Clinical Quiz - American Academy of Family Physicians continuing medical education quiz

American Family Physician,  August 15, 2001  

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Type A Questions

Each question has only one correct answer.

COPD: Management of Acute Exacerbations and Chronic Stable Disease (p. 603)

Q1. Which one of the following is not a commonly recommended treatment of
acute exacerbations of chronic bronchitis and emphysema in patients with
chronic obstructive pulmonary disease (COPD)?

[ ] A. Levofloxacin (Levaquin).
[ ] B. Amoxicillin-clavulanate potassium (Augmentin).
[ ] C. Doxycycline (Vibramycin).
[ ] D. Trimethoprim-sulfamethoxazole (Bactrim DS,
       Septra DS).

Q2. Which one of these factors does not increase mortality in patients
with COPD?

[ ] A. Partial pressure of arterial oxygen of less than 55 mm Hg.
[ ] B. Right-sided heart failure.
[ ] C. Malnutrition.
[ ] D. History of atopy.
[ ] E. Tachycardia at rest.

Commonly Missed Diagnoses in the Childhood Eye Examination (p. 623)

Q3. Which one of the following is the most common cause of uncorrectable
loss of vision in children?

[ ] A. Retinopathy of prematurity.
[ ] B. Amblyopia.
[ ] C. Cataracts.
[ ] D. Glaucoma.
[ ] E. Retinoblastoma.

Q4. In which one of the following situations is a child at most risk of
developing glaucoma?

[ ] A. Following cataract surgery.
[ ] B. Presence of iritis.
[ ] C. Following corneal trauma.
[ ] D. Presence of albinism.

Recognizing Spinal Cord Emergencies (p. 631)

Q5. Which one of the following statements about imaging studies of the
spine is incorrect?

[ ] A. Computed tomographic (CT) scanning and magnetic resonance imaging
       (MRI) can clearly define anatomy; however, these studies have high
       false-positive rates and are expensive.
[ ] B. CT scans image bony structures better than MRI studies. Hence, CT
       scanning is considered the imaging modality of choice to evaluate
       patients for spinal trauma and vertebral fractures.
[ ] C. Unless a suspicious finding is noted on the clinical examination,
       plain film radiographs are not recommended for the routine evaluation
       of patients with acute neck and low back pain within the first month
       of symptoms.
[ ] D. MRI has become the imaging modality of choice for the diagnosis of
       radiculopathy, spinal cord abscess and spinal stenosis.
[ ] E. Bone scans are useful when plain film radiographs of the spine are
       normal because bone scanning is not affected by the presence of
       osteoarthritis.

Q6. Which one of the following statements about the ordering of diagnostic
    studies in patients with neck or back pain is incorrect?

[ ] A. If a lateral projection of the cervical spine (plain film
       radiograph) is inadequate, a swimmer's projection, oblique
       projection or CT scan is indicated.
[ ] B. Strong criteria for ordering plain film radiographs include
       intoxication, lack of clinical alertness and altered mental
       status.
[ ] C. MRI is the diagnostic study of choice in patients with acute
       spinal trauma.
[ ] D. Emergency MRI is indicated in patients with suspected cauda
       equina syndrome.
[ ] E. According to the Agency for Healthcare Research and Quality
       (formerly the Agency for Health Care Policy and Research),
       diagnostic testing is not clinically helpful in the evaluation
       of patients with back pain in the first four weeks of symptoms.

Assessment and Treatment of Depression Following Myocardial Infarction
(p. 641)

Q7. Which one of the following medications is the preferred pharmacologic
treatment in a patient with depression following a recent myocardial
infarction?

[ ] A. Amitriptyline (Elavil).
[ ] B. Nortriptyline (Pamelor).
[ ] C. Trazodone (Desyrel).
[ ] D. Imipramine (Tofranil).
[ ] E. Fluoxetine (Prozac).

Q8. To confirm the diagnosis of depression, five or more DSM-IV criteria
symptoms must be present nearly every day for at least two weeks, and one
of the symptoms must be depressed mood or which one of the following?

[ ] A. Significant weight loss or gain.
[ ] B. Loss of interest or pleasure in activities.
[ ] C. Insomnia.
[ ] D. Psychomotor agitation.
[ ] E. Feelings of worthlessness.

Type X Questions

Each question has one or more correct answer.

COPD: Management of Acute Exacerbations and Chronic Stable Disease
(p. 603)

Q9. Which of the following can be likely side effects of long-term
orally administered corticosteroids in the treatment of severe chronic
obstructive pulmonary disease (COPD)?

[ ] A. Hyperglycemia.
[ ] B. Secondary infection.
[ ] C. Behavioral changes.
[ ] D. Decreased bone mineral density.

Q10. Long-term continuous oxygen therapy is usually considered when
which of these conditions is/are present?

[ ] A. Partial pressure of arterial oxygen of less than 55 mm Hg at rest.
[ ] B. Partial pressure of arterial carbon dioxide of greater than 45 mm Hg.
[ ] C. Left-sided heart failure.
[ ] D. Polycythemia.

Commonly Missed Diagnoses in the Childhood Eye Examination (p. 623)

Q11. Which of the following conditions can cause leukocoria (white pupil)?

[ ] A. Hyphema.
[ ] B. Cataract.
[ ] C. Vitreous opacity.
[ ] D. Retinoblastoma.

Recognizing Spinal Cord Emergencies (p. 631)

Q12. Signs and symptoms of true spinal cord emergencies include which of
the following?

[ ] A. Bowel and bladder symptoms and perianal numbness.
[ ] B. A positive Babinski's sign and hyperreflexia.
[ ] C. Sudden onset of myelopathy in a patient with known metastatic cancer.
[ ] D. New onset of neck or back pain in a patient who has a history of
       recent infection or a current fever, an elevated white blood cell
       count and an elevated erythrocyte sedimentation rate.

Assessment and Treatment of Depression Following
Myocardial Infarction (p. 641)

Q13. Which of the following drugs has/have significant
interactions with fluoxetine and, therefore, should be used
with caution in patients following a myocardial infarction?

[ ] A. Metoprolol (Lopressor).
[ ] B. Quinidine (Quinaglute).
[ ] C. Warfarin (Coumadin).
[ ] D. Clonidine (Catapres-TTS).

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 539.

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. COPD: Management of Acute Exacerbations and Chronic Stable
       Disease (p. 603).
[ ] B. Commonly Missed Diagnoses in the Childhood Eye Examination
       (p. 623).
[ ] C. Recognizing Spinal Cord Emergencies (p. 631).
[ ] D. Assessment and Treatment of Depression Following Myocardial
       Infarction (p. 641).

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

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group