Clinical quiz

Clinical Quiz questions are based on selected articles in this issue of American Family Physician. Answers appear in this issue. AFP has been reviewed by the American Academy of Family Physicians as having content acceptable for Prescribed credit. Term of approval is for one year from the beginning distribution date of January 2005. This issue has been reviewed and is acceptable for up to 5.0 Prescribed credits, of which 0.75 credit conforms to AAFP criteria for evidence-based continuing medical education (EB CME) clinical content. The amount of CME has been doubled to reflect two-for-one credit for the EB CME portion only. 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 EB CME for reporting purposes.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education to provide CME for physicians.

The AAFP designates this educational activity for a maximum of 5.0 Category 1 credits toward the American Medical Association Recognition Award (AMA/PRA). 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 CME 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 the 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 issue will link you to the Clinical Quiz. Just follow the online directions to take the quiz and, if you are 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, 2006). 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

Diagnosis and Management of Ectopic Pregnancy
(p. 1707)

Q1. Approximately what percentage of women have difficulty
conceiving after treatment of an ectopic pregnancy?

[] A. 10.
[] B. 30.
[] C. 50.
[] D. 70.

Q2. Which one of the following is the most cost-effective
approach to evaluating patients with suspected ectopic
pregnancy?

[] A. Quantitative beta subunit of human chorionic
gonadotropin (beta-hCG) alone.
[] B. Urgent laparoscopy.
[] C. Transvaginal ultrasonography alone.
[] D. Transvaginal ultrasonography followed by
quantitative beta-hCG.

Detection and Evaluation of Chronic Kidney Disease
(p. 1723)

Q3. Which one of the following statements about imaging
options in chronic kidney disease is correct?

[] A. Computed tomography is the most effective for
diagnosing renovascular disease.
[] B. Intravenous pyelography is commonly used in
patients with chronic kidney disease.
[] C. Plain-film radiographs of the kidneys, ureters,
and bladder are used to screen for polycystic
kidney disease.
[] D. Radioisotope renal scanning can monitor
individual kidney function.

Management of Acute Renal Failure (p. 1739)

Q4. Which one of the following statements about the use of
dopamine to promote renal perfusion in patients with acute
renal failure is correct?

[] A. Dopamine reduces morbidity.
[] B. Dopamine reduces mortality.
[] C. Dopamine has no benefit.
[] D. Dopamine reduces the need for dialysis.
[] E. Dopamine reduces the length of intensive care
unit stays.

Q5. Which one of the following is the most common prerenal
cause of acute renal failure?

[] A. Intravascular volume depletion.
[] B. Nephrotic syndrome.
[] C. Nonsteroidal anti-inflammatory drugs.
[] D. Angiotensin-converting enzyme inhibitors.
[] E. Congestive heart failure.

A Clinical Approach to Diagnosing Wrist Pain (p. 1753)

Q6. Which one of the following statements about the
mechanical causes of wrist pain is correct?

[] A. de Quervain's tenosynovitis is associated with
tenderness at the distal ulna with palpation.
[] B. Nonunion of the hook-of-the-hamate is associated
with tenderness in the proximal hypothenar area
1 cm distal to the flexion crease of the wrist.
[] C. Kienbock's scaphoid bone.
[] D. Triangular fibrocartilage complex tear is identified
by tenderness in the distal hollow between the
scaphoid and ulnar styloid.

Q7. Which one of the following statements about
examination of the wrist is correct?

[] A. Watson's
[] B. Finkelstein's ligament tear.
[] C. Pain, crepitus, or a snap during the grind test
identifies fracture of the hamate.
[] D. The lunotriquetral shear test involves asking the
patient to place his or her palms on the underside of a
table and lift it.

Extrapulmonary Tuberculosis: An Overview (p. 1761)

Q8. Which one of the following statements about tuberculous
lymphadenitis is correct?

[] A. Inguinal adenopathy is the most common.
[] B. Patients without human immunodeficiency virus
(HIV) infection typically present with fever, night
sweats, and weight loss.
[] C. Most patients have an abnormal result on chest
radiography.
[] D. Left untreated, the lymph nodes become fluctuant
and drain spontaneously with sinus tract
formation.
[] E. Fine-needle aspiration is the diagnostic procedure
of choice for patients without HIV infection.

Medications for Treating Alcohol Dependence (p. 1775)

Q9. Which one of the following statements about disulfiram
(Antabuse) is correct?

[] A. It is recommended for patients older than 60 years.
[] B. It decreases the rate of relapse.
[] C. It is the drug of choice for long-term prevention
of relapse.
[] D. Consuming alcohol after taking it can cause a
severe reaction.

Cochrane for Clinicians:
Putting Evidence into Practice EB CME

Psychological Interventions for Noncardiac Chest Pain
(p. 1701)

Q10. Which one of the following statements about treatment
for chronic, nonspecific chest pain in patients with normal
coronary anatomy is correct?

