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Southern Medical Journal:
doi: 10.1097/SMJ.0b013e3181a71f9f
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June 2009 CME Questions

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Answers can be found on page 664

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Stair Design in the United States and Obesity: The Need for a Change

1. The following statements about obesity and physical activity are correct except:

A. In contrast to the cardiovascular and other health benefits attributed to moderate and vigorous activity, the maintenance of a healthy body weight is a function of total energy expenditure, including household and workplace activity.

B. Data from the Behavioral Risk Factor Surveillance System found that trends in physical activity had increased over the period from 1990–1998.

C. Data have shown that leisure time physical activity contributed approximately 5% of the population's total energy expenditures.

D. “Passive” interventions, such as restricting downtown centers to foot or bicycle traffic, or making stairways more appealing and user friendly, are often more successful in achieving population-wide changes than those requiring active decision-making by individuals.

2. The following statements regarding using stairs as an intervention to promote physical activity are correct except:

A. Light to moderate physical activity has been found to be most effective in motivating sedentary and obese individuals.

B. Based on a hypothetical city intervention, some researchers projected that a 2.8% increase in stair usage would result in a weight loss and/or weight gain prevention of 300 grams/person/year among new stair users.

C. Using stairs instead of escalators is recommended by the US Department of Health and Human Services as a step in the national health campaign to combat obesity in the US.

D. Lifestyle modification and exercise interventions are deleterious for pain and function of patients with osteoarthritis.

3. Suggestions to encourage the use of stairs in buildings include all the following except:

A. Architectural design change: increasing area of stairs to make stairs more comfortable with less height per stair; adding lighting, music, and air conditioning that automatically shuts off in case of fire.

B. Health education that encourages using stairs is more effective than environmental policies to make societies more active.

C. Policy interventions that address standard national building codes that incorporate health concerns and support active living, and offer incentive to owners.

D. Legislative interventions that include proactive measures to reduce liability barriers from injuries secondary to physically active designs.

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Cardiac Complications after Smallpox Vaccination

4. The most likely mechanism for myopericardial injury following smallpox vaccination is:

A. Direct injury to the myocardium from viral invasion.

B. Systemic inflammatory/immune response leading to precipitation of underlying cardiac disease.

C. Immune-mediated direct myopericardial damage.

D. None; smallpox vaccination does not lead to direct myopericardial injury.

5. Regarding cardiac complications after smallpox vaccination, all the following are true except:

A. Reports of cardiac complications following smallpox vaccination date back to the 1950s.

B. The incidence of myopericarditis in military smallpox vaccinees exceeds the expected background rate.

C. There is insufficient data currently to establish a causal relationship between smallpox vaccination and the occurrence of dilated cardiomyopathy.

D. The evidence available so far supports an association between smallpox vaccination and precipitation of ischemic cardiac complications.

E. Patients with multiple cardiac risk factors should be excluded from the vaccination program.

6. Regarding presentation and management of myopericarditis after smallpox vaccination, the following two statements are true (choose 2):

A. Most cases will only require supportive care (ie, NSAIDS, activity restriction for 4–6 weeks)

B. Corticosteroids are the mainstay of treatment for all patients with suspected vaccinia-associated myopericarditis.

C. Most patients with vaccinia-associated myopericarditis will not present with a pericardial effusion.

D. Most cases of myopericarditis after smallpox vaccination are severe and have a high mortality.

© 2009 Southern Medical Association