This document is for personal reference only—please do not use to submit for credit. Requests must be completed electronically. Final version will be emailed on 2.20.12

DRAFT

Preventive Medicine 2012

Maintenance of Certification (MOC) Questions

Please note: Questions are subject to change. This question packet is intended for reference only. Session quizzes and requests must be completed online at

Institute: ACPM Board Review Course

1. Name an important theory or theoretical framework which contributes to a scientific foundation for coaching competencies.

A) Self-motivation theory

B) Trans-cognitive model

C) Motivational counseling

D) Social cognitive theory

2. Name a key factor which predicts lasting behavior change

A) Introjected regulation

B) Physician recommendation

C) Autonomous motivation

D) Number of attempts followed by relapse

3. Name an important aim of a physician/patient discussion of lifestyle change

A) Physician describes benefits of a healthy lifestyle

B) Physician expresses warm and genuine empathy about patient’s situation

C) Patient describes all of his/her barriers to change

D) Physician asks patient to explain why s/he is not developing new healthy habits

4. Name a strategy to help a patient improve resilience

A) Elicit information about what’s positive and meaningful in a patient’s life

B) Start visit by telling patient about your concerns about his/her health to get his/her attention

C) Ask patient about his/her weaknesses to be overcome

D) Give patient a formula of specific habits that you think will work best

5. Name a skill which will improve your rapport, connection, and influence with a patient

A) Describe what your successful patients do to stay engaged in healthy habits

B) Listen without thinking about what you’ll say next or any other matter

C) Find ways to motivate your patient to stop unhealthy habits

D) Give your patients realistic goals to work on.

  1. Which of the following is most suggestive of a unilateral L4/5 lumbar disc herniation?
  2. Saddle anaesthesia
  3. Quadriceps weakness
  4. Diminished ankle jerk
  5. Weakness on heel walking

7. Occupational allergic contact dermatitis

  1. Is a Type I (IgE-mediated) hypersensitivity reaction
  2. Demonstrates sharply-demarcated borders at the site of contact
  3. Is likely to affect the majority of workers using a suspected substance
  4. In many cases may persist despite removal from the workplace

8. Squamous cell carcinoma of the skin is most likely to arise from work as a:

  1. Lead battery reclaimer
  2. Roofer
  3. Doctor
  4. Photographic printer
  1. A healthy 30-year-old chemical worker is sent to the hospital in respiratory distress after an ammonia spill. He recovers from the acute injury but six months later still has intermittent wheezing on exposure to cigarette smoke and work in the cold. His disorder is most consistent with:
  2. Inhalation fever
  3. Reactive airways dysfunction syndrome
  4. Occupational asthma
  5. Hypersensitivity pneumonitis
  1. Match the neurotoxic disorder with the occupational etiology: (each answer may be used more than once, or not at all)