[] A. Cognitive behavior therapy reduces the number of
days with chest pain.
[] B. Comorbid psychiatric symptoms are rare.
[] C. Reassuring the patient that the cause is noncardiac
usually eliminates the symptoms.
[] D. No treatment is needed because functional
impairment is rare.

BMJ: Clinical Evidence Concise EB CME

Chronic Fatigue Syndrome (p. 1793)

Q11. Which one of the following therapies for patients with
chronic fatigue syndrome has been shown to be beneficial in a
controlled trial?

[] A. Corticosteroids.
[] B. Antidepressants.
[] C. Graded aerobic exercise.
[] D. Prolonged rest.

Type X Questions

Each question has one or more correct answers.

Articles

Diagnosis and Management of Ectopic Pregnancy
(p. 1707)

Q12. Which of the following statements about methotrexate
therapy for ectopic pregnancy is/are correct?

[] A. The single-dose regimen is significantly more
effective than the multiple-dose regimen.
[] B. The success rate is higher with lower baseline
levels of beta subunit of human chorionic gonadotropin.
[] C. The overall success rate is 66 percent.
[] D. The single-dose regimen has slightly fewer side
effects compared with the multiple-dose regimen.

Detection and Evaluation of Chronic Kidney Disease
(p. 1723)

Q13. Which of the following statements about diagnostic
evaluation of kidney disease is/are correct?

[] A. Rash and arthritis are clues to the presence of
glomerulonephritis.
[] B. Red blood cell casts are associated with essential
hypertension.
[] C. Dysmorphic red blood cells are associated with
low flow states.
[] D. Red blood cell casts are associated with
glomerulonephritis.

Q14. Which of the following tests is/are recommended by the
Kidney Disease Outcomes Quality Initiative guidelines to
screen for chronic kidney disease?

[] A. Serum creatinine level.
[] B. A 24-hour urine collection for creatinine clearance.
[] C. Estimation of the glomerular filtration rate.
[] D. Microalbumin-sensitive urine dipstick.

Management of Acute Renal Failure (p. 1739)

Q15. A 45-year-old patient has allergic interstitial nephritis.
Which of the following medications can cause this condition?

[] A. Allopurinol (Zyloprim).
[] B. Cephalosporins.
[] C. Furosemide (Lasix).
[] D. Cimetidine (Tagamet).

A Clinical Approach to Diagnosing Wrist Pain (p. 1753)

Q16. Which of the following conditions is/are possible causes
of wrist pain?

[] A. Amyloidosis.
[] B. Carpal tunnel syndrome.
[] C. Osteomyelitis.
[] D. Reflex sympathetic dystrophy (i.e., complex
regional pain syndrome).

Extrapulmonary Tuberculosis: An Overview (p. 1761)

Q17. Limited evidence suggests adjunctive corticosteroids
may be beneficial in patients with which types of extrapulmonary
tuberculosis?

[] A. Tuberculous meningitis.
[] B. Tuberculous pericarditis.
[] C. Miliary tuberculosis with refractory hypoxemia.
[] D. Gastrointestinal tuberculosis.

Medications for Treating Alcohol Dependence (p. 1775)

Q18. Which of the following drugs is/are approved by the
U.S. FDA for the treatment of alcohol disorders?

[] A. Disulfiram (Antabuse).
[] B. Acamprosate (Campral).
[] C. Topiramate (Topamax).
[] D. Naltrexone (Trexan).

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

Screening for Gonorrhea (p. 1799)

Q19. At a routine wellness examination, a pregnant
gonorrhea screening test is positive. Which of the following
actions is/are appropriate?

[] A. Arrange testing or presumptive treatment for the
patient's sexual partner.
[] B. Treat the patient with a third-generation
cephalosporin.
[] C. Consider a second gonorrhea screening test during
the third trimester.
[] D. Delay treatment until the second trimester.

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 1635.
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 Management of Ectopic Pregnancy
(p. 1707).
[] B. Detection and Evaluation of Chronic Kidney
Disease (p. 1723).
[] C. Management of Acute Renal Failure (p. 1739).
[] D. A Clinical Approach to Diagnosing Wrist Pain
(p. 1753).
[] E. Extrapulmonary Tuberculosis: An Overview
(p. 1761).
[] F. Medications for Treating Alcohol Dependence
(p. 1775).
[] G. Psychological Interventions for Noncardiac Chest
Pain (p. 1701).
[] H. Chronic Fatigue Syndrome (p. 1793).
[] I. Screening for Gonorrhea (p. 1799).

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. B Q2. D Q3. D Q4. C Q5. A Q6. B Q7. A Q8. D Q9. D Q10. A Q11. C Q12. B, D Q13. A, D Q14. A, C, D Q15. A, B, C, D Q16. A, B, C, D Q17. A, B, C Q18. A, B, D Q19. A, B, C

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American Family Physician