Patient Management Problem

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The following Patient Management Problem was chosen to reinforce the subject matter presented in the issue. It emphasizes decisions facing the practicing physician. As you read through the case you will be asked to complete 12 questions regarding history, examination, diagnostic evaluation, therapy, and management. For each item, select the single best response.
To obtain CME credits for this activity, subscribers must complete this Patient Management Problem online at A tally sheet is provided with this issue to allow the option of marking answers before entering themonline. A faxable scorecard is available only upon request to subscribers who do not have computer access or to nonsubscribers who have purchased single back issues (send an email to
US Participants: Upon completion of the Patient Management Problem, US participants may earn up to 2 AMA PRA Category 1 Credits™. US participants have up to 3 years from the date of publication to earn CME credits. No CME will be awarded for this issue after June 30, 2020.
Canadian Participants: This program is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the Office of Continuing Medical Education and Professional Development, University of Calgary, on April 1, 2017. Refer to the CME tab on for dates of accreditation. Canadian participants should visit MAINPORT ( to record learning and outcomes. Canadian participants can claima maximum of 2 hours (credits are automatically calculated).
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