CME Quiz

Continuing Medical Education (CME) Quiz questions are based on selected articles in this issue of American Family Physician. The questions are written and reviewed by the AFP medical editors. The answers appear in this issue at the end of the Practice Guidelines department. Each copy of AFP contains a CME Quiz answer card. Physicians and other health care professionals are invited to submit answer cards for CME credit.

AAFP Credit

This issue of AFP has been reviewed and is acceptable for up to 3.75 Prescribed credits by the American Academy of Family Physicians (AAFP). Of these credits, 0.25 conforms to the AAFP criteria for evidence-based (EB) CME clinical content. CME credit has been increased to reflect two-for-one credit for the EB CME portion only; AAFP accreditation begins January 2008. The term of approval is for one year from this date. When reporting AAFP credit, report total Prescribed credit for this activity. It is not necessary to label credit as EB CME for reporting purposes.

The EB CME credit awarded for this activity was based on practice recommendations that were the most current and had the strongest level of evidence available at the time. Because clinical research is ongoing, the AAFP recommends that learners verify sources and review these and other recommendations before incorporating them into practice (http://www.aafp.org/ ebcme). Other health care organizations may or may not accept the two-for-one EB CME credits. The AAFP is accredited by the Accreditation Council for Continuing Medical Education to provide CME for physicians.

AMA/PRA Category 1 Credit

The AAFP designates this educational activity for a maximum of 3.5 American Medical Association Physician’s Recognition Award (AMA/PRA) Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Health care professionals who satisfy the Academy’s CME requirements are automatically eligible for the AMA/PRA. Health care professionals who are not family physicians are eligible to receive the designated number of credits in Category 1 of the AMA/PRA on completion and return of the answer card. AAFP keeps a record of AMA/PRA Category 1 credit for non-family physicians. This record will be provided upon written request; however, non-family physicians are responsible for reporting their own CME credits when applying for the AMA/PRA or other certificates or credentials.

Online Quiz

The full text of AFP, including each issue’s CME Quiz, is available at http:// www.aafp.org/afp. The online table of contents for each issue will link to the CME Quiz. Online directions are provided to take the quiz, and learners who are AAFP members may submit their answers for CME credit.

Instructions

(1) Read each article, answer all questions on the quiz pages, and transfer your answers to the CME 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 CME Quiz answer card within one year (by June 30, 2009). The bar code on the answer card contains your identification for CME credit hours.

Before beginning the test, please note: Each CME 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. Which one of the following causes allergic reactions to foods?

[] A. IgA deficiency.

[] B. IgG and IgM antibodies.

[*] C. IgE antibodies.

[] D. Enzyme deficiencies.

[] E. 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. Which of the following is/are causes of varicosities in pregnancy?

[*] A. Hormonal changes.

[*] B. Venous compression.

[*] C. Familial tendency.

[*] D. Prolonged sitting and standing.

CME Quiz questions are written by the associate and assistant editors of AFP.

Type A Questions

Each question has only one correct answer.

Articles

Food Allergies: Detection and Management (p. 1678)

Q1. An eight-month-old boy presents for a routine checkup. His mother says that he occasionally has blood-streaked stools. After an extensive work-up, he is diagnosed with an eosinophilic gastrointestinal disorder. Which one of the following statements is correct?

[] A. Children with allergic eosinophilic esophagitis respond well to antireflux therapy.

[] B. Most infants with allergic proctocolitis have never been breastfed.

[] C. Allergic eosinophilic esophagitis is associated with a decreased esophageal pH.

[] D. Allergic eosinophilic gastritis can sometimes present as gastric outlet obstruction.

Q2. Two days ago, a 35-year-old woman developed wheezing, throat swelling, and shortness of breath after going out to dinner. In the ambulance, she was given some medication, and her symptoms improved dramatically by the time she reached the hospital. Which one of the following statements is correct?

[] A. Her symptoms are not consistent with an anaphylactic reaction because she did not experience any nausea or abdominal cramping.

[] B. Adults with food allergies usually remain allergic; symptoms do not usually spontaneously resolve with time.

[] C. Egg, milk, wheat, and soy are the most common food allergies in adults.

[] D. This patient should be advised to carry diphenhydramine (Benadryl) with her at all times in case of an emergency.

Impairment and Disability Evaluation: The Role of the Family Physician (p. 1689)

Q3. Which one of the following best describes the role of the physician in the evaluation of impairment and disability?

[] A. Determine whether the patient is disabled.

[] B. Determine the presence and severity of impairment.

[] C. Determine the disability standards for a particular profession.

[] D. Provide appropriate follow-up after an independent medical evaluation.

Q4. Which one of the following statements about the legal determination of causality for impairment and disability is correct?

[] A. The legal standard is “beyond a reasonable doubt.”

