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Journal CME Quiz:
The Maryland Family Doctor, Spring 2010

The Maryland Family Doctor has been reviewed and is acceptable for Prescribed credits by the American Academy of Family Physicians (AAFP). This Spring, 2010 edition (vol. 46, No. 4) is approved for 2.5 Prescribed credits. Credit may be claimed for two years from the date of this edition.

AAFP Prescribed credit is accepted by the American Medical Association (AMA) as equivalent to AMA PRA Category 1 credit toward the AMA Physicians Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed credit, not as Category I.

CREDIT REPORTING PROCEDURE: To obtain credit through the Maryland Family Doctor publication, complete and return this post-test (CME quiz) directly to the Maryland Academy of Family Physicians. MAFP staff will then report credits to AAFP. Each participant will receive a confirmation email (or postcard if no email) upon receipt of the quiz forms and be able to track credits posted on the AAFP website at www.aafp.org. Please keep a copy of the completed quiz for your records. Questions? Contact the MAFP office.

Articles

1. Focus on Prevention and Screening for CVD p. 5
2. Screening for Cardiovascular Disease p. 6
3. Aspirin for the Primary Prevention of Cardiovascular Disease Events p. 7
4. The Recognition and Treatment of Depression in Family Medicine, Part 2 p. 8
5. ACOs – Friend or Foe? p. 12
6. Sexual Assault: The Role of the Family Physician p. 15

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Indicate Each Correct Answer

Questions Article #1:

1. Risk of CVD over the next 10 years and risk of GIB are the only factors to discuss with patients when considering aspirin for the primary prevention of CVD.

	A.	True
	B.	False

Questions Article #2:

2. Which is (are) true regarding current USPSTF recommendations for asymptomatic screening of abdominal aortic aneurysm?

	A.	Women age 65-75 years old who have smoked greater than 100 cigarettes in their lifetime should be screened.
	B.	No women should be screened.
	C.	Women age 65-75 years old who never smoked should be screened.
	D.	Men age 65-75 years old who have smoked greater than 100 cigarettes in their lifetime should be screened.
	E.	Both b and d are true

3. Which is (are) true regarding peripheral vascular disease?

	A.	It primarily impacts the upper extremities.
	B.	An ankle-brachial index score of 0.93 is considered severe disease.
	C.	Definitive treatment is available that improves mortality beyond treatment determined by a standard cardiac assessment
	D.	Smoking cessation and anti-lipid medications can help to improve symptoms.
	E.	Easy fatigue of lower extremities and decreased physical activity is rarely a symptom.

4. Cardiovascular screening in asymptomatic individuals as recommended by the United States Preventive Service Task Force includes:

	A.	Men aged 65-75 years old who have smoked, for aortic aneurysm
	B.	Women who have smoked, for abdominal aortic aneurysm
	C.	Men 65-75 years old who have smoked, for peripheral artery disease
	D.	Women who have not smoked, for carotid artery stenosis
	E,	Men who have smoked, for carotid artery stenosis

5. Carotid artery duplex scan should be considered

	A.	When a 65-year-old woman who smokes presents to her family doctor with no neurological signs or symptoms
	B.	When a 72-year-old man who does not smoke presents to his family doctor with new neurologic symptoms in the area of the right carotid artery distribution
	C.	When a 45-year-old man who smokes and has a family history of cardiovascular disease presents to his family doctor
	D.	When a 55-year-old woman who does not smoke presents to family doctor

6. Mr. Reagan, who is 74 years old and a former smoker, comes to your office after his wife heard about vascular screenings on the radio. You suggest:

	A.	a duplex doppler ultrasound on his carotid arteries
	B.	an ankle-brachial index to screen for peripheral vascular disease
	C.	a one-time abdominal ultrasound to screen for an abdominal aortic aneurysm
	D.	All of the above
	E.	None of the above

Questions Article #3:

7. Which of the following is true regarding the epidemiology of cardiovascular disease (CVD) in men and women in the U.S.?

	A.	Men are more likely than women to die after a first myocardial infarction.
	B.	After age 75, the risk of ischemic stroke in women is greater than the risk for men.
	C.	The 10-year risk of initial ischemic stroke at 55 years of age is 10 percent for women.
	D.	Women tend to be younger than men at first myocardial infarction.
	E.	After age 40 the lifetime risk for CVD is greater for women than men.

8. Regarding the evidence for aspirin for the primary prevention of CVD events, which of the following is true?

	A.	Aspirin consistently reduces mortality from stroke in women without a history of neurovascular disease
	B.	Men benefit from aspirin in the reduction of all-cause mortality.
	C.	Women benefit from aspirin in the reduction of myocardial infarctions.
	D.	Men benefit from aspirin in the reduction of overall CVD events.
	E.	Men experience a reduced risk of hemorrhagic stroke associated with aspirin.

