Clinical Quiz

Date: Sept 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 approved for up to 3.5 Prescribed credit hours. Thirty minutes of these credit hours conform to AAFP criteria for evidence-based CME clinical content. 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 CME 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 (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.

A Mail the Clinical Quiz answer card within one year (by September 30, 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 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.4 | 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:4 | A. Hormonal changes.4 | B. Venous compression.4 | C. Familial tendency.4 | D. Prolonged sitting and standing.

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

Type A Questions

Each question has only one correct answer.

Articles

New Developments in the Management of Hypertension (p. 853)

Q1. Which one of the following correctly describes eplerenone (Inspra)?

| A. Selective aldosterone receptor antagonist.

| B. Vasopeptide inhibitor.

| C. Angiotensin-II receptor blocker.

| D. Short-acting calcium channel blocker.

Recognition and Prevention of Inhalant Abuse (p. 869)

Q2. Which one of the following statements about inhalant abuse is correct?

| A. Acute inhalant toxication is rarely harmful.

| B. Withdrawal symptoms occur infrequently with inhalant abuse.

| C. Urine drug screens confirm the diagnosis of inhalant abuse.

| D. Guillain-Barre syndrome is a common manifestation of inhalant abuse.

| E. Antidotes can reverse acute solvent intoxication.

Failure to Thrive (p. 879)

Q3. Which one of the following is the recommended daily caloric intake for a child diagnosed with failure to thrive?

| A. 100 percent of recommended caloric intake for actual weight for age.

| B. 100 percent of recommended caloric intake for expected weight for age.

| C. 150 percent of recommended caloric intake for actual weight for age.

| D. 150 percent of recommended caloric intake for expected weight for age.

Smallpox Vaccine: Contraindications, Administration, and Adverse Reactions (p. 889)

Q4. Which one of the following is the most common adverse reaction to smallpox vaccine?

| A. Progressive vaccinia.

| B. Eczema vaccinatum.

| C. Accidental implantation (autoinoculation).

| D. Generalized vaccinia.

Q5. Which one of the following best describes "robust takes" after smallpox vaccination?

| A. They occur eight to 10 days after vaccination and require no treatment.

| B. They should be treated with a tapering dose of oral prednisone.

| C. They typically last three to four weeks.

| D. They should be treated with vaccinia immune globulin.

Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests (p. 907)

Q6. Which one of the following statements about radiographs applies to patients with knee pain?

| A. According to the Ottawa knee rules, radiographs should be obtained in all patients older than 40 years who have a history of knee trauma.

| B. According to the Ottawa knee rules, radiographs should be obtained in patients with diffuse knee pain after a knee injury.

| C. If osteoarthritis is suspected, standing weight-bearing radiographs should be obtained.

| D. When radiographs are indicated, an anteroposterior view is sufficient.

Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis (p. 917)

Q7. Which one of the following statements about the differential diagnosis of knee pain by anatomic site is correct?

| A. Tibial apophysitis usually causes anterior knee pain.

| B. Pes anserine bursitis is a condition that contributes to posterior knee pain.

| C. Iliotibial band tendonitis causes medial knee pain.

| D. Meniscal tears tend to cause pain in the opposite side of the knee.

| E. Popliteal cysts cause anterior pain.

Cochrane for Clinicians: Putting Evidence into Practice

Is Leflunomide as Safe and Effective in the Treatment of Rheumatoid Arthritis as Other DMARDs? (p. 849)

Q8. Which one of the following statements about the use of leflunomide for treatment of rheumatoid arthritis is correct?

| A. Leflunomide is more effective than sulfasalazine at 24 months.

| B. Leflunomide is less effective than methotrexate at 12 months.

| C. Leflunomide is the least expensive disease-modifying antirheumatic drug available.

| D. The adverse effects of leflunomide are significantly greater than those of sulfasalazine.

| E. Leflunomide has been proved safe and effective after five years of therapy.

Clinical Evidence Concise

Headache (Chronic Tension Type) (p. 929)

Q9. Which one of the following has proved beneficial for treatment of chronic tension-type headaches?

| A. Amitriptyline.

| B. Benzodiazepines.

| C. Regular acetaminophen (Tylenol) use.

| D. Regular ibuprofen (Advil) use.

Articles

New Developments in the Management of Hypertension (p. 853)

Q10. Which of the following medications has/have been proved to reduce morbidity and mortality in patients with cardiovascular disease?

| A. Angiotensin-converting enzyme inhibitors.

| B. Long-acting calcium channel blockers.

| C. Selective aldosterone receptor antagonists.

| D. Short-acting calcium channel blockers.

Recognition and Prevention of Inhalant Abuse (p. 869)

Q11. When treating ventricular fibrillation secondary to inhalants, it is important to avoid using which of the following drugs?

| A. Epinephrine.

| B. Propranolol (Inderal).

| C. Isoproterenol (Isuprel).

| D. Norepinephrine.

Failure to Thrive (p. 879)

Q12. Which of the following is/are typically part of the initial work-up in a patient with suspected failure to thrive?

| A. Plotting of weight, height, and head circumference for age.

| B. Careful history taking.

| C. Physical examination.

| D. Laboratory testing.

Smallpox Vaccine: Contraindications, Administration, and Adverse Reactions (p. 889)

Q13. Which of the following is/are contraindications to the administration of smallpox vaccine to vaccinees and their sexual and household contacts?

| A. Immunodeficiency or immunosuppression.

| B. Certain skin and eye diseases.

| C. Use of steroid-containing inhaler.

| D. Pregnancy.

Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests (p. 907)

Q14. Which of the following statements about the laboratory evaluation of knee pain is/are correct?

| A. A warm, exquisitely tender knee joint with effusion warrants obtaining a complete blood count with differential and an erythrocyte sedimentation rate (ESR).

| B. A tense, painful, swollen knee always requires arthrocentesis to confirm the diagnosis.

| C. Because rheumatoid arthritis may involve the knee joint, serum ESR and rheumatoid factor testing are indicated in selected patients.

| D. A simple joint effusion produces clear, straw-colored transudative fluid, as in a knee sprain or chronic meniscal injury.

Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis (p. 917)

Q15. Which of the following statements about knee pain associated with overuse syndrome is/are correct?

| A. Medial plica syndrome is associated with medial knee pain after a marked increase of usual activities.

| B. The pes anserine bursa is located at the tendinous insertion of the gracilis, sartorius, and semitendinosus muscles at the anteromedial aspect of the tibia.

| C. Excessive friction between the iliotibial band and the medial femoral condyle is the cause of iliotibial band tendonitis.

| D. Patellofemoral pain syndrome is associated with mild to moderate knee pain after long episodes of sitting.

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. New Developments in the Management of Hypertension (p. 853).

| B. Recognition and Prevention of Inhalant Abuse (p. 869).

| C. Failure to Thrive (p. 879).

| D. Smallpox Vaccine: Contraindications, Administration, and Adverse Reactions (p. 889).

| E. Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests (p. 907).

| F. Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis (p. 917).

| G. Is Leflunomide as Safe and Effective in the Treatment of Rheumatoid Arthritis as Other DMARDs? (p. 849).

| H. Headache (Chronic Tension Type) (p. 929).

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've 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 Clinical Quiz

Q1. A

Q2. B

Q3. D

Q4. C

Q5. A

Q6. C

Q7. A

Q8. A

Q9. A

Q10. A

Q11. A,C,D

Q12. A,B,C

Q13. A,B,D

Q14. A,C,D

Q15. A,B,D

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 777.

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