Actigall

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.

Mail the Clinical Quiz answer card within one year (by February 29, 2000). 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. 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.

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:

A. Hormonal changes.

B. Venous compression.

C. Familial tendency.

D. Prolonged sitting and standing.

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

Clinical Quiz questions are based on selected articles and selected items in "Tips from Other Journals" in this issue. Answers appear in this issue.

AFP's clinical quizzes are eligible for AAFP Prescribed credit, depending on the number of article pages covered in the quiz. This program has been reviewed and is acceptable for up to 8 Prescribed credit hours by the American Academy of Family Physicians.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The AAFP designates this issue's CME activity for 8 credit hours in Category 1 of the Physician's Recognition Award of the American Medical Association (AMA/PRA).

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 (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.8.0 hours credit

Diagnosis and Treatment of the Acute Scrotum (p. 817)

Type A Questions

Each question has only one correct answer.

Q1. The likelihood of testicular salvage decreases proportionately to which one of the following factors?

A. Age of the patient.

B. Severity of the torsion.

C. Duration of the torsion.

D. Skill of the surgeon.

E. Time under anesthesia.

Q2. Which one of the following is a preferred procedure in the evaluation of possible torsion?

A. Doppler stethoscope.

B. Magnetic resonance imaging.

C. Conventional gray-scale ultrasonography.

D. Color Doppler ultrasonography.

E. Nuclear testicular flow studies.

Recognizing Problem Sleepiness in Your Patients (p. 829)

Q3. Which one of the following statements about the management of problem sleepiness is correct?

A. Behavioral therapies are inappropriate for management of obstructive sleep apnea.

B. Restless legs syndrome may be treated with muscle relaxants.

C. Periodic limb movements may be treated with benzodiazepines or opioids.

D. Short-term, short-acting hypnotics may be used for treatment of sleep apnea.

E. Stimulants are a major aspect of management in most types of problem sleepiness.

Q4. Which one of the following statements about disrupted sleep is correct?

A. Patients with chronic bronchitis are typically able to initiate sleep but have difficulty maintaining it.

B. Patients with congestive heart failure are more likely to have periodic limb movements during sleep.

C. Beta blockers do not interfere with falling asleep but contribute to more frequent awakenings.

D. Nicotine increases total sleep time, leading to excessive daytime sleepiness.

E. Sleep debt is not cumulative.

Evaluating Patients for Return to Work (p. 844)

Q5. Which one of the following most accurately reflects the annual percentage of injuries in the United States that are occupational in nature?

A. 10 percent.

B. 30 percent.

C. 50 percent.

D. 75 percent.

E. 90 percent.

Q6. Which one of the following choices is a collection of tests and activities used to assess a person's work-related capabilities and limitations?

A. Job demand analysis.

B. Functional capacity evaluation.

C. AMA occupational guidelines.

D. Return-to-work assessment.

E. Dictionary of Occupational Titles.

Common Uncommon Anemias (p. 851)

Q7. Which one of the following is the mainstay of therapy for anemia of renal disease?

A. Iron replacement.

B. Corticosteroids.

C. Androgens.

D. Erythropoietin.

E. Angiotensin-converting enzyme (ACE) inhibitors.

Evaluation and Treatment of Childhood Obesity (p. 861)

Q8. The National Cholesterol Education Program recommends that physicians consider screening obese children for elevated cholesterol levels if they are older than which one of the following ages?

A. One year of age.

B. Two years of age.

C. Five years of age.

D. 10 years of age.

E. 12 years of age.

Neurologic Complications of Systemic Cancer (p. 878)

Q9. Which one of the following statements about epidural spinal cord compression is incorrect?

A. It is relatively common, occurring in 5 to 14 percent of all cancer patients.

B. Neurologic deterioration can be rapid, resulting in paraplegia.

C. It typically presents as lumbosacral pain.

D. Weakness is symmetric, usually affecting the legs.

E. Urinary retention or incontinence resulting from autonomic dysfunction is common.

Esophageal Atresia and Tracheoesophageal Fistula (p. 910)

Q10. Which one of the following is the most common type of esophageal atresia? A. Blind esophageal pouch with no accompanying fistula.

B. Blind esophageal pouch with a fistula between the trachea and distal esophagus.

C. Esophageal atresia with a proximal tracheoesophageal fistula.

D. Pure atresia without a tracheoesophageal fistula.

E. H-type fistula without esophageal atresia.

Gout and Hyperuricemia (p. 925)

Q11. Patients with asymptomatic hyperuricemia should be treated with urate-lowering agents if they have which one of the following serum urate levels?

A. 6 mg per dL (355 [micro sign]mol per L) or greater.

B. 7 mg per dL (415 [micro sign]mol per L) or greater.

C. 8 mg per dL (475 [micro sign]mol per L) or greater.

D. 9 mg per dL (535 [micro sign]mol per L) or greater.

E. No need for treatment.

Q12. Which one of the following is the preferred treatment for an acute gouty attack?

A. Intra-articular steroids.

B. Oral steroids.

C. Colchicine.

D. Nonsteroidal anti-inflammatory drugs.

E. Acetaminophen with codeine.

Liver Disease in Pregnancy (p. 937)

Q13. Which one of the following diseases represents the most common cause of jaundice in pregnancy?

A. Viral hepatitis.

B. Choledocholithiasis.

C. Intrahepatic cholestasis of pregnancy.

D. Preeclampsia.

E. Acute fatty liver of pregnancy.

Q14. Which one of the following medications represents the most successful therapy for intrahepatic cholestasis of pregnancy?

