Diprivan

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. One half hour of these credit hours conforms 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.

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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

(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 August 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 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 Questions

Each question has only one correct answer.

Articles

Lower Extremity Abnormalities in Children (p. 461)

Q1. Which one of the following is the most common cause of intoeing in early childhood (older than toddlers)?

[] A. Metatarsus adductus.

[] B. Internal tibial torsion.

[] C. Femoral anteversion.

[] D. Internal tibial torsion combined with metatarsus adductus.

Q2. Which one of the following is the recommended initial treatment for internal tibial torsion?

[] A. Osteotomy of the tibia.

[] B. Night splints.

[] C. Shoe wedges.

[] D. Positional advice and observation.

Management of Status Epilepticus (p. 469)

Q3. Most episodes of status epilepticus are of which one of the following types?

[] A. Generalized tonic-clonic.

[] B. Partial onset.

[] C. Secondary generalized.

[] D. Generalized atonic.

Q4. Most U.S. authors agree that which one of the following drugs should be initiated first in the treatment of status epilepticus?

[] A. Phenytoin (Dilantin) or fosphenytoin (Cerebyx).

[] B. Lorazepam (Ativan) or diazepam (Valium).

[] C. Phenobarbital.

[] D. Midazolam (Versed).

[] E. Propofol (Diprivan).

Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome (p. 483)

Q5. Which one of the following is the usual fatal event in patients with long QT syndrome who have sudden death?

[] A. Myocardial infarction.

[] B. Asystole.

[] C. Supraventricular tachyarrhythmia.

[] D. Torsade de pointes or ventricular fibrillation.

Off-Label Applications for SSRIs (p. 498)

Q6. Which one of the following statements about off-label uses of selective serotonin reuptake inhibitors (SSRIs) in the treatment of diabetic neuropathy is correct?

[] A. SSRIs are just as efficacious as other therapies.

[] B. Paroxetine (Paxil) has been shown to be superior to imipramine (Tofranil).

[] C. SSRIs are superior to placebo in relieving painful neuropathy.

[] D. SSRIs are the most effective agents for treating pain and sleep disturbance.

[] E. SSRIs should not be considered as first-line therapy.

Q7. Which one of the following statements about off-label uses of SSRIs is correct?

[] A. Paroxetine is useful for neurocardiogenic syncope refractory to traditional therapy.

[] B. Fluoxetine (Prozac) is not recommended for migraine prophylaxis.

[] C. Sertraline (Zoloft) has not been shown to be effective in the treatment of neurocardiogenic syncope.

[] D. Citalopram (Celexa) has been shown to be effective in the treatment of premature ejaculation.

[] E. For best results, SSRIs should be used at the same time daily for the treatment of premature ejaculation.

Prevention of Malaria in Travelers (p. 509)

Q8. Which one of the following steps has been shown to reduce the risk of mosquito bites by 97 percent?

[] A. Limiting evening activities.

[] B. Using insect repellent.

[] C. Using a fan.

[] D. Using a bed net.

Q9. Which one of the following is the drug of choice for malaria prophylaxis in most chloroquine-resistant areas?

[] A. Mefloquine (Lariam).

[] B. Doxycycline (Vibramycin).

[] C. Atovaquone/proguanil (Malarone).

[] D. Primaquine (Palum).

Clinical Evidence Concise

Acute Myocardial Infarction (p. 519)

Q10. Which one of the following statements about the use of angiotensin-converting enzyme inhibitors 36 hours to 14 days after acute myocardial infarction is correct?

[] A. They decrease hypotension.

[] B. They decrease renal dysfunction.

[] C. They reduce mortality after 30 days.

[] D. They should not be used in patients with heart failure.

Putting Prevention into Practice: An Evidence-Based Approach

Screening for Cervical Cancer (p. 525)

Q11. Which one of the following statements regarding the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for cervical cancer is correct?

[] A. The USPSTF strongly recommends screening women who have been sexually active and have a cervix.

[] B. The USPSTF strongly recommends screening women age 25 and older.

[] C. The USPSTF does not recommend for or against screening women for cervical cancer.

[] D. The USPSTF recommends screening only women who are at increased risk for cervical cancer.

