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Spring 2017 CME Quiz
The Maryland Family Doctor - Spring 2017
1.Editorial: The Vital Matter of Chronic Pain p. 8
2. Psychological Contributions to the Understanding and Management of Chronic Pain p. 10
3. Soothing the Pain Associated with Choosing Non-Opioid Medications for Chronic Pain Management p. 16
4. Non-Pharmacologic Alternatives to Chronic Pain Management p. 18
5. HPV Vaccination Clinical Update for Primary Care Providers p. 24
This Medical Journal activity has been reviewed and is acceptable for Prescribed credits by the American Academy of Family Physicians (AAFP).
This Spring, 2017 edition of The Maryland Family Doctor (vol. 53, No. 4) is approved for five (5) Prescribed Credits. Credit may be claimed for one year from the date of this edition (expiring April 30, 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.
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
Quiz Answers and Article References
AAFP Membership #
Address Line 2
State / Province / Region
ZIP / Postal Code
Indicate Each Correct Answer
Article 1 Questions
1. Chronic pain has been defined as a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort and typically leading to evasive action which lasts beyond the ordinary duration of time that an insult or injury to the body needs to heal.
2. Which of the following is FALSE in reference to Addiction?
A. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.
B. Addiction is a chronic disease and should be viewed similar to Diabetes and Hypertension
C. Pseudo-addiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated
D. Without treatment or engagement in recovery activities, addiction resolves on its own and does not result in disability or death
3. Tolerance is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Article 2 Questions
4. Education and support from health care provider and family/friend are principle psychological foundations for the management of chronic pain. This statement is:
5. Which statement is FALSE?
A. Depression and anxiety are commonly associated with chronic pain. Exercise is an inexpensive and effective way of combating these ailments while building self-esteem
B. Patients with chronic pain would benefit from an exercise program in consultation with their health care provider
C. Exercise programs should be associated with delayed gratification so as to build new behavior
D. If pain is exacerbated by lifting weights or other weight bearing exercises, patients with chronic pain can consider aquatic exercises
6. The psychological impact of loss of independence when completing activities such as eating, bathing, dressing, toileting, walking and continence (activities of daily living) in a patient with chronic pain is of no consequence.
7. Other activities that can be recommended to patients for psychological management of chronic pain include
A. Drawing or painting
B. Listening to or singing various types of music
C. Interacting with pets
D. All of the above
8. Which statement is in reference to Cognitive Behavioral Therapy (CBT) is FALSE?
A. CBT addresses the maladaptive thoughts of individuals who are often engaged in negative behaviors
B. CBT addresses the triggers which initiate the negative behavior
C. Negative behaviors include smoking, drinking, abusive eating patterns and lack of exercise
D. The goal of CBT is to empower the individual to have control over their thoughts and emotions which serves to correct maladaptive behavior
E. All statements are true
Article 3 Questions
9. When opioids are the chosen treatment, providers should avoid increasing the dose to greater than which morphine equivalence per day?
A. 20 mg morphine equivalence
B. 40 mg morphine equivalence
C. 90 mg morphine equivalence
D. 120 mg morphine equivalence
10. Strong evidence exists for which class of medications for the treatment of chronic nonspecific pain?
B. Skeletal muscle relaxants
D. None of the above
11. Which medication is NOT approved by the FDA for neuropathic pain?
12. Which TCA is associated with less anticholinergic adverse effects?
13. Skeletal muscle relaxants are a good option for patients who will need to be on long term therapy for chronic pain.
Article 4 Questions
14. Non-Pharmacologic alternatives to chronic pain management include:
A. Cognitive Behavioral Therapy
E. All of the above
15. Which of the following is FALSE about massage therapy?
A. It is an accepted form of alternative therapy
B. Patients of any socioeconomic status can afford this method
C. It has been used for medical issues such as anxiety, sleep and pain management
D. Studies have shown improvement in pain and social functioning
16. The RAND criteria are one of the most popular measures of quality of life. Which of the following is NOT one of the eight (8) dimensions by which quality of life is assessed?
B. Days missed from work
C. Role limitations caused by physical health problems
17. Which of the following is TRUE about the use of Non-Pharmacologic alternative management of Chronic Pain?
A. Studies have shown increased utilization in acupuncture and this is in part due to physician attitudes towards alternative medicine
B. Studies have shown that Cognitive Behavioral Therapy (CBT) is effective even if the patient is skeptical of alternative medicine, biased toward “medical” treatment and have limited time to invest
C. Studies have shown great success with Transcutaneous Electrical Nerve Stimulation (TENS) (>90%)
D. Stimulating therapies include Transcutaneous Electrical Nerve Stimulation (TENS), Spinal Cord Stimulation (SCS) and Cognitive Behavioral Therapy (CBT)
18. Which of the following is not listed as a risk of Spinal Cord Stimulation (SCS)?
A. Leads can break, migrate, or fail to activate
B. Loss of therapeutic effectiveness
Article 5 Questions
19. A 15 year old female comes to your office, she received her first HPV vaccine at the age of 14 years old, you recommend?
A. 2 more HPV vaccines
B. 1 more HPV vaccine
C. 3 HPV vaccines
D. No HPV vaccines
20. A 17 year old transgender male Lucas is in your office, he has never received an HPV vaccine, you recommend how many HPV vaccines?
A. 3 HPVC series vaccines
B. 2 HPV series vaccines
C. 1 HPV vaccine
D. 0 HPV vaccines
21. 9vHPV protects against which HPV strains?
A. 16,18, 6,11, 31,33,45,52,58
B. 16,18,5, 12, 31, 33, 45, 52, 57
C. 10,12, 16, 22, 33, 45, 52, 58