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. This issue has been approved for up to 4 Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of December 2000. 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 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.

NOTE: The full text of AFP is available online (http://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

(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 December 31, 2001). 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

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.

Urinary Incontinence in Women: Evaluation and Management (p. 2433)

Q1. Women with stress incontinence typically describe which one of the

following symptoms?

[ ] A. Repeated strong urge to void.

[ ] B. Nocturia.

[ ] C. Dysuria.

[ ] D. Involuntary wetting during exercise.

[ ] E. Urgency.

Q2. Which one of the following is not part of the initial

evaluation of most women with urinary incontinence?

[ ] A. Urodynamic testing.

[ ] B. Measurement of post-void residual volume.

[ ] C. Testing of bulbocavernous reflex.

[ ] D. Assessment of levatori ani muscle function.

[ ] E. Deep tendon reflex testing.

The Importance of Beta Blockers in the Treatment of Heart Failure

(p. 2453)

Q3. Which one of the following beta blockers is currently

manufactured in a dosage that is appropriate for the initiation of

therapy for heart failure?

[ ] A. Bucindolol (Bextra).

[ ] B. Metoprolol tartrate (Lopressor).

[ ] C. Carvedilol (Coreg).

[ ] D. Bisoprolol (Zebeta).

Q4. Which one of the following appears to be the mechanism that accounts

for the effectiveness of beta blockers in the treatment of heart failure?

[ ] A. Diuresis of excess fluid.

[ ] B. Decreased afterload.

[ ] C. Decrease in rhythm disturbances.

[ ] D. Decreased impact of neurohormones.

[ ] E. Anticoagulant effect.

Updated Treatment for Influenza A and B (p. 2467)

Q5. Which one of the following antiviral agents should be used with

caution in patients with asthma or chronic obstructive pulmonary disease?

[ ] A. Zanamivir (Relenza).

[ ] B. Amantadine (Symmetrel).

[ ] C. Oseltamivir (Tamiflu).

[ ] D. Rimantadine (Flumadine).

Gamma-Hydroxybutyrate (GHB): A Newer Drug of Abuse

(p. 2478)

Q6. In the late 1980s, gamma-hydroxybutyrate was marketed and sold in

health food stores for which one of the following uses?

[ ] A. Vitamin supplement.

[ ] B. Growth hormone stimulator.

[ ] C. Antidepressant.

[ ] D. Memory stimulator.

[ ] E. Weight loss supplement.

Q7. The management of gamma-hydroxybutyrate ingestion,

when there is no reason to suspect a combination toxic response,

consists primarily of which one of the following steps?

[ ] A. Gastric lavage.

[ ] B. Observation.

[ ] C. Narcotic antagonists.

[ ] D. Protection from aggression and self-harm.

[ ] E. Aspiration precautions and pulse oximetry.

Myxedema Coma: Diagnosis and Treatment (p. 2485)

Q8. Elderly patients with hypothyroidism often present with which one

of the following signs or symptoms?

[ ] A. Weight loss.

[ ] B. Heat intolerance.

[ ] C. Altered mentation.

[ ] D. Hot, moist skin.

[ ] E. Diarrhea.

Q9. A patient presents with symptoms that suggest myxedema. The initial

blood draw includes a renal panel, glucose level, complete blood count,

creatine kinase (CPK) and thyroid studies. All of the laboratory work

has been completed except the thyroid studies. Which one of the following

laboratory results is consistent with a diagnosis of myxedema?

[ ] A. Low sodium, glucose and hemoglobin levels, and elevated

CPK levels.

[ ] B. Elevated sodium, glucose, hemoglobin and CPK levels.

[ ] C. Elevated sodium level, and low glucose, hemoglobin and

CPK levels.

[ ] D. Low sodium and CPK levels, and elevated glucose and

hemoglobin levels.

[ ] E. Elevated sodium, glucose and hemoglobin levels, and low

CPK levels.

Type X Questions

Each question has one or more correct answer.

Urinary Incontinence in Women: Evaluation and Management (p. 2433)

Q10. Which of the following medications may be indicated for the

treatment of women with stress incontinence?

[ ] A. Beta-adrenergic blockers.

[ ] B. Alpha-adrenergic stimulants.

[ ] C. Local estrogen.

[ ] D. Local progesterone.

The Importance of Beta Blockers in the Treatment of Heart Failure

(p. 2453)

Q11. Which of the following medications should be used (if

tolerated and not contraindicated) in all patients with New York Heart

Association class II or III heart failure?

[ ] A. Spironolactone (Aldactone).

[ ] B. Beta blockers.

[ ] C. Digoxin (Lanoxin).

[ ] D. Angiotensin-converting enzyme (ACE) inhibitors.

Updated Treatment for Influenza A and B (p. 2467)

Q12. Which of the following antiviral agents has/have activity against

influenza virus B?

[ ] A. Zanamivir (Relenza).

[ ] B. Amantadine (Symmetrel).

[ ] C. Oseltamivir (Tamiflu).

[ ] D. Rimantadine (Flumadine).

Gamma-Hydroxybutyrate (GHB): A Newer Drug of Abuse

(p. 2478)

Q13. Adverse effects related to the use of gamma-hydroxybutyrate include

which of the following?

[ ] A. Respiratory depression.

[ ] B. Orthostatic hypotension.

[ ] C. Tachycardia.

[ ] D. Hypothermia.

Myxedema Coma: Diagnosis and Treatment (p. 2485)

Q14. Which of the following laboratory abnormalities is/are

usually associated with myxedema?

[ ] A. Leukocytosis.

[ ] B. Hyperglycemia.

[ ] C. Hyponatremia.

[ ] D. Elevated creatine kinase levels.

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 2387.

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. Urinary Incontinence in Women: Evaluation and Management

(p. 2433).

[ ] B. The Importance of Beta Blockers in the Treatment of Heart

Failure (p. 2453).

[ ] C. Updated Treatment for Influenza A and B (p. 2467).

[ ] D. Gamma-Hydroxybutyrate (GHB): A Newer Drug of Abuse

(p. 2478).

[ ] E. Myxedema Coma: Diagnosis and Treatment (p. 2485).

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. A

Q3. C

Q4. D

Q5. A

Q6. B

Q7. E

Q8. C

Q9. A

Q10. B,C

Q11. B,D

Q12. A,C

Q13. A,B,D

Q14. C,D

COPYRIGHT 2000 American Academy of Family Physicians

COPYRIGHT 2001 Gale Group