Clinical quiz

Date: Sept 15, 2004

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. Term of approval covers issues published within one year from the beginning distribution date of January 2004. This issue has been reviewed and is acceptable for up to 3 Prescribed credits. One half of one credit conforms to AAFP criteria for evidence-based CME content. 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 evidence-based or Prescribed for CME reporting purposes.

The American Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AAFP designates this educational activity for a maximum of 3 Category 1 credits toward the American Medical Association Physician's Recognition Award. 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 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 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 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 (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

(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 September 30, 2005). 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 reactionsto 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 oneor more correct answers. Theyare multiple true-false questionswith four options. Here is atypical Type X question:Q2. Causes of varicosities inpregnancy include: [check] A. Hormonal changes. [check] B. Venous compression. [check] C. Familial tendency. [check] D. Prolonged sitting and standing.Clinical Quiz questions are writtenby the associate and assistant editorsof AFP.ARTICLESAsthma Update: Part II. Medical Management (p. 1061)Q1. Which one of the following symptoms or risk factorsshould lead physicians to consider starting long-term therapyfor asthma control in infants and children? [] A. One episode of wheezing within the past year if the wheezing lasted one day and affected sleep. [] B. Two episodes of wheezing within the past year lasting more than one day but not affecting sleep. [] C. Three episodes of wheezing within the past year. [] D. Four or more episodes of wheezing within the past year if the wheezing lasted more than one day and affected sleep, and if the patient has risk factors for the development of asthma.Q2. According to updated guidelines from the National AsthmaEducation and Prevention Program, which one of the followingstatements about combination therapy with an inhaled corticosteroidand a long-acting beta2 agonist is not correct? [] A. The dosage of inhaled corticosteroid may be reduced when a long-acting beta2 agonist is added. [] B. An inhaled corticosteroid can be weaned and discontinued after a long-acting beta2 agonist is added. [] C. Combination therapy with an inhaled corticosteroid and a beta2 agonist is superior to the addition of a leukotriene modifier. [] D. Combination therapy with an inhaled corticosteroid and a long-acting beta2 agonist is superior to doubling the corticosteroid dosage.Management of Normal Pressure Hydrocephalus(p. 1071)Q3. Which one of the following signs and symptoms concerningthe dementia that affects patients with normal pressurehydrocephalus is not accurate? [] A. Lack of spontaneity. [] B. Fact recall delayed but accurate. [] C. Inattention. [] D. Difficulty with word formation.Q4. When assessing patients who may have normal pressurehydrocephalus, which one of the following findings on a spinaltap would suggest that the patient has another process thatcould be causing the neurologic symptoms? [] A. Normal levels of cerebrospinal fluid (CSF) protein. [] B. Opening pressure of 250 mm H2O. [] C. Normal CSF glucose. [] D. CSF white blood cell count of 5 per mcL (or mm3) or less.Type A QuestionsEach question has only one correct answer.Clinical Practice Guidelines for Chronic Kidney Diseasein Adults: Part II. Glomerular Filtration Rate,Proteinuria, and Other Markers (p. 1091)Q5. The National Kidney Foundation defines chronic kidneydisease at which one of the following levels of GFR? [] A. GFR of less than 90 mL per minute per 1.73 m2 for three months or more. [] B. GFR of less than 80 mL per minute per 1.73 m2 for three months or more. [] C. GFR of less than 70 mL per minute per 1.73 m2 for three months or more. [] D. GFR of less than 60 mL per minute per 1.73 m2 for three months or more. [] E. GFR of less than 50 mL per minute per 1.73 m2 for three months or more.Efficient Identification of Adults with Depression andDementia (p. 1101)Q6. Which one of the following is the recommended approachto screening for depression? [] A. A more specific test such as the Patient Health Questionnaire-9 (PHQ-9) followed by a sensitive test such as the Patient Health Questionnaire-2 (PHQ-2). [] B. A sensitive test such as the PHQ-2 followed by a specific test such as the