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  Vol. 9 No. 5, May 2000 TABLE OF CONTENTS
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The Archives of Family Medicine Continuing Medical Education Program

Arch Fam Med. 2000;9:463-465.

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; tel: (312) 419-0400, ext 225; fax: (312) 269-1636.


Our goal is to continually assess the educational needs of our readership zfor 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 May 2000

French Physicians' Knowledge of Practice Guidelines (SEE ARTICLE)

Q1.Regarding regulatory practice guidelines, known as references medicales opposables (RMOs):

A. The RMOs were introduced by law in France in 1970.
B. The RMOs are selected by representatives of French insurance funds and physicians' unions, using specific guidelines drawn up by a national publicly funded agency.
C. The RMOs cover only medical topics.
D. The RMOs are rarely published and discussed in French professional medical journals.
E. The awareness and knowledge of RMOs among French family physicians seem strong.

Flexible Sigmoidoscopy Training and Colorectal Cancer Screening (SEE ARTICLE)

Q2 Regarding colorectal cancer:

A. Flexible sigmoidoscopy and fecal occult blood testing increase detection of cancer, but have not been shown to reduce mortality.
B. Colorectal cancer is the second most common cause of cancer-related deaths in the United States.
C. Screening with flexible sigmoidoscopy is recommended every 10 years, beginning at age 50 years.
D. More than 50% of Americans older than 50 years have undergone sigmoidoscopic examination in the preceding 5 years.
E. Cure rates for colorectal cancer are poor, regardless of the stage at detection.

How Does Physician Advice Influence Patient Behavior? (SEE ARTICLE)

Q3 Receiving advice from a physician:

A. Before being sent printed educational materials on the same topic made patients unlikely to show the materials to a friend or family member.
B. To quit smoking before receiving educational materials about quitting is unlikely to increase patients' attempts at quitting.
C. Before being sent printed educational materials on the same topic was unlikely to help patients remember the materials.
D. Before being sent printed educational materials on the same topic was more likely to make patients perceive the materials as applying to them specifically.

Deliveries by Family Physicians in Connecticut (SEE ARTICLE)

Q4. Regarding obstetric care provided by family physicians:

A. Restrictions on obstetric privileges are fairly uniform across the United States.
B. Nationally, roughly 45% of family physicians practice obstetrics.
C. The primary cesarean section rate is lower for family physicians compared with obstetrician-gynecologists.
D. In Connecticut, only 20% of family physicians practice obstetrics.
E. Use of obstetric intervention and consultation varies little among Connecticut family physicians.

Clinical and Demographic Predictors of Late-Stage Cervical Cancer (SEE ARTICLE)

Q5.Regarding cervical cancer:

A. Medicare currently reimburses for Papanicolaou smears.
B. Smoking is not a risk factor for cervical cancer.
C. Age at diagnosis is the most important prognostic determinant for invasive cervical cancer.
D. Insurance status is not a risk factor for late-stage disease.
E. Most authorities recommend discontinuation of routine Papanicolaou smears in women older than 65 years.

Q6.Papanicolaou smears:

A. Should be performed at least every 3 years in all women who are or have been sexually active.
B. Have not been shown to reduce mortality from cervical cancer.
C. Are more likely to be performed on unmarried than married women.
D. Do not need to be performed on homosexual women.

Health Consequences of Physical and Psychological Intimate Partner Violence (SEE ARTICLE)

Q7.Regarding intimate partner violence (IPV):

A. Most victims of IPV experience multiple abusive relationships.
B. Intimate partner violence limited to psychological abuse is not associated with adverse physical health.
C. The health consequences of physical IPV are limited to injuries sustained as a direct result of the physical abuse.
D. The lifetime prevalence of IPV among women receiving primary care at a university-associated clinic is approximately 15%.
E. Screening for IPV can consist of a questionnaire that is short, easy to administer, sensitive, and specific.

Primary Care Physician Incentives in Group Practices (SEE ARTICLE)

Q8.Regarding primary care physician incentives:

A. Little variation exists in the types of primary care physician incentives implemented by medical groups.
B. Many group practices rely heavily on measures of primary care physician production.
C. A large number of groups use quality of care measures.
D. Physician incentives based on resource utilization are commonly used.
E. Physician incentives based on group financial performance are uncommon.

Adults With Cerebral Palsy (SEE ARTICLE)

Q9.When caring for an adult with cerebral palsy:

A. Understanding the etiology of the patient's cerebral palsy is important.
B. It is very important to elicit a functional and social history, focusing on social and daily living skills.
C. Standard routine health screening tests and preventive practices do not need to be performed.
D. A detailed physical examination is almost always difficult to perform.
E. Taking a history from the patient is likely to be fruitless and may be skipped.

Q10.Regarding children with cerebral palsy:

A. Cerebral palsy is the most frequent developmental disability in children.
B. Fewer than 25% of children with cerebral palsy survive into adulthood.
C. Cerebral palsy is defined as a disorder of motor function dating to events occurring in the prenatal or perinatal period.
D. Athetoid or ataxic movements typically are present from birth.
E. Cerebral palsy has been conclusively shown to be related to injury sustained at birth or perinatal asphyxia related to delivery.

Q11.Regarding adults with cerebral palsy:

A. Cerebral palsy is becoming less prevalent in the adult population.
B. Adults with cerebral palsy have a reduced risk of mortality from cancer, stroke, and ischemic heart disease.
C. Cerebral palsy rarely includes paresis and incoordination.
D. Twenty percent of adults with cerebral palsy can walk.

Following Depression in Primary Care (SEE ARTICLE)

Q12.Symptoms of depression:

A. Are assessed more frequently by internal medicine than by family physicians.
B. Rarely mimic symptoms of somatic disorders.
C. Can only be elicited after a substantial investment of time and energy.
D. Should be assessed and reassessed over time.
E. Are uncommonly detected in primary care patients.

© 2000 American Medical Association. All Rights Reserved.