FALL 2017 CME QUIZ

CME Articles:

1. Face of Depression in Family Practice
2. The Somatic and Medical Implications of Depression
3. Anxiety and Stress Disorders in Family Care
4. Correlation Between Childhood Trauma and Adult Illness

This Medical Journal activity has been reviewed and is acceptable for Prescribed credits by the American Academy of Family Physicians (AAFP). This Fall, 2017 edition of The Maryland Family Doctor (vol. 55, No. 1) is approved for four (4) Prescribed Credits. Credit may be claimed for one year from the date of this edition (expiring October 31, 2018). Readers must claim only the credit commensurate with the extent of their participation in the activity.

The American Medical Association (AMA) accepts the American Academy of Family Physicians (AAFP) Prescribed credit as equivalent to AMA PRA Category 1 Credit for the AMA Physicians Recognition Award (PRA).

CME activities approved for AAFP Prescribed credit are recognized by the American Osteopathic Association (AOA) as equivalent to AOA Category 2 credit.

Directions:
1. Complete the quiz and click the “submit” button.
2. You will then receive an immediate confirmation that your quiz has been received by MAFP.
3. Print the confirmation for your records.
4. Directly report the indicated number of credits to AAFP (MAFP does not report credits to AAFP)
5. Questions or in need of assistance? Contact the MAFP office at info@mdafp.org or 410-747-1980.

Quiz Answers and Article References

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Article 1 Questions

1. If a patient presents with prominent sadness, which of the following is most suggestive of major depressive disorder?

A. Recent loss of a loved one
B. Crying spells and reduced concentration
C. Persistent feelings of guilt and anhedonia
D. Difficulty falling asleep

2. If grief or grieving are the cause of depressive symptoms (bereavement)

A. there is no role for psychopharmacology
B. it should be treated with supportive counseling
C. antidepressant pharmacotherapy may be considered if the criteria for MDD are met
D. the best course of action is referral to pastoral or similar counseling

3. When faced with a potentially suicidal patient

A. the true intent of self harm is almost always shared with the physician in the month preceding the event
B. a suicide contract is the most effective way to prevent someone suiciding
C. asking about firearms is dangerous and may precipitate someone suiciding
D. intense distress, substance abuse, a history of prior attempts, an urge for instant relief are warning signs that require urgent attention (ED or stat Psych referral)

4. Since all antidepressants have essentially the same effectiveness the family doctor is most effective in treating MDD when she/he

A. uses the one or two drugs they know best and recognizes the side effects
B. looks at the drugs in the different classes (TCA, SSRI, SNRIs etc) and uses those whose side effects may have a beneficial secondary effect
C. tells the patient their problems are psychological and refers them directly to a mental health / behavioral professional
D. accepts a patients report of subjective improvement rather than use a formal questionnaire such as the Zung scale, PHQ-9, or Burns questionnaire

5. Regarding the patient with Bipolar disorder

A. the family doctor MUST obtain a good family psychiatric history
B. there may be a history of “treatment resistant” MDD
C. mood instability may be increased by SSRIs
D. patients may describe hypomania as their “normal” state
E. ALL the above

Article 2 Questions

6. Telling a patient in whom you have ruled out physical / organic causes of distress that the diagnosis is anxiety is

A. reassuring
B. not helpful
C. useful when accompanied by a psycho- biological explanation

7. Can hypochondriasis be considered a form of OCD

A. True
B. False

8. Agitation is best treated with

A. reassurance
B. Benzodiazepines
C. Mood stabilizers and “Atypicals”

9. Anxiety disorders can be heritable. Discussing this with patients can

A. create a feeling of shame
B. can present as family members with alcoholism
C. implies the necessity of pharmacotherapy
D. implies it rarely responds to CBT or ACT, meditation or regular exercise

Article 3 Questions

10. Family physicians prescribe what percent of psychotropic drugs ?

A. 10%
B. 30%
C. 60%
D. 80%

11. Physical and emotional syndromes use radically different pathophysiological mechanisms*

A. True
B. False

12. The telltale signs of depression include

A. Isolated, solitary symptoms
B. Symptoms responsive to medical therapies
C. Suicidal ideation
D. A very slow development of cognitive decline

13. Questionnaires are a better tool for unmasking depressions than simple directed questions and history taking by a family doctor

A. True
B. False

Article 4 Questions

14. There is a direct correlation between childhood experience and risky health behaviors, chronic health conditions, low life potential, and early death.

A. True
B. False

15. Over 17,000 Health Maintenance Organization members from Southern California participated in the Adverse Childhood Experiences Study (ACE). These participants received a physical exam followed by a confidential questionnaire. Define the age range the questionnaire focused:

16. Participants in the Adverse Childhood Experiences Study (ACE) received a physical exam followed by a confidential questionnaire. Identify the category(ies) of question(s) the Adverse Childhood Experiences Study (ACE) focused:

A. Abuse - emotional, physical, sexual
B. Household Challenges - mother treated violently, household substance abuse, mental illness in household, parental separation or divorce, criminal household member
C. Neglect - emotional, physical
D. All the above

17. The value of knowing whether a patient has a high ACE score depends significantly on what point in their development it is discovered. Identified early, there is a wider range of primary prevention strategies available to address the needs of children and families. Which of the following is NOT considered a primary prevention strategy:

FALL 2017 CME QUIZ

The Maryland Family Doctor - Fall 2017

Article 1 Questions

Article 2 Questions

Article 3 Questions

Article 4 Questions

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