9. Which of the following statements is true concerning the harms of aspirin?

	A.	Aspirin consistently increases the risk of gastrointestinal bleeding (GIB) in men and women.
	B.	Aspirin consistently increases the risk of hemorrhagic stroke in men and women.
	C.	Women have a higher risk of GIB from aspirin than men.
	D.	Drugs like ibuprofen given with aspirin increase the risk of GIB approximately twofold.
	E.	Age is not an important risk factor for GIB associated with aspirin.

10. Who of the following should take aspirin, according to the U.S. Preventive Services Task Force recommendations:

	A.	A 42-year-old man with an average 10 year risk of MI and GIB
	B.	A 42-year-old woman with an average 10 year risk of MI and GIB
	C.	A 50-year-old man with an increased 10 year risk of MI and average risk of GIB
	D.	A 60-year-old woman with an average 10 year risk of MI and average risk of GIB
	E.	A 50-year-old woman with an average 10 year risk of MI and an average risk of GIB

11. Which of the following is true regarding the epidemiology of CVD in the U.S.?

	A.	CVD accounts for approximately one million deaths per year.
	B.	CVD is the underlying or contributing cause in 58 percent of deaths.
	C.	CVD is second to cancer as a cause for death in adults in the U.S.
	D.	Overall, 1 in 5 adults have some form of CVD.

Questions Article #4:

12. Which would be the most accurate statement about anti-depressant medications?

	A.	SSRIs work better than tricyclics.
	B.	Tricyclics are very safe.
	C.	All anti-depressants work in about 70 percent of patients.
	D.	Anti-depressants should start working within two days.
	E.	Fluoxetine has a short half-life.

13.Which is correct?

	A.	Stop medication at end of acute phase.
	B.	Continuation phase should last 3 months.
	C.	Maintenance may be lifelong.
	D.	Lower dose during continuation phase.
	E.	Stop medication when achieve remission.

14. Which is true?

	A.	St. John’s Wort is highly effective in severely depressed patients.
	B.	Psychotherapy is as effective as medication in severely depressed patients.
	C.	Adolescent suicide has declined since the “black box warning.”
	D.	Bupropion is the most effective antidote for SSRI-induced sexual dysfunction.
	E.	A recent meta-analysis showed escitalopram to be the best first antidepressant.

Questions Article #5:

15. Which one of the following factors is a fundamental requirement of the accountable care organization (ACO) model of care?

	A.	The ACO accepts insurance risk.
	B.	Payment to physicians is based primarily upon a capitation model.
	C.	Goals and incentives of physicians and other providers of clinical care are aligned.
	D.	Participating primary care doctors are employees of the ACO.
	E.	Participating non-primary care doctors are employees of the ACO.

16. All of the following payment models incentivize hospitals to participate in coordination of care EXCEPT:

	A.	Accountable care organization
	B.	Patient-centered medical home model of blended payment
	C.	Bundled payment for episodes of care
	D.	Full capitation

17. The accountable care organization model of care promotes all of the following EXCEPT:

	A.	Local accountability for the quality of care of a defined population.
	B.	Standardized performance measurements
	C.	Payments that incentivize the volume of care performed
	D.	Local accountability for per capita cost of care of a defined population
	E.	A culture of teamwork in the practices

Questions Article #6:

18. Which of the following is true regarding the epidemiology of sexual assault?

	A.	There was a 53 percent decrease in rape/sexual assault between 1999 and 2008.
	B.	There are approximately 5000 rapes a year in Maryland.
	C.	There are approximately 500,000 rapes a year in the U.S.
	D.	About half of Americans will experience rape/sexual assault in their lifetimes.

19. Age and sex are important risk factors for sexual assault/rape; which of the following is true?

	A.	The elderly are at highest risk.
	B.	Three percent of men and 18 percent of women will be victims during their lifetimes.
	C.	Approximately 75 percent of female victims were first raped before their 18th birthday.
	D.	Approximately 25 percent of female victims were first raped after their 25th birthday.

20. Regarding the consequences of sexual assault, which of the following is true?

	A.	Approximately 10 percent of rape victims will develop post-traumatic stress disorder (PTSD).
	B.	Drug therapies for PTSD are most effective for negative symptoms, such as numbing and avoidance.
	C.	Selective serotonin reuptake inhibitors have been shown to be an effective first-line drug.
	D.	Psychotherapy has been shown to be ineffective in the treatment of PTSD.

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Journal CME Quiz: The Maryland Family Doctor, Spring 2010

Journal CME Quiz:
The Maryland Family Doctor, Spring 2010