1. Parkinsonism / A. Trichloroethylene
2. Peripheral neuropathy / B. Arsenic
3. Encephalopathy / C. Manganese
4. Trigeminal neuralgia / D. Methylmercury
5. Ataxia / E. Lead
  1. Which of the following statements on occupational noise-induced hearing loss (NIHL) is true :
  2. Symptoms are recognizable when average pure-tone thresholds reach 20 dB
  3. Adequate protection for almost all workers is achieved by adherence to the OSHA PEL of 90 dB / 8 hour time-weighted average day
  4. Findings of NIHL are reversible when detected early by screening audiometry
  5. Speech clarity, rather than volume, is affected first
  1. Which pairing is correct?
  2. Lead :: peripheral neuropathy sensory > motor
  3. Arsine :: hyperpigmentation and squamous cell CA
  4. Cadmium :: osteomalacia
  5. Chromium :: intersitial lung disease
  1. Which of the following is NOT true as it pertains to individual health risk appraisals?
  1. Intent is to determine both healthy and unhealthy behavioral practices
  2. Considers only those behavioral risks that are modifiable
  3. Can provide a baseline against which to monitor change
  4. Identifies areas for health behavior improvement
  1. Behavioral Risk Factor Surveillance System (BRFSS) is intended to assess both behavioral risk factors and:.
  1. Use of preventive health services
  2. Socioeconomic indicators
  3. Occupational risk
  1. The fundamental assumption of the Health Belief Model is that people ______,
  2. Fear of disease
  3. Seek consensual validation
  4. Require normative influence
  1. and that their actions to promote change are a product of ______
  1. degree of fear
  2. anger
  3. rejection
  4. reliability of physician expertise
  1. and ______.
  1. perceived barriers to action
  2. Psychosomatic disorders
  3. Self-awareness
  1. In the Theory of Reasoned Action, the most important determinant of behavior is:
  1. Fear
  2. Stress
  3. Classical conditioning
  4. Behavioral intent
  1. The Theory of Planned Behavior is an extension of the Theory of Reasoned Action. The authors extended the theory to add ______to account for factors outside of one’s personal control that might influence intention to change.
  1. Perceived behavioral control
  2. Prosocial behavior
  3. Belief-bias effect
  1. Rothman’s typology entwines which three concepts to address how communities organize to identify health issues and prepare a plan to mobilize to address these issues?
  1. Locality development
  2. Social planning
  3. Social action
  4. All of the above
  1. Due to the high concordance of symptoms between major depressive disorder and those of a variety of chronic health conditions, the most popular inventories tend to over-diagnose depression by how much? ______.
  1. Approximately 300%
  2. 50%
  3. 10%
  4. 100%
  1. ______percent of adults with a diagnosed mental health disorder, and an even smaller proportion of children, will receive any mental health services in a given year.
  1. 100%
  2. 70%
  3. Less than 50%
  4. This data is unavailable
  1. Over ______% of US adults will meet the diagnostic criteria for a DSM disorder during their lifetime.
  1. 46%
  2. Less than 5%
  3. 80%
  4. 10%

24. A major risk factor for carpal tunnel syndrome is:

  1. Hyperthyroidism
  2. Keyboarding
  3. Forceful repetitive hand work
  4. Male gender

Institute 2: Public Health/Media

1. You’re trying to get the local TV news to cover a public health story. Which of the following is most likely to be true?

a. If the advertisers aren’t interested, the news probably won’t cover it.

b. The news team will consider whether their viewers will want to watch the story.

c. A press release from the health department is usually enough to get a story on the news.

d. TV news is a bad venue for public health stories, because they are usually too complicated for viewers to understand.

2. Which of the following statements about health news is correct?

a. A “health reporter” is required to have a strong background in medical science.

b. News reports about medical studies often confuse association and causality.

c. Most readers/viewers will have at least a basic understanding of statistics.

d. Most health news stories are reviewed by an MD or RN before publication.

3. Based on the 2003 National Assessment of Adult Literacy, what percentage of Americans have “proficient” health literacy (with skills including reading complex texts, making complex inferences, synthesizing information from multiple sources)?

a. 12%

b. 25%

c. 37%

d. 55%

4. Reporters have different preferences about how they want to be contacted. In general, however, which of the following is most likely to be effective?

a. Mail a formal press release to all local news outlets.

b. Call all the local news outlets and leave a message in the general assignment mailbox.

c. Keep track of which reporters cover this type of story, and either make a call or send them the information via email.

d. Keep track of which reporters cover this type of story, and send them the information via fax.

5. You are working on a local campaign called “Heart Health Month” and hope that media coverage will help spread the word. Which of the following approaches fits best with how news is reported?

a. Describe the concept of Heart Health Month, highlight the importance of healthy habits, and ask the reporter to write an article about what people need to know.

b. Send “swag” from the campaign (T-shirts, bumper stickers) to the news office.

c. Offer several ideas, such as a list of 5 heart-healthy foods plus a patient who used those foods to help lower his risk; an on-air Q&A with expert cardiologists; details of a fun “kickoff” event.

d. Wait until the campaign is underway, then make a press kit to show how well it is going.

6. You have an article coming out in a major journal, and you’re invited (for the first time!) to speak on a radio program. The interview will last 10 minutes. How should you prepare?

a. Ten minutes, great! I’ll prepare a 10-minute talk, the audience will love it.

b. There might be other scientists listening. I’d better practice explaining all the details of what we did.

c. I wonder what the reporter will want to know? I’ll ask for the main topics of interest and think of some brief, simple statements.

d. It can’t be that different from a Q&A at a conference. I’ll just wing it.

