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Journal CME Quiz:
The Maryland Family Doctor, Winter 2011

The Maryland Family Doctor has been reviewed and is acceptable for Prescribed credits by the American Academy of Family Physicians (AAFP). This Winter, 2011 edition (vol. 47, No. 3) is approved for 2 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.

Articles

1. State of the Art Review of Lumbar Stenosis - p.10
2. Buttock Pain: A Diagnostic Dilemma - p.12
3. Spinal Cord Stimulation – The Pain Pacemaker - p.14
4. Current Guidelines for Opioid Use in Chronic Pain Management - p.17
5. Pain Without Proof - p.20

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Indicate Each Correct Answer

Questions Article #1:

1. What are the diagnostic tests typically used for the diagnosis of lumbar spinal stenosis?

	A.	MRI scan
	B.	CT scan
	C.	X-ray
	D.	Electromyography
	E.	All of the above

2. Name the one most common early clinical presentation for spinal stenosis?

	A.	Loss of bowel and bladder control
	B.	Pain and numbness when standing and walking
	C.	Weakness
	D.	Paraplegia

3. What nerve is usually affected from spinal stenosis due to a paramedian L5-S1 disc HNP?

	A.	L3
	B.	L4
	C.	L5
	D.	S1

4. The potential long term complication if cauda equina syndrome if not treated immediately is permanent loss of bowel and bladder function.

	A.	True
	B.	False

5. The physiologic value of an epidural injection on spinal stenosis to decrease the inflammation around the nerve root and reduce the pain.

	A.	True
	B.	False

6. The value of electrodiagnostic testing in spinal stenosis is to determine the degree of severity of the stenosis and to help localize the level of the radiculopathy.

	A.	True
	B.	False

Questions Article #2:

7. A positive Straight Leg Raise (SLR) test points to a diagnosis of:

	A.	Hip DJD
	B.	Radiculopathy
	C.	Trochanteric bursitis
	D.	Lumbar facet joint pain

8. The gold standard for diagnosis of zygapophyseal joint pain is:

	A.	Ultrasound
	B.	MRI of the spine
	C.	Relief from low volume local anesthetic injection
	D.	Patient history

9. The clinician should have a low threshold for ordering imaging in patients with:

	A.	Profound, unintentional weight loss
	B.	Worsening pain at night
	C.	A history of neoplasm
	D.	All of the above

10. An abnormal ankle jerk reflex suggests:

	A.	An abnormality involving the S1 nerve root
	B.	A facet joint cause of pain
	C.	Sacroiliac joint dysfunction
	D.	Piriformis syndrome

Questions Article #3:

11. Spinal Cord Stimulators are manufactured by which three companies? (Select three):

	A.	Boston Scientific
	B.	St. Jude
	C.	Smith and Nephew
	D.	Stryker
	E.	Medtronic

12. Spinal Cord Stimulators are indicated for the treatment of acute and chronic neuropathic pain of the back, trunk and/or limbs.

	A.	True
	B.	False

13. Examples of Neuropathic Pain Successfully Treated with Spinal Cord Stimulators (Select all that apply)

	A.	Complex Regional Pain Syndrome (CRPS 1 and 2), formerly known as RSD
	B.	FBSS (Failed Back Surgery Syndrome), frequently with radicular components
	C.	Migraine headaches
	D.	PHN (Post Herpetic Neuralgia)
	E.	Phantom Limb Pain
	F.	Neuropathic pain from Peripheral Diabetic Neuropathy

14. At what level can Spinal Cord Stimulators be considered?

	A.	Level 1 Basic Pain Therapies
	B.	Level 2 Mid-Level Pain Therapies
	C.	Level 3 Advanced Pain Therapies

15. Spinal Cord Stimulator implants are typically performed in two stages; the trial or “Test Drive” and the permanent implantation.

	A.	True
	B.	False

16. Spinal Cord Stimulators are contraindicated for those who are: (Select all that apply)

	A.	Poor surgical candidates
	B.	People over the age of 75
	C.	Pregnant
	D.	Unable to operate the remote control
	E.	Those who have had success with a spinal cord stimulator trial

Questions Article #4:

17. Physicians are hesitant to prescribe opioids because of concerns about the potential for misuse, abuse, addiction, side effects (respiratory depression), tolerance, diversion and fear of regulatory action.

	A.	True
	B.	False

18. Biological risk factors for aberrant behaviors/harm include the following EXCEPT:

	A.	Age > 45 years
	B.	Female gender
	C.	Family history of drug or alcohol abuse
	D.	Cigarette smoking

19. In an opioid naïve patient, a safe starting dose for methadone is:

	A.	1mg every 8 hours
	B.	2.5mg every 8 hours
	C.	5mg every 8 hours
	D.	10mg every 8 hours

20. Common potential adverse side effects of opioid include the following EXCEPT:

	A.	Cloudy thinking
	B.	Somnolence
	C.	Slower reflexes
	D.	Diarrhea
	E.	Decreased concentration

21. Which of the following are the primary sanctioning bodies for offenses related to prescribing opioid analgesics?

	A.	Food & Drug Administration (FDA)
	B.	State medical boards
	C.	Federation of State Medical Boards (FSMB)
	D.	American Academy of Pain Medicine (AAPM)
	E.	U.S. Drug Enforcement Agency (DEA)

Questions Article #5:

22. All of the following are commonly seen in fibromyalgia patients, EXCEPT:

	A.	Chronic fatigue syndrome
	B.	Depression
	C.	Hypertension
	D.	Anxiety

23. A diagnosis of fibromyalgia requires 9 out of 11 specific areas with pain and are mostly above the waist.

	A.	True
	B.	False

24. First line treatment of Fibromyalgia, once the criteria is met is antidepressants.

	A.	True
	B.	False

25. Fibromyalgia may affect patients of all ages, both sexes and with any type of co-morbididities.

	A.	True
	B.	False

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Journal CME Quiz: The Maryland Family Doctor, Winter 2011

Journal CME Quiz:
The Maryland Family Doctor, Winter 2011