PHYSICIANS WHO read selected articles in this issue of Archives of Family Medicine, answer the Self-assessment Quiz, complete the CME Evaluation, and mail in the Answer Card are eligible for category 1 credit toward the American Medical Association (AMA) Physician's Recognition Award (PRA). There is no charge to subscribers or nonsubscribers.
The AMA is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The AMA designates this education activity for up to 3 hours of category 1 credit per issue toward the AMA PRA. Each physician should claim only those hours of credit that he or she actually spent in the educational activity.
In addition, Archives of Family Medicine has been approved by the American Academy of Family Physicians (AAFP) as having educational content acceptable for Prescribed credit hours. This issue has been approved for up to 3 Prescribed credit hours. Credit may be claimed for 1 year from date of individual issue.
EARNING CREDIT
To earn credit, read the articles designated for CME credit carefully and take the following Self-assessment Quiz. Mark your responses on the accompanying Answer Card and complete the CME Evaluation. Then fax your Answer Card to the Blackstone Group at (312)269-1636 or mail it to the address on the back of the card. Answers are provided elsewhere in Figure 1 so that you can immediately assess your performance.
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Answers to This Issue's Self-assessment Quiz
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Answer Cards must be submitted within 1 year of the issue date. The AMA maintains no permanent record of individual quiz scores. A certificate specifying the total amount of credit received for this educational activity will be returned to you by mail or fax. Please allow up to 4 weeks for your certificate to arrive. Questions about CME processing should be directed to the Blackstone Group; fax: (312) 269-1636.
CME EVALUATION
Our goal is to continually assess the educational needs of our readership for the purpose of enhancing the educational effectiveness of the Archives of Family Medicine. To achieve this goal, we need your help. You must complete the CME Evaluation on the Answer Card to receive credit. Participants are encouraged to reply within 2 months of the issue date, to facilitate the assessment of its educational value.
STATEMENT OF EDUCATIONAL PURPOSE
The Archives of Family Medicine is devoted to strengthening the science, practice, and art of family medicine. Its emphasis is on original research that is clinically practical and academically sound. A flexible curriculum of article topics is developed annually by the journal's editorial board and is then supplemented throughout the year with information gained from readers, authors, reviewers, and editors.
Readers of the Archives of Family Medicine should be able to attain the following educational objectives: (1) use the latest information on diagnosis and treatment of diseases commonly seen in clinical practice to maximize patient health; (2) recognize uncommon illnesses that present with common symptoms to the family physician and treat or refer as appropriate; (3) use practical tools for health promotion and disease prevention; and (4) learn the clinical indications and adverse effects of pertinent new drugs or new uses for available drugs.
Self-assessment Quiz
Questions for May/June 1999
Physician-Assisted Suicide and the Supreme Court (SEE ARTICLE)
Q1. According to a recent Supreme Court ruling, the key requirement to distinguishing between permissible acts of aggressive pain relief and impermissible acts of hastening death is:
A. The patient's desire for hastened death.
B. Physician's intent to relieve pain.
C. The state's law on prohibition against assisted suicide.
D. The presence of an explicit living will.
E. Whether a physician, a nurse, or the patient administers the medicine.
Q2. Based on the recent Supreme Court ruling, which of the following is true concerning end-of-life care?
A. In the case of an incompetent patient, without a previous living will, the physician should err on the side of prolonging life.
B. A physician should stop increasing pain medicine when it is clear that the patient can no longer eat because of sedation from the medicine.
C. The "double effect" doctrine is unacceptable practice in the United States.
D. Physicians can and should treat pain aggressively, but must be careful to not overly sedate patients to treat other symptoms such as shortness of breath.
E. Physical signs can be used to assess the level of pain, even when the patient cannot talk.
Effectiveness of Assistive Technology for Frail Elderly Patients (SEE ARTICLE)
Q3. Assistive technology and environmental interventions for frail elderly patients:
A. Are mostly covered by Medicare.
B. Are arranged through the local Social Security office.
C. Are usually quite expensive and require a prescription.
D. Can decrease the rate of functional decline.
E. Usually require computer-support technology.
Successful Long-term Withdrawal From Antihypertensive Medications (SEE ARTICLE)
Q4. Which combination of factors is associated with the greatest long-term success in withdrawing a patient from antihypertensive medication?
A. No smoking, low alcohol intake, younger age.
B. Recent diagnosis of hypertension, greater maintained weight loss, maintenance of low-salt diet.
C. White race, lower baseline weight, moderate alcohol intake.
D. Regular exercise, lower baseline weight, use of diuretics.
E. Younger age, regular exercise, lower baseline weight.
Treatment of Acute Diarrhea (SEE ARTICLE)
Q5. Acute diarrhea in adults:
A. Is not usually accompanied by symptoms of "gas."
B. Is most often caused by food poisoning.
C. Affects about 10% of travelers from the United States to developing countries.
D. Occurs on average to more than half of adults per year in the United States.
E. Is better treated by no medication than an antimotility agent.
Depression in Late Life (SEE ARTICLE)
Q6. Depression in elderly patients:
A. Is associated with functional impairment.
B. Is underdiagnosed, but unchanged in incidence.
C. Usually presents with sadness as a major symptom.
D. Does not require treatment if associated with significant cognitive impairment.
E. Is less responsive to psychotherapy than depression in younger individuals.
Testosterone Replacement Therapy (SEE ARTICLE)
Q7. The most common cause of primary testicular failure is:
A. Prader-Willi syndrome.
B. Cryptorchidism.
C. Klinefelter syndrome.
D. Orchitis.
E. Trauma.
Q8. The most accurate indicator of hypogonadism is:
A. Low free testosterone level.
B. Low bound testosterone level.
C. Low evening testosterone level.
D. High luteinizing hormone level, low follicle-stimulating hormone level.
E. High luteinizing hormone level, high follicle-stimulating hormone level.
Q9. Testosterone replacement for male hypogonadism:
A. Decreases bone mass.
B. Increases high-density lipoprotein cholesterol.
C. Causes immediate epiphyseal closure in pubertal boys.
D. Causes rises in prostate-specific antigen to about 1
times the normal level for age.
E. Can cause gynecomastia.
Q10. Which of the following is an incorrect match-up of testosterone type and associated side effect?
A. Scrotal patch and excessively elevated dihydrotestosterone level.
B. Intramuscular and fluctuations in mood over the month.
C. Nonscrotal transdermal and reversed diurnal blood levels.
D. Testosterone ester and emotional lability.
E. 17
-alkylated androgens and hepatocellular carcinoma.
Trigeminal Neuralgia (SEE ARTICLE)
Q11. Which of the following is most typical of trigeminal neuralgia?
A. Recurrent attacks, increasing in frequency.
B. Modest effectiveness of carbamazepine.
C. Miosis.
D. Mild pain with eye movement.
E. Persistent pain.