7. Which of the following is NOT correct regarding serving as a medical expert for a media program?

a. Reporters often keep a list of experts who are good on television and readily available.

b. Reporters will sometimes ask you about issues outside your area of expertise.

c. You can be an expert even if you have not published a peer-reviewed article on the topic.

d. The “experts” are always the top people in the fields they are discussing.

8. You are asked to take part in a TV news story about a local epidemic. Which of the following is most likely to be true?

a. As the medical expert, you will be asked to review the story before it is shown on television.

b. The news team will consider it unethical to ask for your help in finding patients to tell their stories.

c. You will have only a brief time to speak and get your message across.

d. You do not have to worry about “sound bites,” because it is considered unethical to edit or shorten a statement from a medical expert.

9. While responding to questions in online, radio and television interviews, it’s important to use the following techniques:

a. Speak rapidly to get as much information in as possible in the brief answer period.

b. Use lots of statistics to demonstrate your grasp of public health.

c. Answer the questions provocatively and rhetorically with more questions.

d. Speak slowly and minimize the use of statistics.

10. The use of metaphors in conveying public health messages and images is:

a. An ineffective but widely used technique.

b. An effective but largely underused technique.

c. An ineffective but largely underused technique.

d. An effective but widely used technique.

11. Reviewing video- and audiotapes of past media interviews:

a. Is a bad idea and waste of time because what’s done can’t be changed.

b. Is a good idea because it helps determine which reporters are ethical enough to work with again.

c. Is a bad idea because, if an answer is taken out of context or a source is misquoted, it can harden one’s resolve not to work with media in the future.

d. Is a good idea because there are lessons to be carried forward about one’s effectiveness in conveying public health messages.

12. When being interviewed for live electronic media, it’s important to grab the viewer’s attention by:

a. wearing brightly-colored clothing, patterned ties and large dangling earrings.

b. speaking loudly, rapidly and voluminously.

c. addressing the interviewer by first name and pausing briefly before answering questions.

d. talking over other panelists for the most airtime.

Institute 3: Population Medicine Ethics

  1. In developing a Code of Ethics it is important to:
  2. Get it done quickly once initiated.
  3. Have final approval of the governing body of the organization.
  4. Be very detailed so all possible circumstances are covered by the code.
  5. Reach out to the group being governed by the Code for group acceptance after iterative contacts.
  1. The principle of the ACPM Code of Ethics that states, “PM physicians will respect the law” means:
  2. In all circumstances and no matter the consequences.
  3. Legal concerns dictate ethical concerns and moral behavior.
  4. Casuistry requires consideration of consequences within constraints of the law.
  5. Legislation always takes into account issues of justice.
  1. Conflicts that may need identifying and disclosing include all of the following:
  1. Financial relationships
  2. Personal commitments
  3. Limitations of care because of personal conscience
  4. All of the above.
  1. Privacy and confidentiality:
  2. ...is more important for individuals than corporations.
  3. …in some ways is as important for individuals and corporations.
  4. …is more important for corporations than individuals.
  5. …none of the above.
  1. Professionalism in medicine is as important whether practicing on individuals or on populations. Which of the following statement about professionalism is true:
  2. The physician’s interests should be weighed equally with the individual or the population.
  3. Maintaining competence in clinical medicine is more important than in population medicine because the consequences may be worse if I make a mistake for a patient than for a community.
  4. Public trust in a personal physician is more important than public trust in a public health physician.
  5. Commitment to improving access to care is necessary whether in private or public health care.
  1. The ACPM Code of Ethics includes a principle that population medicine physicians should act as health role models. Implications for this principle include:
  2. Overweight PM physicians (BMI >25) will lose membership in ACPM when renewal occurs.
  3. PM physicians should strive to exhibit good health behaviors in order to show others in the community that they believe it is important to “do as I say and as I do.”
  4. During the summer and when weather permits PM physicians must ride their bicycles around town instead of using motorized transportation.
  5. No dessert unless you finish your vegetables.
  1. Which of the following is incorrect? A duty to care for a community during a public health threat may be suspended if…
  2. …you are pregnant.
  3. …you would be under heightened personal risk.
  4. …your children are grown and no longer dependent.
  5. …you feel it is against your religion to provide care in the face of danger.

