Keflex

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 4 Prescribed credits. Three quarters 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 4 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 November 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 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:

[ ] 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.

Type A Questions Each question has only one correct answer.

Articles

Acute Bacterial Rhinosinusitis in Adults: Part II. Treatment (p. 1697)

Q1. Which one of the following is the best first-line antibiotic for the treatment of acute bacterial rhinosinusitis in patients without drug allergy?

[ ] A. Azithromycin (Zithromax).

[ ] B. Clarithromycin (Biaxin).

[ ] C. Amoxicillin.

[ ] D. Amoxicillin-clavulanate potassium (Augmentin).

Q2. In acute bacterial rhinosinusitis, in patients with moderate disease or disease that fails to respond to first-line antibiotics, which one of the following regimen choices is a good treatment option?

[ ] A. Amoxicillin-clavulanate potassium or cephalexin (Keflex).

[ ] B. Amoxicillin-clavulanate potassium or erythromycin.

[ ] C. A fluoroquinolone or cefprozil (Cefzil).

[ ] D. Amoxicillin-clavulanate potassium or a fluoroquinolone.

Tympanometry (p. 1713)

Q3. Which one of the following statements about tympanometry is correct?

[ ] A. High static admittance can result from middle ears with ossicular fixation.

[ ] B. Increased stiffness of the eardrum, tympanosclerosis, cholesteatoma, and middle ear tumor are all potential causes of a type B tracing.

[ ] C. Tympanometry has a better sensitivity and specificity than pneumatic otoscopy for otitis media with effusion.

[ ] D. Type A tracings are flat and consistent with middle ear effusion.

Childhood Bullying: Implications for Physicians (p. 1723)

Q4. Which one of the following statements about bullying behaviors is correct?

[ ] A. Children cannot be both a bully and a victim.

[ ] B. Bullies are likely to stop their behavior if no one intervenes.

[ ] C. There are clear criteria for classifying a bully and a victim.

[ ] D. Involvement in a community group or a sports team can help a child resist bullying.

[ ] E. An "assistant" is a child who helps the victim.

Q5. Which one of the following statements about bullying is correct?

[ ] A. Bullying has no long-term health consequences.

[ ] B. A single episode of name calling qualifies as bullying.

[ ] C. Only physical bullying warrants intervention.

[ ] D. Harassment of homosexual students is not a form of bullying.

[ ] E. Bullying entails a deliberate intent to harm the victim.

Common Dietary Supplements for Weight Loss (p. 1731)

Q6. Use of which one of the following supplements is discouraged based on studies of efficacy for weight loss?

[ ] A. Dandelion.

[ ] B. Apple cider vinegar.

[ ] C. Ginseng.

[ ] D. Guar gum.

Q7. Which one of the following is not a purported mechanism of weight-loss supplements?

[ ] A. Water elimination.

[ ] B. Blocking dietary fat absorption.

[ ] C. Decreased fat oxidation.

[ ] D. Increased satiety.

Clinical Evidence Concise EB CME

Otitis Externa (p. 1741)

Q8. Which one of the following statements about the treatment of otitis externa is correct?

[ ] A. Oral antibiotics plus a topical anti-infective are more effective than topical anti-infectives alone.

[ ] B. After one week, symptom scores are the same in patients treated with high-potency topical steroids and low-potency topical steroids.

[ ] C. Topical quinolones are more effective than other anti-infectives.

[ ] D. Budesonide does not improve symptoms in patients with mild or moderate, acute or chronic otitis externa.

Putting Prevention into Practice: An Evidence-Based Approach EB CME

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (p. 1743)

Q9. Which one of the following statements about behavioral counseling for alcohol misuse is correct?

[ ] A. Behavioral counseling interventions in adolescents decrease alcohol misuse.

[ ] B. Behavioral counseling interventions in adults decrease alcohol misuse.

[ ] C. Behavioral counseling interventions for alcohol misuse clearly reduce alcohol-related morbidity in adults.

[ ] D. Effective initial counseling interventions should last at least one hour.

[ ] E. Effective counseling interventions must be delivered by physicians.

Q10. Which one of the following statements about screening and counseling for alcohol misuse is correct?

[ ] A. The 5-A's behavioral counseling framework is useful for delivering a counseling intervention.

[ ] B. Patients should follow up monthly to monitor progress in reducing alcohol misuse.

[ ] C. Patients who test negative for alcohol misuse should be rescreened every six months.

[ ] D. Serum [gamma]-glutamyltransferase level is a useful test for detecting alcohol misuse.

[ ] E. The serum carbohydrate deficient transferrin level is a useful test for detecting alcohol misuse.

Type X Questions Each question has one or more correct answers.

Articles

Acute Bacterial Rhinosinusitis in Adults: Part I. Evaluation (p.1685)

Q11. Which of the following is/are the most common causes of community-acquired acute bacterial rhinosinusitis?

[ ] A. Streptococcus pneumoniae.

[ ] B. Moraxella catarrhalis.

[ ] C. Haemophilus influenzae.

[ ] D. Staphylococcus aureus.

Acute Bacterial Rhinosinusitis in Adults: Part II. Treatment (p. 1697)

Q12. Treatments with no proven benefit in patients with acute bacterial rhinosinusitis include which of the following?

[ ] A. Less-sedating antihistamines.

[ ] B. Oral decongestants.

[ ] C. Vitamin C.

[ ] D. Echinacea extract.

Tympanometry (p. 1713)

Q13. Which of the following is/are objective data obtained from a tympanogram?

[ ] A. Maximum compliance of middle ear.

[ ] B. Pressure at which the middle ear has the most mobility.

[ ] C. Equivalent ear canal volume.

[ ] D. Width of tympanogram curve.

Common Dietary Supplements for Weight Loss (p. 1731)

Q14. Patients use weight-loss supplements for which of the following reasons?

[ ] A. Desire for "magic bullet."

[ ] B. Belief that "natural" means "safe."

[ ] C. Availability without prescription.

[ ] D. Advertising claims.

Cochrane for Clinicians Putting Evidence into Practice EB CME

Interventions for Impetigo (p. 1680)

Q15. Which of the following treatments has/have been shown to be effective in patients with mild or moderate impetigo?

[ ] A. Topical mupirocin.

[ ] B. Oral erythromycin.

[ ] C. Disinfectant solution.

[ ] D. Topical gentamicin.

Putting Prevention into Practice: An Evidence-Based Approach EB CME

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (p. 1743)

Q16. Which of the following is/are validated screening tools for alcohol misuse in adults in primary care?

[ ] A. The Alcohol Use Disorders Identification Test.

[ ] B. The CAGE questionnaire.

[ ] C. The 5-A's behavioral counseling framework.

[ ] D. The CRAFFT questionnaire.

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 1611.

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. Acute Bacterial Rhinosinusitis in Adults: Part I. Evaluation (p. 1685)

[ ] B. Acute Bacterial Rhinosinusitis in Adults: Part II. Treatment (p. 1697).

[ ] C. Tympanometry (p. 1713).

[ ] D. Childhood Bullying: Implications for Physicians (p. 1723).

[ ] E. Common Dietary Supplements for Weight Loss (p. 1731).

[ ] F. Interventions for Impetigo (p. 1680).

[ ] G. Otitis Externa (p. 1741).

[ ] H. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (p. 1743).

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. C Q2. D Q3. B Q4. D Q5. E Q6. D Q7. C Q8. B Q9. B Q10. A Q11. A, C Q12. A, C, D Q13. A, B, C, D Q14. A, B, C, D Q15. A, B Q16. A, B

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