[] B. Physicians should not make any statements regarding causality or attribution because this is a legal matter.

[] C. The legal standard is “more probable than not.”

[] D. Only a single attributable cause can legally be identified.

Gastrointestinal Complications of Diabetes (p. 1697)

Q5. Which one of the following treatments for delayed gastric emptying is supported by some evidence from randomized, double-blind clinical trials?

[] A. Metoclopramide (Reglan).

[] B. Bethanechol (Urecholine).

[] C. Total parenteral nutrition.

[] D. Botulinum toxin type A (Botox) injection into the pylorus.

Q6. Which one of the following statements about treatment of nonalcoholic fatty liver disease is correct?

[] A. Metformin (Glucophage) reduces hepatic transaminase levels and improves ultrasound findings.

[] B. Metformin reduces the likelihood of progression to cirrhosis.

[] C. Metformin reduces cardiovascular mortality.

[] D. Metformin reduces all-cause mortality.

Venous Thromboembolism During Pregnancy (p. 1709)

Q7. Which one of the following statements about deep venous thrombosis (DVT) in pregnancy is correct?

[] A. DVT occurs most commonly in the third trimester.

[] B. In most cases, DVT occurs in the right leg.

[] C. The Homans’ sign is neither sensitive nor specific for diagnosis.

[] D. Clinical suspicion is confirmed in 25 percent of pregnant women.

Q8. Which one of the following statements about the diagnosis of DVT in pregnancy is correct?

[] A. A positive d-dimer test does not require confirmatory testing in pregnancy.

[] B. Venous compression ultrasonography is the test of choice.

[] C. The sensitivity of venous compression ultrasonography is higher in asymptomatic patients.

[] D. d-dimer values decrease progressively in pregnancy.

BMJ: Clinical Evidence Concise Hepatitis C (Chronic) (p. 1724)

Q9. Which one of the following treatment interventions is most effective in persons with chronic hepatitis C who have not responded to interferon treatment?

[] A. Peginterferon.

[] B. Peginterferon plus ribavirin.

[] C. Interferon-alfa plus ribavirin.

[] D. Interferon retreatment.

Type X Questions

Each question has one or more correct answers.

Articles

Food Allergies: Detection and Management (p. 1678)

Q10. In the past several months, a six-year-old girl has had several episodes of acute urticaria after ingesting various foods. Neither the child nor the mother is able to determine which foods may be causing this reaction. The physician refers the patient for allergy testing. Which of the following statements is/are correct?

[] A. In patch testing, the patch is removed and the skin is observed for erythema and induration at the site at 72 hours.

[] B. Patients must avoid antihistamines for 48 hours before skin-prick testing.

[] C. Patients must avoid antihistamines for 48 hours before radioallergosorbent testing.

[] D. In skin-prick testing, the skin is observed for any wheal and flare reaction developing after 15 to 20 minutes.

Impairment and Disability Evaluation: The Role of the Family Physician (p. 1689)

Q11. Which of the following is/are contraindications to a functional capacity evaluation of impairment and disability?

[] A. The patient is medically unstable.

[] B. The patient is unable to communicate effectively with the evaluator.

[] C. The patient is younger than 18 years or older than 65 years.

[] D. The patient has medical problems that would not be impacted by testing.

Gastrointestinal Complications of Diabetes (p. 1697)

Q12. Which of the following tests is/are typically included in the evaluation of the patient with suspected delayed gastric emptying?

[] A. Abdominal magnetic resonance imaging.

[] B. Upper endoscopy or upper gastrointestinal series.

[] C. Gastric emptying scintigraphy.

[] D. Abdominal computed tomography.

Venous Thromboembolism During Pregnancy (p. 1709)

Q13. Which of the following statements about the treatment of venous thromboembolism in pregnancy is/are correct?

[] A. Unfractionated heparin may be used initially instead of low-molecular-weight heparin.

[] B. Regional anesthesia should be avoided for 48 hours after the last dose of low-molecular-weight heparin.

[] C. Warfarin (Coumadin) should be avoided.

[] D. Warfarin is contraindicated in women who are breastfeeding.

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 1639.

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. Food Allergies: Detection and Management (p. 1678).

[] B. Impairment and Disability Evaluation:

The Role of the Family Physician (p. 1689).

[] C. Gastrointestinal Complications of Diabetes (p. 1697).

[] D. Venous Thromboembolism During Pregnancy (p. 1709).

[] E. Hepatitis C (Chronic) (p. 1724).

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 have 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 CME Quiz

Q1. D

Q2. B

Q3. B

Q4. C

Q5. A

Q6. A

Q7. C

Q8. B

Q9. C

Q10. B, D

Q11. A, B

Q12. B, C

Q13. A, C

COPYRIGHT 2008 American Academy of Family Physicians

COPYRIGHT 2008 Gale, Cengage Learning