Clinical Quiz

Date: Oct 1, 2000

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 3.5 Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of October 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 3.5 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


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 October 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 pregnancyinclude: [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 QuestionsEach question has only one correct answer.Withholding and Withdrawing Life-Sustaining Treatment(p. 1555)Q1. Which one of the following statements about tube feeding in patientswith severe dementia is correct? [] A. It helps prevent aspiration. [] B. It helps prevent pressure sores. [] C. It typically reverses malnutrition states. [] D. It may cause discomfort. [] E. It is likely to improve cognitive function.Q2. Which one of the following statements about withdrawing orwithholding care at the end of life is correct? [] A. Do-not-resuscitate (DNR) orders refer strictly to preventing the use of cardiopulmonary resuscitation (CPR). [] B. Physicians are legally required to provide all life- sustaining measures possible. [] C. It is illegal to administer high doses of opioids to relieve patients with symptoms such as breathlessness. [] D. Ventilator withdrawal is usually considered a form of euthanasia. [] E. Withdrawal and withholding of care are usually thought to be legally and ethically distinct decisions.Anemia in the Elderly (p. 1565)Q3. Which one of the following combinations of test resultssuggests the diagnosis of anemia of chronic disease? [] A. Low serum iron, high total iron-binding capacity (TIBC) and low serum ferritin levels. [] B. Low serum iron, high TIBC and high serum ferritin. [] C. Low serum iron, low TIBC and high serum ferritin. [] D. High serum iron, high TIBC and high serum ferritin. [] E. High serum iron, high TIBC and low serum ferritin.Q4. Complete blood count reveals a hemoglobin of 10.5 g per dL (105 gper L) in a 70-year-old woman. Her red blood cell indices indicate anormochromic, normocytic anemia. Her serum ferritin level is 10 ng per L(10 mg per L). Based on this information, which one of the following isthe most likely diagnosis? [] A. Anemia of chronic disease. [] B. Vitamin B12 deficiency. [] C. Folate deficiency. [] D. Myelodysplastic syndrome. [] E. Iron deficiency anemia.Treating Fibromyalgia (p. 1575)Q5. To meet the American College of Rheumatology criteria forclassification of fibromyalgia, patients must have tenderness in howmany of the 18 designated sites? [] A. 1 [] B. 6 [] C. 11 [] D. 16Q6. Which one of the following conditions is commonly confused withfibromyalgia? [] A. Rheumatoid arthritis. [] B. Depression. [] C. Somatoform disorder. [] D. Myofascial pain syndrome.Generalized Anxiety Disorder (p. 1591)Q7. A 22-year-old woman complaining of episodes of severeanxiety accompanied by shortness of breath and rapid pulse rate occurringup to three days per week for seven months most likely has which oneof the following problems? [] A. Generalized anxiety disorder. [] B. Panic attacks. [] C. Major depression. [] D. Alcohol abuse. [] E. Benzodiazepine withdrawal.Q8. Which one of the following benzodiazepines is the most appropriatefirst choice for the treatment of elderly patients with generalizedanxiety disorder? [] A. Oxazepam (Serax). [] B. Alprazolam (Xanax). [] C. Clonazepam (Klonopin). [] D. Diazepam (Valium). [] E. Chlordiazepoxide (Librium).A Family Physician's Guide to Monitoring Methotrexate(p. 1607)Q9. Which one of the following sets of disorders is currently an approvedindication for the use of methotrexate? [] A. Systemic lupus erythematosus and rheumatoid arthritis. [] B. Rheumatoid arthritis and psoriasis. [] C. Psoriasis and dermatomyositis. [] D. Crohn's disease and giant cell arteritis. [] E. Asthma and ectopic pregnancy.Q10. Which one of the following is not an appropriate aspect ofcounseling patients who are taking methotrexate? [] A. Strongly encouraging avoidance of all alcoholic beverages. [] B. Emphasizing appropriate contraception for both men and women. [] C. Explaining the importance of notifying the physician's office about any signs of bleeding or infection. [] D. Informing the patient of the potential for stomatitis, anorexia and diarrhea. [] E. Instructing the patient to take the medication on a daily basis.Withholding and Withdrawing Life-Sustaining Treatment(p. 1555)Type X QuestionsEach question has one or more correct answer.Q11. Which of the following is/are clear indications for initiatingartificial hydration in a terminally ill patient? [] A As a short trial to reassure the family that it doesn't improve the symptoms. [] B. If there is decreased urine output (less than 500 mL per day). [] C. If a swallowing problem is present and the patient is thirsty. [] D. If the patient has a dry mouth.Anemia in the Elderly (p. 1565)Q12. Which of the following tests can be useful in determining if anelderly patient has folate deficiency? [] A. Red blood cell folate concentration. [] B. Serum homocysteine level. [] C. Serum ferritin level. [] D. Methylmalonic acid level.Treating Fibromyalgia (p. 1575)Q13. Which of the following diagnoses is/are a common comorbid conditionin patients with fibromyalgia? [] A. Migraine headache. [] B. Irritable bowel syndrome. [] C. Depression. [] D. Chronic fatigue syndrome.Generalized Anxiety Disorder (p. 1591)Q14. Which of the following groups of patients do not respond well topsychologic therapies for generalized anxiety disorder? [] A. Patients with personality disorders. [] B. Elderly patients. [] C. Patients with low expectations of psychologic therapy. [] D. Patients with chronic social stressors.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 thisissue's quiz card. We would appreciate hearing any suggestions you havefor improving the CME experience offered through AFP. See the directoryon page 1467.Q1. Which of the following articles covered in this quiz provideinformation that you find useful? (On the answer card, please circleall that apply.) [] A. Withholding and Withdrawing Life-Sustaining Treatment (p. 1555). [] B. Anemia in the Elderly (p. 1565). [] C. Treating Fibromyalgia (p. 1575). [] D. Generalized Anxiety Disorder (p. 1591). [] E. A Family Physician's Guide to Monitoring Methotrexate (p. 1607).Q2. In general, how clear was the presentation of the information inthese 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, pleaserate the overall quality of AFP as a vehicle for continuing medicaleducation 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. E Q5. C Q6. D Q7. B Q8. A Q9. BQ10. EQ11. A,CQ12. A,BQ13. A,B,C,DQ14. A,C,D

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