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 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 April 2000
Isolated Systolic Hypertension in Elderly Patients (SEE ARTICLE)
Q1. Isolated systolic hypertension:
A. Is present in 55% of the US population by age 75 to 80 years.
B. Is a benign consequence of aging.
C. Is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic blood pressure of 90 mm Hg or less.
D. Is clearly related to stroke, coronary heart disease, heart failure, heart size, renal failure, and decreased renal size.
E. Has not been found to respond to a low-sodium diet.
Q2. Regarding treatment of isolated systolic hypertension:
A. Angiotensin-converting enzyme inhibitors are not well tolerated by elderly patients.
B. Prudent control of the systolic pressure at levels between 140 and 169 mm Hg (depending on the age of the patient) is desirable.
C. The 
-blockers should not be used in combination with other agents.
D. Short-acting calcium-channel blockers are recommended
E. Dry mouth is an important adverse effect of the pure 
-blockers doxazosin and terazosin.
Physicians' Workload and Patients' Assessments of Primary Care Performance (SEE ARTICLE)
Q3. Patients whose physicians work more than 65 hours per week, compared with patients whose physicians work fewer hours, experienced higher levels of:
A. Visit-based continuity.
B. Preventive counseling.
C. Clinician-patient communication.
D. Interpersonal treatment.
E. Patient-physician trust.
Continuity of Care and Emergency Department Utilization (SEE ARTICLE)
Q4. Patients with high provider continuity of care:
A. Are less likely to take medicines correctly.
B. Are less satisfied with their care.
C. Are less likely to have their problems identified by their physicians.
D. Are less likely to have multiple hospital emergency department visits.
E. Are more likely to be hospitalized.
Depression Management Program for High Utilizers of Medical Care (SEE ARTICLE)
Q5. Depression among primary care patients:
A. Leads to utilization of health care services that is 25% higher than utilization by similar patients without depressive illness.
B. Goes unrecognized 70% of the time.
C. Has a low rate of undertreatment.
D. Is treated 85% of the time according to expert guidelines.
E. Has an economic burden that vastly exceeds the resources currently devoted to treatment.
Recreational Firearm Use and Hearing Loss (SEE ARTICLE)
Q6. Hearing loss:
A. Among hunters and target shooters is more pronounced at a lower frequency range.
B. Has been associated with misdiagnosis of medical or emotional problems.
C. Is equally prevalent among men and women.
D. Is less in the ear opposite from a firearm, secondary to the head shadow effect.
E. Among former military recruits is similar in both ears.
Physicians' Prevention-Related Practices (SEE ARTICLE)
Q7. Which of the following was found to be most significantly correlated with physicians' reported prevention-related counseling and screening practices?
A. Practicing a related health habit oneself.
B. Career satisfaction.
C. Personal health status.
D. A personal or family history of disease.
E. Control of the work environment.
Enhancing Influenza Immunization (SEE ARTICLE)
Q8. Influenza immunization:
A. A national immunization rate goal of 60% among Medicare beneficiaries was set by the Healthy People 2000 objectives.
B. Occurs within a system that is centralized.
C. Results in a 15% reduction in deaths among elderly individuals residing in the community.
D. Was documented in 50% of elderly persons in the United States in 1988.
E. Was paid for by Medicare beginning in 1990.
Reducing Antihypertensive Medication Use in Nursing Home Patients (SEE ARTICLE)
Q9. Concerning nursing home patients:
A. Diuretics are the most frequently used antihypertensives.
B. There are many reports of trials to step down dosage or withdraw antihypertensives.
C. In nursing home patients with a diagnosis of hypertension, there is a high degree of blood pressure control.
D. Nursing home staff members have been found to significantly overestimate systolic blood pressure and underestimate diastolic blood pressure.
E. Between 62% and 74% of nursing home residents are diagnosed with hypertension.
Prescription of Proton Pump Inhibitors Before Endoscopy (SEE ARTICLE)
Q10. For gastric cancer:
A. Prognosis is poor regardless of the stage at which the disease is diagnosed.
B. Any patient older than 45 years who develops new dyspeptic symptoms is at risk.
C. In the United States, it is currently the 11th most deadly cancer.
D. Progression from the early to the advanced stages takes months rather than years.
E. Diagnosis has not been found to be delayed by continuous proton pump treatment.
Vagally Mediated Atrial Fibrillation in a Young Man (SEE ARTICLE)
Q11. In atrial fibrillation, which of the following is true?
A. It is often secondary to increased sympathetic tone in patients with heart disease.
B. It is not associated with emotional stress.
C. It is associated with ingestion of hot foods.
D. It should not be treated with -blockers.
E. In a healthy young person, it is unlikely to be caused by increased vagal tone.
