Clinical Quiz

Date: Oct 15, 1999

Clinical Quiz questions are based on selected articles in this issue. Answers appear in this issue.

AFP's clinical quizzes are eligible for AAFP Prescribed credit, depending on the number of article pages covered in the quiz. This program has been reviewed and is acceptable for up to 5 Prescribed credit hours by the American Academy of Family Physicians.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The AAFP designates this issue's CME activity for 5 credit hours in Category 1 of the Physician's Recognition Award of the American Medical Association (AMA/PRA).

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 American Family Physician 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

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 October 31, 2000). 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. Here is a typical Type A question:

Q1. Most allergic reactions to foods are: o A. Due to IgA deficiency. o B. Due to IgG and IgM antibodies. o C. IgE-mediated. o4 D. Due to enzyme deficiencies. o 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: o4 A. Hormonal changes. o4 B. Venous compression. o4 C. Familial tendency. o4 D. Prolonged sitting and standing.

Clinical Quiz questions are written by the associate and assistant editors of American Family Physician.

Type A QuestionsEach question has only one correct answer.Anterior Hip Pain (p. 1687)Q1. Overweight male adolescents who present with anterior hip pain during aperiod of rapid growth should be suspected of having which one of thefollowing conditions? n A. Muscle or tendon strain. n B. Tendonitis. n C. Slipped capital femoral epiphysis. n D. Sports hernia. n E. Acetabular labral tear.Q2. Patients with activity-related sharp groin and anterior thigh pain formore than six months, along with episodes of deep clicking and a feeling of"giving way," should be suspected of having which one of the followingconditions? n A. Acetabular labral tear. n B. Osteitis pubis. n C. Sports hernia. n D. Inflammatory arthritis. n E. Femoral stress fracture.Pneumocystis carinii Pneumonia: A Clinical Review (p.1699)Q3. Which one of the following represents the percentage of patients withPneumocystis carinii infections who present with the classic diagnostictriad of fever, exertional dyspnea and nonproductive cough? n A. 10. n B. 25. n C. 50. n D. 75. n E. 90.Q4. Which one of the following is the method of choice for a diagnosis ofP. carinii pneumonia? n A. Open lung biopsy. n B. Transbronchial biopsy. n C. Percutaneous needle biopsy. n D. Sputum induction or bronchoalveolar lavage. n E. Transtracheal aspiration.Drug Treatment of Common STDs: Part II. Vaginal Infections, PelvicInflammatory Disease and Genital Warts (p. 1716)Q5. Which one of the following statements about pelvic inflammatory disease(PID) is correct? n A. Teenagers with PID never require parenteral therapy. n B. The diagnosis of PID requires definitive identificationof organisms. n C. Treatment of incidental genital warts lowers transmissionof organisms associated with PID. n D. Sexual partners should be treated empirically forChlamydia and gonorrhea. n E. Available oral regimens require concomitant use ofdoxycycline (Vibramycin).Q6. Which one of the following conditions may be treated with patient-applied therapies? n A. Mucopurulent proctitis. n B. Anal warts. n C. Vaginal warts. n D. Oral warts. n E. External genital warts.Right Ventricular Infarction: Specific Requirements of Management (p. 1727)Q7. Loss of right ventricular (RV) contractility in patients with RVinfarction leads to which one of the following conditions? n A. Left ventricular preload deficit. n B. Left atrial overload. n C. Atrial dysrhythmias. n D. Ventricular dysrhythmias. n E. Valvular leakage.Q8. Approximately what percentage of patients who present with acuteinferior infarction also have electrocardiographic signs of RV free wallischemia or infarction? n A. 10. n B. 25. n C. 50. n D. 66. n E. 75.In Pursuit of Perfection: A Primary Care Physician's Guide to BodyDysmorphic Disorder (p. 1738)Q9. Which one of the following behaviors is not characteristic of bodydysmorphic disorder? n A. Preoccupation with perceived facial defects. n B. Bingeing and purging. n C. Camouflage of a specific body part. n D. History of unnecessary surgical alterations. n E. Avoidance of social interaction.Q10. Which one of the following statements about persons with bodydysmorphic disorder is incorrect? n A. Approximately 50 percent of those affected meet DSM-IVcriteria for a delusional disorder, somatic type. n B. About 30 percent of those affected attempt suicide. n C. Selective serotonin reuptake inhibitors may improvesocial functioning. n D. Better outcomes are achieved if the family physicianstrongly recommends psychiatric referral. n E. At least 25 percent of those affected have had surgery tocorrect a perceived defect.Pediatric Advanced Life Support: A Review of the AHA Recommendations (p.1743)Q11. Which one of the following is the most sensitive parameter fordetermining perfusion and oxygenation in children? n A. Respiratory rate. n B. Heart rate. n C. Skin color. n D. Extremity temperature. n E. Pulse quality.Type X QuestionsEach question has one or more correct answer.Q12. A six-year-old child in septic shock initially received crystalloidsolution, 20 mL per kg, to normalize perfusion parameters. Despitereceiving a total of 60 mg per kg of crystalloid, no response is evident.Which one of the following inotropic agents should be given next? n A. Epinephrine, 0.1 to 1.0 [micro sign]g per kg per minute. n B. Dopamine, 2 to 5 [micro sign]g per kg per minute. n C. Dopamine, 10 to 20 [micro sign]g per kg