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Nuclear Medicine Continuing Education

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 hours. This issue has been approved for up to 4 Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of April 2001. Credit may be claimed for one year from the date of this issue.

The American Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AAFP designates this educational activity for a maximum of 4 hours in Category 1 credit toward the American Medical Association Physician's Recognition Award. Each physician should claim only those hours of credit that he or she actually spent in the educational 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 credit hours 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 credit hours 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 hours 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

* 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.

* Mail the Clinical Quiz answer card within one year (by April 30, 2002). 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.
     [ ] C. IgE-mediated.
     [ ] D. Due to enzyme deficiencies.
 [check] 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 questions has only one correct answer.

Diagnosis and Initial Management of Kidney Stones (p. 1329)

Q1. Which one of the following tests is showing great promise in the
identification of urinary tract stones and is likely to become the
diagnostic gold standard for urolithiasis?
 [ ] A. Magnetic resonance imaging.
 [ ] B. Abdominal contrast-enhanced computed tomography.
 [ ] C. Nuclear imaging.
 [ ] D. Laparoscopy.
 [ ] E. Noncontrast helical computed tomography.

Q2. Which one of the following diagnostic tests has the
highest sensitivity for identifying ureteral stones?
 [ ] A. Plain-film radiography of the kidneys, ureters and bladder.
 [ ] B. Abdominal ultrasonography.
 [ ] C. Urinalysis.
 [ ] D. Intravenous pyelography.

Management of Asthma in Children (p. 1341)

Q3. Which one of the following statements about the use of
long-term medications for the treatment of children with asthma is incorrect?
 [ ] A. Inhaled corticosteroids are the most potent and effective
        long-term anti-inflammatory medications.
 [ ] B. Therapy with inhaled corticosteroids should not exceed recommended
        dosages unless other options, such as the addition of an
        antileukotriene agent or a long-acting beta2 agonist, have been
        tried unsuccessfully.
 [ ] C. Long-acting beta2 agonists are not indicated in the treatment of
        exercise-induced bronchospasm.
 [ ] D. Cromolyn (Intal) and nedocromil (Tilade) are first-line, daily
        anti-inflammatory agents with virtually no serious side effects
        and no known drug interactions.
 [ ] E. Antileukotrienes can be of additional benefit in children with
        symptomatic, moderate asthma who are already taking a maintenance
        dosage of inhaled corticosteroids.

Q4. Which one of the following statements about treating
children with asthma is incorrect?
 [ ] A. In patients with persistent asthma symptoms, inhaled
        corticosteroids are often not prescribed or are prescribed in
        insufficient dosages.
 [ ] B. Emergency action plans should be developed in consultation with
        care givers and patients.
 [ ] C. Treatment for asthma should begin with the most aggressive therapy
        necessary to achieve control, followed by stepping down to the
        minimal therapy that will maintain control.
 [ ] D. Histamines are more potent than leukotrienes in mediating an
        inflammatory response.
 [ ] E. Theophylline is used only in cases of asthma when polypharmacy is
        necessary.

Diagnosis and Management of Malignant Melanoma (p. 1359)

Q5. Which one of the following is the most significant risk factor
for the development of malignant melanoma?
 [ ] A. Multiple nevi.
 [ ] B. Atypical nevi.
 [ ] C. Atypical nevus syndrome with a personal and family history
        of melanoma.
 [ ] D. Personal history of melanoma before 40 years of age.
 [ ] E. Sun sensitivity.

Q6. Which one of the following is the most common subtype of melanoma?
 [ ] A. Superficial spreading melanoma.
 [ ] B. Lentigo maligna melanoma.
 [ ] C. Nodular melanoma.
 [ ] D. Acral-lentiginous melanoma.
 [ ] E. Amelanotic melanoma.

Flexible Sigmoidoscopy (p. 1375)

Q7. Which one of the following findings on sigmoidoscopy requires
a follow-up colonoscopy?
 [ ] A. Polyps less than 5 mm in diameter.
 [ ] B. Polyps greater than 10 mm in diameter.
 [ ] C. Diverticulosis.
 [ ] D. Internal hemorrhoids.
 [ ] E. Pseudomembranes.

Q8. Which one of the following statements about flexible
sigmoidoscopy is correct?
 [ ] A. It is recommended for routine screening for colon cancer
        at seven- to 10-year intervals.
 [ ] B. It is believed that most colon cancers are within the
        reach of the sigmoidoscope.
 [ ] C. Colonic mucosa is inspected as the scope is advanced.
 [ ] D. Biopsies should be obtained of all lesions encountered.

