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Volume 16, Number 7—July 2010

CME ACTIVITY

Extensive Drug Resistance in Malaria and Tuberculosis

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions and earn continuing medical education (CME) credit, please go to http://cme.medscape.com/viewpublication/30063. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.com. If you are not registered on Medscape.com, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit is acceptable as evidence of participation in CME activities. If you are not licensed in the US and want to obtain an AMA PRA CME credit, please complete the questions online, print the certificate and present it to your national medical association.

CME Questions

  • You are seeing a couple who recently emigrated from Uganda. One of these patients, a 32-year-old woman, has a history of active tuberculosis (TB) and said she was treated with several drugs for 2 months, but she was told they were not working.

    • According to international consensus, multidrug-resistant (MDR) TB is defined by resistance to at least which of the following medications?

    • A. Rifampin only

    • B. Rifampin and isoniazid

    • C. Isoniazid and ethambutol

    • D. Ethambutol, pyrazinamide, and Rifampin

  • Which of the following statements regarding the treatment of this patient with TB is most accurate?

    • A. Guidelines in the United States now recommend extending 4-drug treatment for TB based on the patients' symptoms alone

    • B. The World Health Organization recommends directly observed therapy (DOT) for treatment with Rifampin

    • C. Previous TB treatment does not affect her risk of harboring resistant organisms

    • D. TB treatment should be changed when there is no clinical improvement after 2 weeks

  • The other patient is a 31-year-old man with intermittent fever and headache for 3 weeks. He is hospitalized, and malaria is diagnosed.

    • Which of the following general principles regarding the treatment of this patient is most accurate?

    • A. Multidrug resistance in Plasmodium falciparum is defined by resistance to more than 2 operational antimalarial compounds from 2 different classes

    • B. The use of combination antimalarial therapy has not improved efficacy or reduced resistance

    • C. The decision to treat MDR malaria is based on complicated laboratory data

    • D. Geography has little impact on the treatment choice of malaria

  • Which of the following statements regarding drug-resistant malaria is most accurate?

    • A. The simplest way to monitor the efficacy of a given therapeutic regimen is through molecular characterization

    • B. There is no known resistance to the combination of artesunate and mefloquine

    • C. Artemisinin resistance is now common in Africa

    • D. Rates of artemisinin-based combination resistance need to be monitored in Africa

Activity Evaluation
1. The activity supported the learning objectives.
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2. The material was organized clearly for learning to occur.
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3. The content learned from this activity will impact my practice.
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1 2 3 4 5
4. The activity was presented objectively and free of commercial bias.
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