Clinical quiz

Date: Oct 15, 2005

Clinical Quiz questions are based on selected articles in this issue of American Family Physician. Answers appear in this issue. AFP has been reviewed by the American Academy of Family Physicians as having content acceptable for Prescribed credit. Term of approval is for one year from the beginning distribution date of January 2005. This issue has been reviewed and is acceptable for up to 4.0 Prescribed credits, of which 0.5 credit conforms to AAFP criteria for evidence-based continuing medical education (EB CME) clinical content. The amount of CME has been doubled to reflect two-for-one credit for the EB CME portion only. When reporting CME credits, AAFP members should report total Prescribed credits earned for this activity. It is not necessary for members to label credits as EB CME for reporting purposes.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education to provide CME for physicians.

The AAFP designates this educational activity for a maximum of 4.0 Category 1 credits toward the American Medical Association Physician's Recognition Award (AMA/PRA). Each physician should claim only those credits that he or she actually spent in the 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 CME requirements are automatically eligible for the AMA/PRA.

Physicians who are not members of the AAFP are eligible to receive the designated number of credits 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 credits 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 the AAFP and will be provided to you on written request. You are responsible for reporting CME credits 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 are 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, 2006). 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 QuestionsEach question has only one correct answer.ArticlesEvaluation of Syncope (p. 1492)Q1. Which one of the following tests is recommended for allpatients with syncope? [] A. Echocardiography. [] B. Electrocardiography. [] C. 24-hour Holter monitoring. [] D. Head-up tilt-table testing.Q2. Which one of the following statements about syncopewith a cerebrovascular cause is correct? [] A. Syncope with a cerebrovascular cause is common. [] B. Computed tomography or magnetic resonance imaging is recommended to rule out a cerebrovascular cause in most patients with syncope. [] C. A cerebrovascular cause is suggested in patients with syncope accompanied by diplopia, seizure, headache, or prolonged loss of consciousness. [] D. Carotid Doppler studies are recommended to rule out a cerebrovascular cause in most patients with syncope.Supporting Self-management in Patientswith Chronic Illness (p. 1503)Q3. Which one of the following statements about self-managementeducation in patients with chronic illnessis correct? [] A. The patient is given technical information about the disease. [] B. The educator is always a health care professional. [] C. The focus is on improving patient confidence in managing the challenges of chronic illness. [] D. The patient is urged to comply with behavioral changes to improve outcomes.Q4. Which one of the following statements about self-managementof chronic illness is correct? [] A. The patient's focus should be on disease-oriented outcomes such as A1C levels. [] B. Each medical condition should be dealt with separately. [] C. A low level of literacy may be a barrier to patient participation. [] D. Increased physician follow-up decreases patient self-efficacy.Subclinical Thyroid Disease (p. 1517)Q5. There is fair evidence that treatment of patients who havesubclinical hyperthyroidism with serum thyroid-stimulatinghormone levels of less than 0.10 [micro]U per mL (0.10 mU per L)improves which one of the following clinical outcomes? [] A. Reductions in bone mineral density. [] B. Atrial fibrillation. [] C. Adverse cardiac endpoints aside from atrial fibrillation. [] D. Progression to overt hyperthyroidism.Genital Herpes: A Review (p. 1527)Q6. Which one of the following statements about genitalherpes simplex virus (HSV) infection is correct? [] A. The strongest predictor of genital HSV infection is the number of lifetime sex partners. [] B. Up to 74 percent of persons who are HSV-2 sero-positive report a history of genital HSV infection. [] C. Asymptomatic HSV shedding accounts for up to 25 percent of HSV transmission. [] D. Only 25 percent of persons with primary genital HSV infections report constitutional symptoms. [] E. Most primary genital HSV infections occur between 10 days and six weeks after exposure.Q7. Which one of the following statements about recurrentgenital HSV outbreaks is correct? [] A. Crusts are shed in approximately three days. [] B. Condom use does not significantly reduce the transmission