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 3 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 3 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.

A Mail the Clinical Quiz answer card within one year (by February 29, 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

Common Benign Skin Tumors (p. 729)

Q1. Which one of the following statements about

dermatofibromas is correct?

[] A. They are most commonly found on the posterior surface of the

lower legs.

[] B. Diagnosis is based on the characteristic appearance and

Fitzpatrick’s sign.

[] C. Shave biopsy is superior to excisional biopsy for diagnosis

and treatment.

[] D. Cryosurgery is not recommended because of unsatisfactory

cosmesis.

Q2. The Leser-Trelat sign is the sudden onset of or increase in the

number of which one of the following lesions as a result of

underlying malignancy?

[] A. Dermatofibroma.

[] B. Seborrheic keratosis.

[] C. Cherry angioma.

[] D. Acrochordon.

[] E. Keratoacanthoma.

Diagnostic and Therapeutic Injection of the Wrist and Hand

Region (p. 745)

Q3. In which one of the following conditions is early

corticosteroid injection most appropriate?

[] A. De Quervain’s tenosynovitis.

[] B. Carpal tunnel syndrome.

[] C. First carpometacarpal joint arthritis.

[] D. Digital flexor tenosynovitis (trigger finger).

Q4. A point just ulnar (medial) to the palmaris longus tendon

and at the proximal wrist crease marks the injection site

for which one of the following conditions?

[] A. Carpal tunnel syndrome.

[] B. De Quervain’s tenosynovitis.

[] C. Volar ganglion cysts.

[] D. Digital flexor tenosynovitis (trigger finger).

[] E. First carpometacarpal joint arthritis.

Antiviral Drugs in the Immunocompetent Host: Part I. Treatment of

Hepatitis, Cytomegalovirus, and Herpes Infections (p. 757)

Q5. Which one of the following agents has been shown to decrease

recurrent episodes of genital herpes to a rate of about 0.8

episodes per year?

[] A. Ganciclovir (Cytovene).

[] B. Topical acyclovir (Zovirax).

[] C. Topical penciclovir (Denavir).

[] D. Oral valacyclovir (Valtrex).

Recognition and Management of Exercise-Induced Bronchospasm (p. 769)

Q6. The most common features of exercise-induced

bronchospasm include all but which one of the following?

[] A. Shortness of breath during the first five minutes of exercise.

[] B. Decreased exercise endurance.

[] C. Chest pain with exercise.

[] D. Upset stomach.

[] E. Sore throat.

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

Screening for Prostate Cancer: Recommendations and Rationale (p. 787)

Q7. Which one of one of the following statements is most consistent

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

for prostate cancer screening?

[] A. The USPSTF found that the evidence supports the routine use of

combined prostate-specific antigen (PSA) testing and digital

rectal examination (DRE).

[] B. The USPSTF found that the evidence supports the routine use of

PSA testing but not DRE.

[] C. The USPSTF found that the evidence supports the routine use of

DRE but not PSA testing.

[] D. The USPSTF found that the evidence is insufficient to recommend

for or against routine use of PSA testing or DRE.

Q8. Which one of the following groups is most likely to benefit from

prostate cancer screening if early detection is proved to improve

health outcomes?

[] A. Men older than 70 years.

[] B. Asian Americans.

[] C. African Americans.

[] D. Men with no family history of prostate cancer.

[] E. Hispanic Americans.

Type X Questions

Each question has one or more correct answers.

Articles

Common Benign Skin Tumors (p. 729)

Q9. Which of the following statements about sebaceous

hyperplasia is/are correct?

[] A. The surface generally is less uniform than that of basal cell

carcinoma.

[] B. The papules may display central umbilication.

[] C. Oral isotretinoin (Accutane) is effective for treatment of

diffuse multiple lesions.

[] D. Curettage is the treatment of choice because of reduced scarring

complications.

Diagnostic and Therapeutic Injection of the Wrist and Hand Region

(p. 745)

Q10. Which of the following statements about wrist and hand injections

is/are correct?

[] A. Injection of the carpal tunnel is performed just ulnar to the

palmaris longus tendon at the proximal wrist crease.

[] B. When injecting for de Quervain’s tenosynovitis, the needle

should be directed parallel to the abductor and extensor

pollicis tendons.

[] C. An 18-gauge needle is too large to aspirate a ganglion cyst.

[] D. Injection of the carpometacarpal joint for osteoarthritis should

be considered as a more effective alternative to conventional

therapies.

Antiviral Drugs in the Immunocompetent Host: Part I. Treatment of

Hepatitis, Cytomegalovirus, and Herpes Infections (p. 757)

Q11. Which of the following agents is/are the recommended treatment

for chronic hepatitis B infection in patients with more than twice

the normal alanine aminotransferase level, who test positive for HBV

DNA and HBe antigen?

[] A. Interferon alfa-2b (Intron A).

[] B. Lamivudine (Epivir-HBV).

[] C. Pegylated interferon alfa-2b (PEG-Intron).

[] D. Ganciclovir (Cytovene).

Antiviral Drugs in the Immunocompetent Host: Part II. Treatment of

Influenza and Respiratory Syncytial Virus Infections (p. 763)

Q12. Which of the following agents has/have been shown to be effective

in the treatment of patients with influenza A?

[] A. Amantadine (Symmetrel).

[] B. Rimantadine (Flumadine).

[] C. Zanamivir (Relenza).

[] D. Oseltamivir (Tamiflu).

Recognition and Management of Exercise-Induced Bronchospasm (p. 769)

Q13. Which of the following is/are appropriate steps in the

management of a patient with exercise-induced bronchospasm?

[] A. Base a presumptive diagnosis on the patient’s symptoms and

response to inhaled beta-agonist therapy.

[] B. Provide initial treatment with a beta agonist and add cromolyn

(Intal) if the patient has an inadequate response.

[] C. Perform baseline pulmonary function tests with an exercise

challenge test in patients who fail to respond adequately to a

clinical trial of a beta agonist plus cromolyn.

[] D. A one-week trial of an inhaled corticosteroid is adequate to

assess its efficacy.

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

Screening for Prostate Cancer: Recommendations and Rationale (p. 787)

Q14. Which of the following statements about prostate-specific antigen

(PSA) testing is/are correct?

[] A. PSA testing can detect early-stage prostate cancers.

[] B. There is a low rate of false-positives in PSA testing.

[] C. If screening with PSA testing were to reduce mortality, annual

screening would yield more benefit than biennial screening.

[] D. PSA testing is more sensitive than digital rectal examination in

detecting prostate cancer.

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 675.

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. Common Benign Skin Tumors (p. 729).

[] B. Diagnostic and Therapeutic Injection of the Wrist and Hand

Region (p. 745).

[] C. Antiviral Drugs in the Immunocompetent Host: Part I. Treatment

of Hepatitis, Cytomegalovirus, and Herpes Infections (p. 757).

[] D. Antiviral Drugs in the Immunocompetent Host: Part II. Treatment

of Influenza and Respiratory Syncytial Virus Infections (p. 763)

[] E. Recognition and Management of Exercise-Induced Bronchospasm

(p. 769).

[] F. Screening for Prostate Cancer: Recommendations and Rationale

(p. 787)

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.)

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