[] E. The USPSTF recommends screening all women between the ages of 18 and 75.

Q12. Which one of the following tests is recommended by he USPSTF for routine cervical cancer screening?

[] A. Human papillomavirus (HPV) testing.

[] B. Liquid-based cytology.

[] C. Conventional Papanicolaou (Pap) smear screening.

[] D. Computerized rescreening.

[] E. Conventional Pap smear screening and HPV testing.

Articles

Lower Extremity Abnormalities in Children (p. 461)

Q13. Torsional profile includes which of the following components?

[] A. Foot progression angle.

[] B. Knee stability.

[] C. Hip rotation.

[] D. Forefoot alignment.

Management of Status Epilepticus (p. 469)

Q14. Once the diagnosis of status epilepticus is made, which of the following steps should be included in immediate intervention?

[] A. Maintaining oxygenation and circulation.

[] B. Obtaining intravenous access and initiating drug therapy.

[] C. Definitive treatment of underlying cause.

[] D. Laboratory evaluation.

Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome (p. 483)

Q15. Which of the following has/have been associated with fatal arrhythmias in persons with long QT syndrome?

[] A. Vigorous exercise.

[] B. Emotional stress.

[] C. Sleep.

[] D. Loud noise.

Q16. Premonitory signs are not always present in patients with long QT syndrome, but historical factors of concern include which of the following?

[] A. European ethnic origin.

[] B. Exertional syncope.

[] C. Seizures.

[] D. Family history of sudden, unexplained death.

Off-Label Applications for SSRIs (p. 498)

Q17. Which of the following statements about selective serotonin reuptake inhibitors is/are correct?

[] A. SSRIs block the reuptake of serotonin at the presynaptic neuron, with minimal or no effect on norepinephrine or dopamine.

[] B. SSRIs appear to be an effective treatment for neurocardiogenic syncope refractory to standard therapies.

[] C. Fluvoxamine (Luvox) is suggested as first-line therapy in the treatment of fibromyalgia.

[] D. Fluvoxamine has the least effect in increasing ejaculatory latency, a difference that is not statistically significant compared with placebo.

Prevention of Malaria in Travelers (p. 509)

Q18. Which of the following actions lower the risk of malaria transmission?

[] A. Traveling to a destination that is above 2,000 m (6,600 ft).

[] B. Limiting outdoor activities between dusk and dawn.

[] C. Spraying aerosolized insecticides outside the living area.

[] D. Minimizing outdoor activities during the day.

Clinical Evidence Concise

Acute Myocardial Infarction (p. 519)

Q19. Which of the following has/have been shown to be beneficial following acute myocardial infarction?

[] A. Aspirin.

[] B. Beta blockers.

[] C. Primary percutaneous transluminal coronary angioplasty versus primary thrombolysis (performed in specialist centers).

[] D. Calcium channel blockers.

Putting Prevention into Practice: An Evidence-Based Approach

Screening for Cervical Cancer (p. 525)

Q20. Which of the following is/are risk factors for development of cervical cancer?

[] A. Cigarette smoking.

[] B. Infection with certain strains of human papillomavirus.

[] C. Immunocompromise.

[] D. Early onset of sexual intercourse.

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. Lower Extremity Abnormalities in Children (p. 461).

[] B. Management of Status Epilepticus (p. 469).

[] C. Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome (p. 483).

[] D. Off-Label Applications for SSRIs (p. 498).

[] E. Prevention of Malaria in Travelers (p. 509).

[] F. Acute Myocardial Infarction (p. 519).

[] G. Screening for Cervical Cancer (p. 525).

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.)

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 397.

Answers to This Issue's Clinical Quiz

Q1. C

Q2. D

Q3. B

Q4. B

Q5. D

Q6. E

Q7. A

Q8. D

Q9. A

Q10. C

Q11. A

Q12. C

Q13. A,C,D

Q14. A,B,D

Q15. A,B,C,D

Q16. B,C,D

Q17. A,B,D

Q18. A,B

Q19. A,B,C

Q20. A,B,C,D

COPYRIGHT 2003 American Academy of Family Physicians
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