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  Vol. 9 No. 2, February 2000 TABLE OF CONTENTS
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The Archives of Family Medicine Continuing Medical Education Program

Arch Fam Med. 2000;9:175-177.

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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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.

Self-assessment Quiz

Questions for February 2000

Postfertilization Effects of Oral Contraceptives (SEE ARTICLE)

Q1. Breakthrough ovulation while on oral contraceptives:

A. Is rare.
B. Is higher with combination pills than progestin-only pills.
C. Is more likely to occur with typical use than perfect use.
D. Is more likely with phasic than monophasic pills.
E. Results in pregnancy about one third of the time.

Q2. Oral contraceptives:

A. Suppress ovulation.
B. Produce a predecidual or decidualized endometrial bed.
C. Alter the biochemical and protein composition of the endometrium.
D. Change integrins.
E. All of the above.

Use of Medical, Complementary, and Self-care Strategies for Arthritis (SEE ARTICLE)

Q3. The most common cause of disability in those 65 years and older in the United States is:

A. Cancer.
B. Arthritis.
C. Stroke.
D. Chronic obstructive lung disease or asthma.
E. Heart disease.

Q4. Which arthritis symptom did patients associate most with the use of self-care, complementary therapies, or medical care modalities?

A. Disruptions in leisure activities.
B. Disruptions in family activities.
C. Difficulty moving around.
D. Disruptions in sleep.
E. Difficulties in completing household chores.

Treatment of Major Depression in Primary Care (SEE ARTICLE)

Q5. Physicians are most likely to treat depressive symptoms if:

A. The patient has other physical problems.
B. The patient has new problems.
C. The patient has more severe emotional symptoms.
D. The patient reports that medication is acceptable.
E. The patient is male.

Orlistat to Treat Obesity in Primary Care Settings (SEE ARTICLE)

Q6. What is the minimum weight loss that is felt to substantially improve the health of obese patients?

A. 5%-10%.
B. 11%-15%.
C. 16%-20%.
D. 21%-25%.
E. Enough weight loss to achieve a body mass index of 25.

Q7. Orlistat:

A. Directly inhibits insulin secretion.
B. Restricts the absorption of triglycerides from the gastrointestinal tract.
C. Increases basal metabolic rate.
D. Decreases the uptake of cholesterol and protein by the intestinal mucosa.
E. Limits the uptake of fatty acids at the cellular membrane.

Q8. The most common side effect of orlistat in this trial was:

A. Gastrointestinal side effects.
B. Palpitations.
C. Jaw cramping.
D. Skin rash.
E. Vaginitis.

Home Diagnosis and Treatment of Obstructive Sleep Apnea (SEE ARTICLE)

Q9. Obstructive sleep apnea has been associated with all of the following except:

A. Hypertension.
B. Stroke.
C. Increased cancer rates.
D. Coronary artery disease.
E. Car accidents.

New Treatments for Acne (SEE ARTICLE)

Q10. The patients with acne most likely to benefit from spironolactone are patients:

A. With multiple lesions on the chest and back.
B. With lesions on the lower face and neck.
C. For whom treatment with benzoyl peroxide failed.
D. With regular menstrual periods.
E. Who are postmenopausal.

Q11. Topical tretinoin in the treatment of acne:

A. Has increased irritant effects if used in combination with a topical antimicrobial agent.
B. Should be stopped if a flare-up of acne occurs 2 to 4 weeks after initiation of therapy.
C. Should not be applied within 1 to 2 hours of benzoyl peroxide.
D. Is ineffective as sole therapy for most patients with mild to moderate acne.
E. Provides its maximum clinical improvement within 1 month.

Q12. Compared with other tetracycline or tetracycline derivatives, minocycline is associated with:

A. More gastrointestinal upset.
B. Photosensitivity.
C. Intracranial hypertension.
D. Vestibular side effects.
E. More development of resistant Propionibacterium acnes.

Spontaneous Splenic Infarction (SEE ARTICLE)

Q13. Which of the following would be the most likely cause of splenic infarction?

A. Atrial fibrillation.
B. Kawasaki disease.
C. Diabetes.
D. Malaria.
E. Hematologic malignant neoplasm.

© 2000 American Medical Association. All Rights Reserved.