CME Quiz

AAFP members and other physicians and health care professionals who
receive the print version of AFP in their own name can submit responses for
CME credit at https://www.aafp.org/afpquiz. Quiz questions are featured below
for your convenience. This issue is approved for up to 6 Prescribed and AMA PRA
Category 1 credits. The total credit for this issue is based on one credit for each
article included in the Quiz. Credits may be claimed for one year from the date
of this issue. Questions? Call 800-274-2237.

Q5. You receive a report that a healthy infant in the

Articles newborn nursery had a test positive for an inborn error
Migraine Headache Prophylaxis (p. 17) of metabolism disorder. The nursing staff reports that the
Q1. Which one of the following should be a consideration infant appears well, is breastfeeding without difficulty,
for beginning prophylactic medications? (check one) and is urinating and stooling normally. Which one of the
l A. Having three migraines per month. following is an appropriate next step in the management
l B. Having migraines from consuming too much
of the infant? (check one)
caffeine. l A. Assume that the test result is a false positive.
l C. Having eight or more migraine days each month. l B. Immediately consult with a metabolic
l D. Having migraines that respond to acute
subspecialist.
treatment. l C. Repeat the test in one month.
l D. Repeat the test immediately.
Q2. Which one of the following medications has the
strongest evidence for use in the prevention of episodic Q6. You are a physician in a remote rural area. Two days
migraine headaches? (check one) ago you delivered an infant who was successfully breast-
l A. Gabapentin (Neurontin). feeding and who appeared initially healthy. Today, the
l
newborn’s test came back positive for an inborn error
B. Propranolol.
of metabolism disorder. On reevaluation this morning,
l C. Fluoxetine (Prozac). the infant is not doing well;​she is lethargic and feeding
l D. Nifedipine. poorly. You consult a metabolic specialist at your regional
referral center and arrange for air transport of the infant,
Q3. Which one of the following is a potentially serious although it may take up to two hours for the transport
adverse effect of petasites, an extract of the butterbur service to arrive. While waiting for the transport service,
plant? (check one) which one of the following is the next appropriate step in
l A. Hepatotoxicity. management of the infant? (check one)
l B. Gastrointestinal upset. l A. Bottle feeding with formula if the infant is not
l
breastfeeding successfully.
C. Palpitations.
l B. Bottle feeding with pumped breast milk if the
l D. Increased belching.
infant is not breastfeeding successfully.
Inborn Errors of Metabolism:​ l C. Discontinuing oral feeding and administering a
From Preconception to Adulthood (p. 25) high-rate glucose infusion.
Q4. Which one of the following best represents the cur- l D. Maintaining hydration with standard saline
rent recommendation for preconception carrier screen- infusion.
ing? (check one)
l A. It does not influence the incidence of inborn
errors of metabolism in infants.
l B. It is an acceptable option for all patients.
l C. It is appropriate only for women of Ashkenazi
Jewish descent.
l D. It has a high sensitivity for detecting all variants of
inborn errors of metabolism by using new DNA
analysis techniques.

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 CME QUIZ

Urine Drug Tests:​Ordering Prophylactic Vaccination Against Human

and Interpretation (p. 33) Papillomavirus to Prevent Cervical
Q7. Which one of the following statements about urine Cancer and Its Precursors (p. 15)
drug testing is correct? (check one) Q11. A 27-year-old woman and her 16-year-old sister
l A. Eating poppy seeds can cause a positive test present to your office for wellness visits. Which one of
result. the following statements about the use of prophylactic
l B. Passive inhalation of marijuana smoke is likely to human papillomavirus vaccine in these individuals is cor-
produce a positive result. rect? (check one)
l C. Patients who are rapid metabolizers may have a l A. When given at 16 years of age, it prevents the
true-negative result. development of cervical intraepithelial neoplasia
l D. Most commercial urine drug tests can detect
(CIN) 2 or CIN 3.
synthetic cathinones (bath salts). l B. When given at 27 years of age, it prevents the
development of CIN 2 or CIN 3.
Q8. Which one of the following statements about urine l C. When given at any age, it is associated with an
drug testing is correct? (check one) increase in serious adverse effects, including mis-
l A. Only positive immunoassay results need to be
carriage in pregnant women.
confirmed. l D. All of the above.
l B. Immunoassays are best for detecting synthetic or
semisynthetic opioids.
Practice Guidelines
l C. Immunoassays provide quantitative measures of
major classes of misused drugs. Deprescribing Benzodiazepine Receptor
l D. Gas or liquid chromatography can accurately
Agonists for Insomnia in Adults (p. 57)
distinguish individual substances. Q12. Which one of the following statements about
deprescribing benzodiazepine receptor agonists (BZRAs)
Q9. A patient who is not taking opioids as prescribed for insomnia is correct? (check one)
attempts to provide a positive urine specimen by adding l A. A BZRA taper should be recommended in a
the drug directly to his urine. Which one of the following 40-year-old woman who has used one for sleep
findings confirms this? (check one) at least two times a week for three weeks.
l A. Low concentration of the drug in the urine. l B. Cognitive behavior therapy in addition to taper-
l B. Low urine creatinine level and specific gravity. ing has not been shown to improve cessation of
l
BZRA use.
C. Drug metabolites are absent in the urine.
l C. A slow taper requires reducing medication dosing
l D. Presence of 6-monoacetylmorphine in the urine.
by 10% weekly for at least six weeks.
l D. Patients 65 years and older should be advised to
Cochrane for Clinicians slowly taper off of BZRAs regardless of the dura-
tion of use.
Pharmacologic Interventions for Apathy
in Patients with Alzheimer Disease (p. 14)
Q10. The family of a patient with a history of Alzheimer
disease asks about methylphenidate (Ritalin) as a possi-
ble adjunctive therapy for this disease. Which one of the
following statements is correct? (check one)
l A. It has been shown to improve apathy scores in
select patients when compared with placebo.
l B. It has not been shown to improve cognition
based on Mini-Mental State Examination scores
when compared with placebo.
l C. It has been shown to increase the risk of serious
adverse effects when compared with placebo.
l D. All of the above.

Answers to this issue’s quiz are on the inside back cover.

12 American Family Physician www.aafp.org/afp Volume 99, Number 1 ◆ January 1, 2019

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 Advertiser Index
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