.

[ ] B. Transvaginal ultrasonography.

[ ] C. Use of a suction uterine catheter.

[ ] D. Postoperative rectal examination.

Asymptomatic Microscopic Hematuria in Adults: Summary of the AUA

Best Practice Policy Recommendations (p. 1145)

Q18. Risk factors for significant disease in patients with

microscopic hematuria include which of the following?

[ ] A. History of pelvic irradiation.

[ ] B. Analgesic abuse.

[ ] C. Exposure to benzenes.

[ ] D. Vigorous exercise.

Insulin Resistance Syndrome (p. 1159)

Q19. Which of the following is/are included in the American

Diabetes Association recommendations for patients with

isolated insulin resistance syndrome?

[ ] A. Metformin therapy.

[ ] B. Increased dietary fiber.

[ ] C. Caloric restriction.

[ ] D. Thiazolidinedione therapy.

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 1007.

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. Antimicrobial Resistance: A Plan of Action for Community

Practice (p. 1087).

[ ] B. Cancer Screening Guidelines (p. 1101).

[ ] C. Acute and Chronic Paronychia (p. 1113).

[ ] D. Osteoporosis: Part II. Nonpharmacologic and Pharmacologic

Treatment (p. 1121).

[ ] E. Endometrial Biopsy (p. 1131).

[ ] F. Asymptomatic Microscopic Hematuria in Adults: Summary of

the AUA Best Practice Policy Recommendations (p. 1145).

[ ] G. Insulin Resistance Syndrome (p. 1159).

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. C

Q2. B

Q3. D

Q4. D

Q5. D

Q6. B

Q7. B

Q8. A

Q9. B

Q10. A

Q11. B

Q12. A

Q13. C,D

Q14. A,B,C

Q15. C,D

Q16. A,B,D

Q17. A,C

Q18. A,B,C

Q19. B,C

COPYRIGHT 2001 American Academy of Family Physicians

COPYRIGHT 2001 Gale Group