per minute. n D. Dobutamine, 2 to 10 [micro sign]g per kg per minute. n E. Dobutamine, 15 to 20 [micro sign]g per kg per minute.Diagnosis and Treatment of Endometriosis (p. 1753)Q13. A 22-year-old woman with oligomenorrhea reports during initialevaluation that she has been unable to conceive for two years. Which one ofthe following approaches should be recommended at this first visit? n A. She should undergo laparoscopy because the most likelycause of the infertility is endometriosis. n B. She should undergo a basic evaluation for the cause ofinfertility. n C. She should begin taking danazol (Danocrine) at 800 mgdaily in divided doses. n D. She should receive an intramuscular injection ofleuprolide (Lupron) in a dosage of 3.75 mg and, if she is not pregnant inone month, the dose should be repeated. n E. She should begin taking oral contraceptive pills toregulate her cycle.Q14. Which one of the following statements about medical therapies forendometriosis is correct? n A. Leuprolide is more effective in relieving pain thandanazol (Danocrine). n B. The pregnancy rate after two months of therapy withdanazol is higher than the rate after six months of therapy with oralcontraceptive pills. n C. Progestational agents are more efficient in reducingrecurrence than oral contraceptive pills. n D. Therapy with GnRH antagonists may result in reversiblebone loss. n E. Danazol is a more cost-effective therapy than oralcontraceptive pills.CME Quality SurveyPlease answer the following questions to help us monitor the quality ofAFP's CME material on an ongoing basis. Mark your answers on this issue'squiz card. We would appreciate hearing any suggestions you have forimproving the CME experience offered through AFP. See the directory on page1609.Evaluation and Management of Dyspepsia (p. 1773)Q15. Which one of the following is the most common cause of dyspepsia? n A. Peptic ulcer. n B. Gastroesophageal reflux disease (GERD). n C. Gastric cancer. n D. Esophageal cancer. n E. Unspecified cause (i.e., nonulcer dyspepsia).Q16. What is the most common cause of bloating, abdominal distention andflatulence in patients with diabetes, especially when peripheral neuropathyis present? n A. Gastroparesis. n B. Peptic ulcer disease. n C. GERD. n D. Gastric or esophageal cancer. n E. Nonulcer dyspepsia.Anterior Hip Pain (p. 1687)Q17. Which of the following descriptions suggest the possibility ofosteitis pubis? n A. Pain aggravated by striding or kicking. n B. Tenderness over the ischium. n C. Pain with adduction against resistance. n D. Restriction of hip motion with pelvic obliquity andsacroiliac dysfunction.Pneumocystis carinii Pneumonia: A Clinical Review (p. 1699)Q18. Which of the following regimens is/are acceptable options for treatingmild to moderate Pneumocystis carinii infections? n A. Trimethoprim-sulfamethoxazole (Bactrim, Septra). n B. Clindamycin (Cleocin) and primaquine. n C. Atovaquone (Mepron). n D. Dapsone and trimethoprim (Proloprim).Drug Treatment of Common STDs: Part II. Vaginal Infections, PelvicInflammatory Disease and Genital Warts (p. 1716)Q19. Topical treatment is acceptable for which of the following vaginaldiseases? n A. Bacterial vaginosis in pregnant patients. n B. Bacterial vaginosis in nonpregnant patients. n C. Trichomoniasis. n D. Candidiasis.Right Ventricular Infarction: Specific Requirements of Management (p. 1727)Q20. Common causes of death in patients with right ventricular infarctioninclude which of the following? n A. Cardiogenic shock. n B. Septal rupture. n C. Ventricular tachycardia. n D. Ventricular fibrillation.In Pursuit of Perfection: A Primary Care Physician's Guide to BodyDysmorphic Disorder (p. 1738)Q21. Which of the following symptoms of body dysmorphic disorder is/arecorrectly matched with a therapy known to relieve the symptom? n A. Ritualistic behavior-selective serotonin reuptakeinhibitor. n B. Irrational belief or conviction-cognitive psychotherapy. n C. Aberrant social interaction-behavioral intervention. n D. Coexisting anxiety-behavioral intervention.Diagnosis and Treatment of Endometriosis (p. 1753)Q22. Medical therapy for patients with endometriosis should be reserved fortreatment of which of the following conditions? n A. Pelvic pain. n B. Dyspareunia. n C. Infertility. n D. Emotional distress.Evaluation and Management of Dyspepsia (p. 1773)Q23. Which of the following symptoms define gastroesophageal refluxdisease? n A. Heartburn. n B. Nausea. n C. Regurgitation. n D. Early satiety.Q1. Which of the following articles covered in this quiz provideinformation that you find useful? (On the answer card, please circle allthat apply.) n A. Anterior Hip Pain (p. 1687). n B. Pneumocystis carinii Pneumonia: A Clinical Review(p. 1699). n C. Drug Treatment of Common STDs: Part II. VaginalInfections, Pelvic Inflammatory Disease and Genital Warts (p. 1716). n D. Right Ventricular Infarction: Specific Requirements ofManagement (p. 1727). n E. In Pursuit of Perfection: A Primary Care Physician'sGuide to Body Dysmorphic Disorder (p. 1738). n F. Pediatric Advanced Life Support: A Review of the AHARecommendations (p. 1743). n G. Diagnosis and Treatment of Endometriosis (p. 1753). n H. Evaluation and Management of Dyspepsia (p. 1773).Q2. In general, how clear was the presentation of the information in thesearticles? (On the answer card, please circle one number: 5 = extremelyclear; 0 = extremely unclear.)Q3. Thinking of all the issues of AFP that you've seen recently, pleaserate the overall quality of AFP as a vehicle for continuing medicaleducation in the clinical aspects of practice. (On the answer card, pleasecircle one number: 5 = excellent; 0 = poor.)

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