rate in susceptible women. [] C. 25 percent of infected persons have a recurrence within one year of the primary outbreak. [] D. Women have more frequent recurrences than men. [] E. HSV-2 infections recur more frequently than HSV-1 infections.Hidradenitis Suppurativa: A Treatment Challenge(p. 1547)Q8. Which one of the following statements about hidradenitissuppurativa is correct? [] A. Scarring, fistulous tracks help to exclude the diagnosis. [] B. The disease is limited to the axillary and perianal regions. [] C. The condition generally is painless. [] D. Hidradenitis nodules tend to be sterile. [] E. If perianal lesions appear, they should be biopsied.Q9. An obese woman who has had several episodes of hidradenitissuppurativa asks what she can do to prevent newlesions from developing. Which one of the following actionswould be effective? [] A. Weight loss. [] B. Use of deodorants. [] C. Axillary depilatory treatment. [] D. Avoidance of contact with other affected persons.U.S. Preventive Services Task Force EB CMEScreening for Genital Herpes: RecommendationStatement (p.1557)Q10. In a 25-year-old woman who presents for routine prenatalcare, which one of the following clinical histories wouldpresent the highest risk of her transmitting herpes simplexvirus (HSV) to the infant? [] A. Recurrent genital herpes outbreaks. [] B. History of a single outbreak. [] C. Primary HSV infection during pregnancy. [] D. No history of genital herpes infection. [] E. Previous positive HSV serology.Type X QuestionsEach question has one or more correct answers.ArticlesEvaluation of Syncope (p.1492)Q11. Which of the following tests should be consideredfor most patients with known or suspected heart diseaseor abnormal results on electrocardiography? [] A. Echocardiography. [] B. 24-hour Holter monitoring or inpatient telemetry. [] C. Head-up tilt-table testing. [] D. Intracardiac electrophysiologic studies.Supporting Self-management in Patientswith Chronic Illness (p.1503)Q12. Which of the following concepts is/are componentsof supporting self-management of chronic illness? [] A. Providing clear information about the disease. [] B. Helping patients build confidence in their ability to cope with the disease. [] C. Addressing potential barriers faced by the patient. [] D. Treating medical barriers to self-management, such as depression.Subclinical Thyroid Disease (p.1517)Q13. Patients at high risk for thyroid disease include thosewith which of the following? [] A. Family history of thyroid disease, especially in women. [] B. Abnormal thyroid gland on examination. [] C. Type 1 diabetes. [] D. Personal history of autoimmune disorder.Genital Herpes: A Review (p.1527)Q14. Which of the following statements about treatment ofgenital herpes simplex virus (HSV) infection is/are correct? [] A. Treatment of patients with recurrent infections should begin during the prodromal phase or within one day of lesion onset. [] B. Suppressive therapy is recommended if a patient has more than six episodes in one year. [] C. Suppressive therapy fully eliminates asymptomatic viral shedding in HSV-2 -discordant couples. [] D. Intravenous acyclovir (Zovirax) should be given to patients with disseminated disease until obvious clinical improvement occurs, followed by oral acyclovir for at least 10 days of total therapy. [] E. Topical acyclovir can be used to treat recurrent infections if preferred by the patient.Hidradenitis Suppurativa: A Treatment Challenge(p. 1547)Q15. Which of the following is/are considered acceptable medicaltreatments for patients with hidradenitis suppurativa? [] A. Topical antibiotics. [] B. Isotretinoin (Accutane). [] C. Oral antibiotics. [] D. Oral contraceptives.CME Quality SurveyPlease answer the following questions to help usmonitor the quality of AFP's CME material on anongoing basis. Mark your answers on this issue's quizcard. We would appreciate hearing any suggestionsyou have for improving the CME experience offeredthrough AFP. See the directory on page 1425.Q1. Which of the following articles covered in this quiz provideinformation that you find useful ? (On the answer card,please circle all that apply.) [] A. Evaluation of Syncope (p. 1492). [] B. Supporting Self-management in Patients with Chronic Illness (p. 1503). [] C. Subclinical Thyroid Disease (p. 1517). [] D. Genital Herpes: A Review (p. 1527). [] E. Hidradenitis Suppurativa: A Treatment Challenge (p. 1547). [] F. Screening for Genital Herpes (p. 1557).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 Clinical Quiz

Q1. B Q2. C Q3. C Q4. C Q5. A Q6. A Q7. E Q8. E Q9. A Q10. C Q11. A, B Q12. A, B, C, D Q13. A, B, C, D Q14. A, B, D Q15. A, B, C, D

COPYRIGHT 2005 American Academy of Family PhysiciansCOPYRIGHT 2005 Gale Group

© 2006,, All Rights Reserved.