8. Accountability for Reasonableness (A4R) is an example of what kind of ethical framework?

a. Principlism

b. Utilitarianism

c. Deontological

d. Process-oriented

9. The “rule of rescue” approach to solving ethical problems does NOT conflict with which of the following:

a. Preventive medicine

b. A values based approach

c. Giving priority to acute care medicine

d. Utilitarianism

10. Which of the following is the most common complaint among preventive medicine physicians?

a. A lack of agency with respect to decision-making in ethical decision-making.

b. Political considerations force unpleasant resolutions to ethical problems.

c. Being troubled by ethical dilemmas at work.

d. None of the above are common.

11. Which of the following refers to the field of ethical inquiry that deals with what one should or ought to do?

a. Normative ethics

b. Metaethics

c. Applied Ethics

d. Realism

12. Which one of the following approaches to ethics is theoretically most difficult to apply to population- oriented medicine?

a. Virtue ethics

b. Deontological ethics

c. Human rights ethics

d. Teleological ethics

13. According to the data presented in this session, public health physicians were least likely to identify with which of the following as an over-arching ethical goal of public health?

a. Maximizing aggregate well-being

b. Ensuring fairness and equity

c. Meeting professional standards

d. Adhering to laws and legislated norms

Institute 4: Nutrition Prescriptions

1.Hypertension is due to:

A.Increased oxidative stress

B.Increased inflammation

C.Autoimmune dysfunction

D.All the above

2.The endothelium produces a vasodilating substance called:

A.Angiotensin II

B.Endothelin

C.Nitric Oxide

D.Superoxide anion

3.Increasing dietary intake of the following LOWERS blood pressure EXCEPT:

Potassium

Omega 3 fatty acids

Magnesium

Sodium

4.Hypertension treatment should:

Increase Nitric Oxide and increase Angiotensin II

Increase Nitric Oxide and reduce Angiotensin II

Reduce Nitric Oxide and reduce Angiotensin II

Reduce Nitric Oxide and increase Angiotensin II

5.High renin hypertension is associated with:

6. Which of the following will reduce blood pressure?

Hydrolyzed Whey Protein

Lycopene

Co-enzyme Q10

Potassium

All the above

7. Which statement about olive oil is INCORRECT?

It contains oleic acid which has one double bond in the cis configuration.

The melting point of 95 Degrees F makes it suitable for deep-frying.

Phytonutrients confer a green hue, most visible in the first press (extra virgin).

Oleic acid is an omega-9, monounsaturated fat.

8. Which statement about polyunsaturated fatty acids is INCORRECT?

A. Flax oil is high in essential fatty acids

B. Fish oil is high in essential fatty acids

C. Supplemental fish oil can interfere with the metabolism of omega-6 fats

D. Diabetes alters metabolism of dietary polyunsaturated fats such as flax oil

9. Which statement about medium chain triglycerides is INCORRECT?

A. Are saturated fats found in tropical nut oils.

B. Are absorbed from the intestinal tract more readily than longer fats.

C. May cause irritable bowel symptoms when taken in excess.

D. May have beneficial effects on gastrointestinal microflora.

E. Are too heat-sensitive to be used for cooking

10. Which statement about laboratory testing is INCORRECT?

A. Analyze the fatty acid content of red blood cell membranes.

B. Are a direct measure of diet alone.

C. Can identify high intake of trans fats.

D. Some identify build-up of very long chain fatty acids.

E. Can detect excessive fish oil supplementation.

11. Intestinal permeability is increased by all of the following except:

A) Probiotics

B) IgG food sensitivities or latent and fully expressed celiac disease

C) Small intestinal bacterial overgrowth

D) NSAIDS

12. Normalization of intestinal permeability may benefit all these conditions except:

A) Autoimmune disorders

B) Obesity

C) Hypothyroidism (non autoimmune)

D) Mood disorders

13. Repairing gut function is accomplished by:

A) Use of probiotics and prebiotics

B) Food allergy and sensitivity elimination diets

C) Use of digestive enzymes

D) Treatment of dysbiosis with medication or herbs

E) All of the above

Institute 5: Cost Effectiveness Analysis

PENDING

Institute 6: How to be an Effective Policy Advocate

1. When meeting with a lawmaker, it’s important to: