Clinical Quiz

Date: March 1, 2003

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 3.5 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 3.5 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 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 (, 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.


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 March 31, 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 fouror 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 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 andassistant editors of AFP.Type A QuestionsEach question has only one correct answer.ArticlesVitamin [B.sub.12] Deficiency (p. 979)Q1. Most dietary vitamin B12 is absorbed in a complex withintrinsic factor at which one of the following locations?[] A. Stomach.[] B. Duodenum.[] C. Jejunum.[] D. Terminal ileum.[] E. Colon.The `Crashing Asthmatic' (p. 997)Q2. Which one of the following statements about [beta.sub.2]-agonisttherapy for asthma is not correct?[] A. Inhaled [beta.sub.2] agonists provide the most rapid relief of bronchospasm with the fewest side effects.[] B. Continuous nebulization of [beta.sub.2] agonists may be useful in patients with severe asthma.[] C. Hyperkalemia may occur with heavy use of [beta.sub.2] agonists.[] D. Subcutaneous or intravenous administration of [beta.sub.2] agonists may be indicated in patients who are too weak to inspire adequately.[] E. Cardiovascular effects limit the use of epinephrine to patients younger than 40 to 50 years of age.Q3. Which one of the following statements about fatal asthma isnot correct?[] A. About one in 500 patients with asthma dies of the disease.[] B. Asphyxia from severe bronchospasm and mucus plugging is the most common fatal scenario.[] C. Inner-city young adults are at highest risk for fatal asthma.[] D. Sedatives and beta blockers have been associated with asthma deaths.Alopecia in Women (p. 1007)Q4. Which one of the following is the most common alopeciain women?[] A. Androgenetic alopecia.[] B. Alopecia areata.[] C. Telogen effluvium.[] D. Traumatic alopecia.[] E. Trichotillomania.Q5. A 28-year-old woman with vitiligo exhibits an asymptomaticoval patch of alopecia. The scalp examination shows "exclamationpoint" hairs. Which one of the following is the most likelydiagnosis?[] A. Androgenetic alopecia.[] B. Alopecia areata.[] C. Telogen effluvium.[] D. Trichotillomania.[] E. Traction alopecia.Diagnosing Night Sweats (p. 1019)Q6. Signs of endocarditis include which one of the following?[] A. Large nodules on elbows and knees.[] B. Circular blue spots in nails.[] C. Small, nodular hemorrhages on palms and soles.[] D. Night sweats without fever.[] E. Diffuse lymphadenopathy.Q7. Which one of the following medications is likely tocontribute to night sweats?[] A. Aspirin.[] B. Simvastatin (Zocor).[] C. Diazepam (Valium).[] D. Metformin (Glucophage).Delirium (p. 1027)Q8. Which one of the following statements about deliriumis correct?[] A. Haloperidol (Haldol) therapy should be stopped immediately when symptoms of delirium improve.[] B. Patients with delirium should be awakened every two hours in the nighttime for mental status checks.[] C. Recovery from delirium usually occurs when laboratory values return to normal.[] D. Lower doses of haloperidol should be used in elderly patients.Q9. Which one of the following typical electroencephalographicfindings in patients with delirium is not caused by alcoholwithdrawal?[] A. Normal.[] B. Fast activity.[] C. Diffuse slowing.[] D. Delta activity.Clinical EvidenceChildhood Constipation (p. 1041)Q10. Which one of the following statements about childhoodconstipation is correct?[] A. Oral cisapride (Propulsid) is the treatment of choice.[] B. Increasing dietary fiber has been proved effective.[] C. Biofeedback in addition to conventional treatment reduces soiling.[] D. Lactulose decreases abdominal pain and flatulence.Type X QuestionsEach question has one or more correct answers.ArticlesVitamin [B.sub.12] Deficiency (p. 979)Q11. Which of the following population groups has/have anincreased risk of vitamin [B.sub.12] deficiency?[] A. The elderly with "tea-and-toast" diets.[] B. Persons using acid-suppressing medications over the long term.[] C. Chronic alcoholics.[] D. Strict vegans.Q12. Which of the following conditions is/are associated withvitamin [B.sub.12] deficiency?[] A. Paresthesias and peripheral neuropathy.[] B. Microcytic anemia.[] C. Irritability.[] D. Memory impairment.The `Crashing Asthmatic' (p. 997)Q13. Which of the following conditions can cause wheezingand therefore may be confused with asthma?[] A. Foreign-body aspiration.[] B. Pulmonary hypertension.[] C. Chronic obstructive pulmonary disease.[] D. Congestive heart failure.Alopecia in Women (p. 1007)Q14. Which of the following is/are the preferredtreatment(s) for androgenetic alopecia in women?[] A. Topical 2 percent minoxidil solution (Rogaine).[] B. Spironolactone (Aldactone).[] C. Finasteride (Proscar).[] D. Oral contraceptive pills.[] E. Hair transplantation.Delirium (p. 1027)Q15. Which of the following characteristics is/are morecommonly associated with delirium than with primary psychiatricdisease?[] A. Fluctuating levels of consciousness.[] B. Auditory hallucinations.[] C. Gradual onset.[] D. Unsteady gait.Clinical EvidenceChildhood Constipation (p. 1041)Q16. Which of the following is/are organic causes ofchildhood constipation?[] A. Hirschsprung's disease.[] B. Cystic fibrosis.[] C. Dehydrating metabolic conditions.[] D. Anal fissures.CME Quality SurveyPlease answer the following questions to help us monitor thequality of AFP's CME material on an ongoing basis. Markyour answers on this issue's quiz card. We would appreciatehearing any suggestions you have for improving the CMEexperience offered through AFP. See the directory on page 907.Q1. Which of the following articles covered in this quizprovide information that you find useful?(On the answer card, please circle all that apply.)[] A. Vitamin [B.sub.12] Deficiency (p. 979).[] B. The 'Crashing Asthmatic' (p. 997).[] C. Alopecia in Women (p. 1007).[] D. Diagnosing Night Sweats (p. 1019).[] E. Delirium (p. 1027).[] F. Childhood Constipation (p. 1041).Q2. In general, how clear was the presentation of the informationin these articles? (On the answer card, please circleone number: 5 = extremely clear; 0 = extremely unclear.)Q3. Thinking of all the issues of AFP that you've seenrecently, please rate the overall quality of AFP as a vehiclefor continuing medical education in the clinical aspects ofpractice. (On the answer card, please circle one number: 5= excellent; 0 = poor.)Answers to this issue's quiz are on page 1136.This quiz has 16 questions.Answers to This Issue's Clinical QuizQ1. DQ2. CQ3. AQ4. AQ5. BQ6. CQ7. AQ8. DQ9. CQ10. CQ11. A,B,C,DQ12. A,C,DQ13. A,C,DQ14. AQ15. A,DQ16. A,B,C,D

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