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  Vol. 9 No. 8, August 2000 TABLE OF CONTENTS
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The Archives of Family Medicine Continuing Medical Education Program

Arch Fam Med. 2000;9:735.

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; tel: (312) 419-0400, ext 225; 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 ractical 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 August 2000

Health Food Store Recommendations for Breast Cancer Patients (SEE ARTICLE)

Q1. Regarding complementary and alternative medicine (CAM):
A. Since 1990, the use of CAM in the United States has grown 30%.
B. A reason for the recent surge in individual use of CAM is public distrust of medical establishments and government agencies.
C. The 1994 DSHEA (Dietary Supplement Health and Education Act: Public Law 103-417 S784) strengthened labeling regulations on CAM products.
D. Federal law does not allow CAM advertisers to make structure/function claims about products.

Nurse Telehealth Care and Peer Support in Treatment of Depression (SEE ARTICLE)

Q2. Regarding nurse telehealth and peer support in treatment of depression:
A. Medication adherence improved with nurse telehealth care.
B. The findings regarding nurse telehealth care have not been of interest to health maintenance orgainizations.
C. Nurse telehealth care is significantly more effective than usual care.
D. The difference between nurse telehealth care and usual care is much smaller than the difference between drug and placebo.
E. There is a great deal of evidence on the effectiveness of nurse telehealth care.

Cost-effectiveness of the Conventional Papanicolaou Test With a New Adjunct to Cytologic Screening (SEE ARTICLE)

Q3. Regarding cervical cancer:
A. Squamous cell carcinomas of the cervix have a short latency period.
B. Since the introduction of the Papanicolaou test in the 1930s, cervical cancer mortality has declined 10% in the United States.
C. The sensitivity and specificity of Papanicolaou tests vary widely, from 11% to 99% and 14% to 97%, respectively.
D. During the past 5 years, no new adjuncts to Papanicolaou tests have become available.
E. Most cervical cancers are not squamous cell carcinomas.

Costs of {beta}-Lactam Allergies (SEE ARTICLE)

Q4. Regarding patients with a reported {beta}-lactam allergy:
A. The presence of an allergy seems to significantly affect antimicrobial prescribing and medication costs.
B. Prescription costs were lower for patients with {beta}-lactam allergies.
C. Patients with a penicillin allergy are less likely to have a similar allergy to cephalosporins.
D. There is no difference in age between patients who report an allergy and those who do not.
E. The date of the "allergic reaction" was usually noted in the medical record.

Is Caffeine a Flavoring Agent in Cola Soft Drinks? (SEE ARTICLE)

Q5. Regarding soft drinks:
A. In 1998, Americans consumed 1 million gallons of flavored carbonated beverages.
B. Soft drinks represent the smallest source of added sugar in the American diet.
C. There is continuing concern that consumption of soft drinks adversely affects health.
D. Caffeine is an added ingredient in approximately 10% of soft drinks sold in the United States.
E. Caffeine has been recognized as a sweet substance that can be used as a flavoring agent.

Management of Nasal Fractures (SEE ARTICLE)

Q6. Regarding nasal fractures:
A. Most nasal fractures occur in the upper half of the nasal bones.
B. Traumatic disruption of the nasal bones and cartilages can result in significant external deformity and airway obstruction.
C. A small object with high velocity imparts less damage than larger objects at a lower velocity.
D. Lateral nasal trauma is uncommon.
E. The physical examination is least accurate if performed before posttraumatic edema.

Q7. Regarding treatment of nasal fractures:
A. There is some controversy as to the most appropriate timing of treatment.
B. Closed reduction within 7 to 10 days cannot be accomplished under local anesthesia.
C. Bone healing does not occur more rapidly in the pediatric population.
D. Mild-to-moderate fractures are more easily assessed and accurately reduced 30 days after injury.
E. Reduction of nasal fractures can only be accomplished with a closed technique.

Update on the Management of Hyperthyroidism and Hypothyroidism (SEE ARTICLE)

Q8. Regarding hyperthyroidism:
A. In patients older than 70 years, the classic clinical manifestations and goiter are usually present.
B. Measurement of serum free thyroxine is the most sensitive test for screening for hyperthyroidism.
C. Propylthiouracil is used in preference to methimazole because it has a longer inhibitory effect on glandular hormone synthesis.
D. Long-term antithyroid drug therapy is not appropriate for Graves hyperthyroidism.
E. Thyroid radioiodine is the treatment of choice for patients with Graves hyperthyroidism who relapse after long-term antithyroid drug therapy.

Q9. Regarding hypothyroidism:
A. Hypothyroidism refers only to primary thyroid failure.
B. The clinical manifestations of hypothyroidism are very specific.
C. The laboratory hallmark of primary hypothyroidism is an increased serum thyrotropin concentration.
D. Levothyroxine should be taken with meals to help with absorption.
E. Subclinical hypothyroidism refers to the state in which a normal serum thyrotropin level is accompanied by a decreased serum free thyrotoxin level.

Evaluation of Migraineurs' Preferences for Naratriptan Over Conventional First-Line Agents (SEE ARTICLE)

Q10. Regarding migraine headaches:
A. It is estimated that 1 in 20 adult women suffer from migraines.
B. Migraine remains an underdiagnosed and undertreated medical condition.
C. Combination analgesics have not been proposed as first-line therapy.
D. To date, "triptans" have for the most part been used as first-line therapies.
E. A recent survey suggests that the average migraineur failed only 1 treatment before receiving a triptan.

© 2000 American Medical Association. All Rights Reserved.