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Volume 18, Number 8—August 2012

CME ACTIVITY

Paragonimus kellicotti Flukes in Missouri, USA

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 (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. 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.org. If you are not registered on Medscape.org, 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 may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title: Paragonimus kellicotti Flukes in Missouri, USA

CME Questions

1. You are seeing a 24-year-old man with a 4-week history of cough, fever, and malaise. He was seen in an urgent care center 10 days ago and prescribed a course of macrolide antibiotics, which did not improve his symptoms. On questioning, the symptoms began after a camping trip in which the patient and his friends experimented with eating raw meat and seafood.

You are concerned regarding the possibility of paragonimiasis in this patient. What should you consider regarding the epidemiology and microbiology of paragonimiasis?

A. Most cases are reported in North America

B. P. kellicotti requires snail and crustacean intermediate hosts

C. Humans usually are infected after eating escargot

D. P. kellicotti infects only humans

2. What should you consider regarding the clinical presentation of paragonimiasis in the current case series as you evaluate this patient?

A. All patients were female

B. Cough and fever were the most common clinical symptoms

C. Vomiting and malaise were the most common clinical symptoms

D. The onset of symptoms occurred within 48 hours of ingesting food contaminated with P. kellicotti

3. What should you consider regarding the management of paragonimiasis in the current case series as you evaluate this patient?

A. The median time from symptom onset to the correct diagnosis was 12 weeks

B. Only half of patients had received antibiotic therapy

C. No patients had received corticosteroids

D. Most patients failed to respond even to appropriate antiparasitic therapy

4. Which of the following tests is most likely to be abnormal if this patient has paragonimiasis?

A. Serum neutrophil counts

B. Serum eosinophil counts

C. Serum sodium levels

D. Electrocardiogram

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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4. The activity was presented objectively and free of commercial bias.

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