Coronary Artery Disease Prevention: What's Different for Women? (p. 1393)

Q9. Which one of the following statements about coronary artery
disease in women as compared with men is correct?
 [ ] A. Women are more likely to have a lower high-density lipoprotein
        cholesterol level.
 [ ] B. Women are more likely to receive drug therapy for secondary
        prevention of coronary artery disease.
 [ ] C. Women are more likely to die of a first myocardial infarction.
 [ ] D. Women are more likely to receive cardiac rehabilitation.
 [ ] E. Women are less likely to have long-term disability.

Diagnosis and Initial Management of Kidney Stones (p. 1329)

Q10. Patients with renal colic often present with which of the
following?
 [ ] A. Unilateral flank pain.
 [ ] B. Nausea and vomiting.
 [ ] C. Lower abdominal pain.
 [ ] D. Diarrhea.

Q11. Which of these urinalysis findings is/are most common in urolithiasis?
 [ ] A. Bacteriuria.
 [ ] B. Microhematuria.
 [ ] C. Amorphous crystals.
 [ ] D. Limited pyuria.

Q12. Which of the following is/are major prognostic factors for urolithiasis?
 [ ] A. Stone size.
 [ ] B. Severity of pain.
 [ ] C. Stone location.
 [ ] D. Degree of hematuria.

Management of Asthma in Children (p. 1341)

Q13. Which of the following statements about short-acting
asthma medications in children is/are correct ?
 [ ] A. Overuse of short-acting beta2 agonists may reduce their efficacy.
 [ ] B. Most short-acting beta2-agonist metered-dose inhalers hold 120
        two-spray doses and should last one month if used four times daily.
 [ ] C. The U.S. Food and Drug Administration has not approved the
        anticholinergic agent ipratropium (Atrovent) for the treatment of
        asthma in children; however, it may be helpful off-label therapy
        in children who cannot tolerate beta2 agonists or may be added
        to beta2-agonist therapy to treat acute asthma exacerbations.
 [ ] D. Oral beta2 agonists should not be used in children.

Diagnosis and Management of Malignant Melanoma (p. 1359)

Q14. Which of the following is/are warning signs of melanoma?
 [ ] A. Asymmetry of a mole.
 [ ] B. Smooth border of a mole.
 [ ] C. Color variability of a mole.
 [ ] D. Distant metastasis.

Flexible Sigmoidoscopy (p. 1375)

Q15. Which of the following is/are special insertion and advancing
techniques for the sigmoidoscope?
 [ ] A. Torquing.
 [ ] B. Vibrating.
 [ ] C. Hooking and straightening.
 [ ] D. Accordionization.

Coronary Artery Disease Prevention: What's Different for Women? (p. 1393)

Q16. Which of the following statements reflect current expert opinion
about hormone replacement therapy and coronary artery disease?
 [ ] A. Evidence is insufficient concerning the effectiveness of hormone
        replacement therapy for primary and secondary prevention.
 [ ] B. Randomized, controlled trials have shown that hormone replacement
        therapy reduces the rate of further cardiac events in women with
        established coronary artery disease (secondary prevention).
 [ ] C. Randomized, controlled trials have demonstrated that hormone
        replacement therapy reduces cardiac events in women without
        established coronary artery disease (primary prevention).
 [ ] D. Estrogen-only hormone replacement therapy improves lipid profiles
        but has not been shown to decrease cardiovascular mortality.

Type X Questions
Each questions has one or more correct answer.

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 Initial Management of Kidney Stones (p. 1329).
 [ ] B. Management of Asthma in Children (p. 1341).
 [ ] C. Diagnosis and Management of Malignant Melanoma (p. 1359).
 [ ] D. Flexible Sigmoidoscopy (p. 1375).
 [ ] E. Coronary Artery Disease Prevention: What's Different for
        Women? (p. 1393).

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.)

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 1265.

Answers to This Issue's Clinical Quiz

Q1. C
Q2. D
Q3. E
Q4. D
Q5. C
Q6. A
Q7. B
Q8. B
Q9. C
Q10. A,B,C
Q11. A,B,C
Q12. B,D
Q13. A,C
Q14. A,C
Q15. A,C,D
Q16. A,D

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group