A. Parenteral vitamin K.

B. Ursodeoxycholic acid (Actigall).

C. Cholestyramine (Questran, Prevalite).

D. Phenobarbital.

E. Interferon therapy.

Low-Molecular-Weight Heparin in Outpatient Treatment of DVT (p. 945)

Q15. Which one of the following is not a benefit of low-molecular-weight heparin compared with unfractionated heparin?

A. Less variability in anticoagulant response.

B. Longer half-life.

C. Subcutaneous administration.

D. Decreased incidence of drug-induced thrombocytopenia.

E. Therapeutic interchangeability of all forms.

Q16. Which one of the following is not part of a protocol of antithrombotic therapy with low-molecular-weight heparin and warfarin (Coumadin)?

A. Active patient participation.

B. Activated partial thromboplastin time monitoring.

C. Overlapping therapy.

D. Prothrombin time/International Normalized Ratio monitoring.

E. Platelet monitoring.

Topical Psoriasis Therapy (p. 957)

Q17. Which one of the following treatments for psoriasis is limited by a tendency to stain clothing and bedding?

A. Corticosteroids.

B. Anthralin.

C. Vitamin D analogs.

D. Retinoids.

E. Keratolytics.

Q18. Which one of the following topical treatments for psoriasis should not be used unless a negative pregnancy test is confirmed?

A. Corticosteroids.

B. Coal tar.

C. Anthralin.

D. Vitamin D analogs.

E. Retinoids.

Diagnosis and Treatment of the Acute Scrotum (p. 817)

Q19. The differential diagnosis of testicular torsion includes which of the following?

A. Torsion of the appendix testis.

B. Epididymitis.

C. Orchitis.

D. Scrotal trauma.

Recognizing Problem Sleepiness in Your Patients (p. 829)

Q20. Narcolepsy is characterized by which of the following features?

A. Daytime sleepiness.

B. Cataplexy.

C. Night time insomnia.

D. Hypnagogic hallucinations.

Evaluating Patients for Return to Work (p. 844)

Q21. Which of the following is/are appropriate aids in assessing a patient's ability to return to work?

A. Discussion with the patient's supervisor.

B. Discussion with the occupational medicine staff at patient's place of employment.

C. A functional job demand analysis.

D. Dictionary of Occupational Titles.

Common Uncommon Anemias (p. 851)

Q22. Myelodysplastic syndrome may be characterized by which of the following conditions?

A. Megaloblastic anemia.

B. Normocytic anemia.

C. Microcytic anemia.

D. Hypersegmented polymorphonuclear leukocytes.

Evaluation and Treatment of Childhood Obesity (p. 861)

Q23. Which of the following strategies is/are known to reduce the likelihood that children will become obese?

A. Skim milk should replace whole milk after one year of age.

B. Offer food as a reward for good behavior.

C. The entire meal should be finished before the child is allowed to get up from the table.

D. The amount of television viewing should be limited.

Neurologic Complications of Systemic Cancer (p. 878)

Q24. The clinical presentation of brain metastases commonly includes which of the following?

A. Headache.

B. Altered mental status.

C. Focal weakness.

D. Neurologic dysfunction in more than one site.

Esophageal Atresia and Tracheoesophageal Fistula (p. 910)

Q25. Which of the following is/are commonly associated with esophageal atresia?

A. Ventricular septal defect.

B. Imperforate anus.

C. Vertebral body abnormalities.

D. Hypospadius.

Gout and Hyperuricemia (p. 925)

Q26. The onset of gout before 30 years of age in men or before menopause in women raises concern about the presence of which of the following conditions?

A. Inherited enzyme defects.

B. Diuretic therapy.

C. Renal disease.

D. Unrecognized hyperparathyroidism.

Low-Molecular-Weight Heparin in Outpatient Treatment of DVT (p. 945)

Q27. Exclusion criteria for outpatient therapy with low-molecular-weight heparin include which of the following?

A. Recurrent deep venous thrombosis (DVT).

B. Protein C or S deficiency.

C. Likelihood of noncompliance.

D. Dyspepsia.

Q28. Indications for in-hospital care of patients with DVT include which of the following?

A. Other concurrently administered subcutaneously injected medications.

B. Risk factors for bleeding.

C. Chronic renal insufficiency.

D. Clear evidence of pulmonary embolism.

Topical Psoriasis Therapy (p. 957)

Q29. Use of topical corticosteroids for psoriasis can result in which of the following side effects?

A. Tachyphylaxis.

B. Acne.

C. Telangiectasia.

D. Thickening of the skin.

Type X Questions

Each question has one or more correct answer.

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. Diagnosis and Treatment of the Acute Scrotum (p. 817).

B. Recognizing Problem Sleepiness in Your Patients (p. 829).

C. Evaluating Patients for Return to Work (p. 844).

D. Common Uncommon Anemias (p. 851).

E. Evaluation and Treatment of Childhood Obesity (p. 861).

F. Neurologic Complications of Systemic Cancer (p. 878).

G. Surgical Options in the Management of Groin Hernias (p. 893).

H. Esophageal Astresia and Tracheoesophageal Fistula (p. 910).

I. Gout and Hyperuricemia (p. 925).

J. Liver Disease in Pregnancy (p. 937).

K. Low-Molecular-Weight Heparin in Outpatient Treatment of DVT (p. 945).

L. Topical Psoriasis Therapy (p. 964).

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.)

COPYRIGHT 1999 American Academy of Family Physicians
COPYRIGHT 2000 Gale Group