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  Vol. 8 No. 6, November 1999 TABLE OF CONTENTS
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The Archives of Family Medicine Continuing Medical Education Program

Arch Fam Med. 1999;8:543-545.

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.


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

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.


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.


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.


Questions for November/December 1999

An Overview of Osteopathic Medicine (SEE ARTICLE)

Q1. In the osteopathic medicine tradition, it is generally believed that:

A. The primary role of the physician is to facilitate the body's inherent ability to heal itself.
B. Manipulation of the spine excites the presynaptic cells of the substantia gelantinosa at the level of the posterior horn, generating a positive energy flow.
C. Manipulation rather than medication should be used for most common diseases.
D. Manipulative therapy helps only with problems of the musculoskeletal system.
E. Manipulative therapy works only because of its psychological benefit.

Q2. The high-velocity, low-amplitude osteopathic manipulation technique (also called thrust or mobilization with impulse):

A. Requires significant force.
B. Pushes the joint just beyond the normal range of motion.
C. Is the osteopathic technique least like chiropractic technique.
D. Is the osteopathic technique with the greatest number of contraindications.
E. Uses counterstrain after maintaining the joint in neutral position for 90 seconds.

Prognostic Factors for Chronic Fatigue (SEE ARTICLE)

Q3. When a patient complains of substantial fatigue:

A. Treatment is usually effective.
B. The diagnosis is usually determined.
C. The natural history is that most patients will be well without treatment in a few months.
D. The most common concurrent physical problem is mononucleosis.
E. The best prognosis is for patients who have no somatoform symptoms and report being able to think clearly most of the time.

Experience With Human Immunodefiency Virus in Clinical Practice (SEE ARTICLE)

Q4. Which of the following statements is true concerning rural California family physicians caring for patients with human immunodeficiency virus (HIV) infection?

A. Less than half have cared for a patient with HIV infection.
B. They cannot have enough knowledge/experience to treat HIV-infected patients effectively.
C. Those with 4 or more patients with HIV infection were significantly more likely to use protease inhibitors.
D. Most were trained in HIV care during residency.
E. Most refuse to care for patients with HIV.

Abnormal Papanicolaou Smears and Patient Adherence (SEE ARTICLE)

Q5. Concerning Papanicolaou smears:

A. Low-grade squamous intraepithelial lesions often regress to normal without treatment.
B. High-grade squamous intraepithelial lesions can be evaluated by Papanicolaou smears every 3 months.
C. Patient loss to follow-up after significantly abnormal Papanicolaou smear is uncommon.
D. A reminder system for women after an abnormal Papanicolaou smear is not helpful.
E. Adherence to Papanicolaou smear regimens is remarkably similar across socioeconomic and racial spectrums.

Prevalence of Gambling Disorders in Primary Care (SEE ARTICLE)

Q6. Gambling:

A. Is not a disorder recognized by the American Psychiatric Association.
B. Is considered to be a disorder of impulse control.
C. Pathologic gambling is present in 9% of the population.
D. Gambling problems are associated with alcohol and tobacco abuse.
E. The typical patient with a gambling problem is male, aged 50 to 70 years.

Breast Cancer Trends in Black Women (SEE ARTICLE)

Q7. Breast cancer:

A. Morbidity rates are declining for white women, aged 40 to 69 years.
B. Mortality rates are declining for white women, aged 40 to 69 years.
C. Morbidity rates are declining for black women, aged 40 to 69 years.
D. Mortality rates are declining for black women, aged 40 to 69 years.
E. Mortality rates are increasing for both white and black women 40 years and younger

Quality of Care for Depression in Managed Care (SEE ARTICLE)

Q8. Care for depression in primary care offices:

A. Is more likely to occur in a visit made for a new problem.
B. Is more likely to occur in an unscheduled visit.
C. Is more likely to occur in an appointment made for another problem.
D. More than half of the time includes full-dose antidepressants.
E. More than half of the time includes depression-specific counseling.

Vitamin E in the Prevention of Heart Disease (SEE ARTICLE)

Q9. Vitamin E:

A. Is a naturally occurring group of 8 tocopherols.
B. Has its main effect on superoxide dismutase.
C. Is less well absorbed when taken with dietary fat.
D. Is well absorbed.
E. Major source in the American diet is eggs.

Traumatic Complications of Acupuncture (SEE ARTICLE)

Q10. The most frequently reported injury caused by acupuncture needles is:

A. Pericardial tamponade.
B. Pneumothorax.
C. Peripheral neuropathy.
D. Pseudoaneurysm.
E. Arachnoiditis.

© 1999 American Medical Association. All Rights Reserved.