PHQ-9. [] C. A sensitive test such as the PHQ-2 alone. [] D. A specific test such as the PHQ-9 alone.Q7. Which one of the following patient groups should be evaluatedfor possible dementia? [] A. All adults older than 65 years. [] B. All adults older than 80 years. [] C. All adults who are taking three or more medications. [] D. All adults in whom cognitive impairment is suspected.U.S. Preventive Services Task Force:Recommendation and Rationale EB CMEScreening for Hepatitis C in Adults: RecommendationStatement (p. 1111)Q8. Of the following statements, which one best reflects theU.S. Preventive Services Task Force (USPSTF) recommendationon screening for hepatitis C virus (HCV) infection in adults? [] A. The USPSTF recommends routinely screening adults in the general population for HCV infection. [] B. The USPSTF recommends against routinely screening adults in the general population for HCV infection. [] C. The USPSTF recommends screening for HCV infection in adults at high risk for infection. [] D. The USPSTF recommends against screening for HCV infection in adults at high risk for infection. [] E. The USPSTF does not recommend for or against screening adults in the general population for HCV infection.Q9. Of the following statements about screening for HCV infection,which one is correct? [] A. General population HCV screening would have a high false-positive rate. [] B. There is a high prevalence of HCV infection in the general population. [] C. Most patients with HCV infection develop liver cirrhosis. [] D. Patients with positive HCV enzyme immunoassay tests do not require confirmatory testing.Type X QuestionsEach question has one or more correct answers.ARTICLESAsthma Update: Part II. Medical Management (p. 1061)Q10. Which of the following statements about the safety of inhaledcorticosteroids in the treatment of children with asthma is/arecorrect? [] A. Inhaled corticosteroids can negatively affect a child's adult height. [] B. Inhaled corticosteroids provide better outcomes than nedocromil (Tilade). [] C. Low to medium dosages of inhaled corticosteroids decrease growth velocity by 1 cm in the first year of use. [] D. Inhaled corticosteroids should be used as first-line therapy.Management of Normal Pressure Hydrocephalus(p. 1071)Q11. The station and gait in patients with normal pressurehydrocephalus include which of the following? [] A. Short steps. [] B. Slow gait. [] C. Shuffling steps. [] D. Narrow-based stance.Clinical Practice Guidelines for Chronic Kidney Diseasein Adults: Part II. Glomerular Filtration Rate,Proteinuria, and Other Markers (p. 1091)Q12. In which of the following patients would a 24-hour urinecollection for creatinine clearance be preferred over estimationof glomerular filtration rate from a prediction equation? [] A. Patients who are strict vegetarians. [] B. Patients who take creatine supplements. [] C. Patients who have had limb amputations. [] D. Patients who have extensive muscle wasting.Efficient Identification of Adults with Depressionand Dementia (p. 1101)Q13. When is neuropsychologic testing indicated? [] A. A patient has sensory losses. [] B. A patient's test scores are normal, but function is abnormal. [] C. Test scores are abnormal but function is normal. [] D. A patient has impairment in one area of cognition.U.S. Preventive Services Task Force:Recommendation and Rationale EB CMEScreening for Hepatitis C in Adults: RecommendationStatement (p. 1111)Q14. Which of the following conditions is/are established riskfactors for hepatitis C virus (HCV) infection? [] A. History of intravenous drug use. [] B. Blood transfusion after 1990. [] C. Dialysis. [] D. Having an HCV-infected mother.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 1003.Q1. Which of the following articles covered in this quiz provideinformation that you find useful? (On the answer card, pleasecircle all that apply.) [] A. Asthma Update: Part II. Medical Management (p. 1061) [] B. Management of Normal Pressure Hydrocephalus (p. 1071). [] C. Clinical Practice Guidelines for Chronic Kidney Disease in Adults: Part II. Glomerular Filtration Rate, Proteinuria, and Other Markers (p. 1091). [] D. Efficient Identification of Adults with Depression and Dementia (p. 1101). [] E. Screening for Hepatitis C in Adults (p. 1111).Q2. In general, how clear was the presentation of the informationin these articles? (On the answer card, please circle onenumber: 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 continuingmedical education in the clinical aspects of practice. (On theanswer card, please circle one number: 5 = excellent; 0 = poor.)Answers to this issue's quiz are on page 1174.This quiz has 14 questions.

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