2018 QME Course Test Disclaimer: The answers to these questions can be found in the audio recording and in the course handouts and represent the opinion of the speakers. They do not necessarily represent COA’s opinion or policy on the issue. Question Title * 1. Contact Information Full Name and Title * Email Address * Phone Number Question Title * 2. Test Date Date Date Question Title * 3. What are the signs when an evaluator should question whether the aches and pains reported by an injured worker are symptoms of fibromyalgia? A. Injured worker presents with little in the way of objective, physical, or laboratory findings B. Normal inflammatory lab results C. Disruptive sleep D. Increased substance P in cerebrospinal fluid E. A and B F. All of the above Question Title * 4. The American College of Rheumatology has developed a list of 18 Trigger Points for diagnosing fibromyalgia. In the injured worker has 5 of the 18 trigger points, the evaluator should consider fibromyalgia as work-related? A) True B) False Question Title * 5. The evaluator should consider lab tests to exclude anemia or thyroid disease. A) True B) False Question Title * 6. Causation may be considered industrial if a major physical or emotional traumatic event preceded diagnosis. A) True B) False Question Title * 7. Thoracic Outlet Sydrome is defined as symptomatic compression of the neurovascular bundle at the thoracic outlet. A) True B) False Question Title * 8. Clinical history of the patient is not very helpful in diagnosing an injured worker with thoracic outlet syndrome. A) True B) False Question Title * 9. Symptoms of thoracic outlet syndrome can manifest themselves as pain and fatigue in the arm, neck, chest, and face-headaches. A) True B) False Question Title * 10. What questions should be asked of the injured worker to help the evaluator determine whether they have thoracic outlet syndrome A) What were you doing when the symptoms first appeared B) How do you reduce the symptoms C) What makes the symptoms worse D All of the above None of the above Question Title * 11. What are the physical characteristics of an injured worker with thoracic outlet syndrome? A) Sloping shoulders B) Short hair for women C) Pale hand color D) Increased venous markings E) All of the above F) None of the above Question Title * 12. What can cause thoracic outlet syndrome? A) Osseous changes B) Soft tissue abnormalities C) Trauma D) Inflammation E) All of the above F) None of the above Question Title * 13. What functional capacity tests should be performed to help determine whether the injured worker has thoracic outlet syndrome? A) Scalene muscle block B) BTE Evaluation C) TOS stress test D) All of the above E) None of the above Question Title * 14. Genetics focus primarily on the DNA code and the influence of single genes. A) True B) False Question Title * 15. There are clear tests that can identify which injured workers have genetic conditions which should be apportioned. A) True B) False Question Title * 16. Biological processes underlying the rate of degeneration of connective-tissue constituents are not ever genetically predetermined. A) True B) False Question Title * 17. Degeneration is never a predisposition to symptoms possibly associated with the injury. A) True B) False Question Title * 18. Issues that should be considered when deciding whether to apportion to an injured worker’s genetics. A) Pre-existing disease B) Prior injury C) Genetic factors unique to the worker D) Subsequent injury E) All of the above F) None of the above Question Title * 19. Even minor trauma can increase the risk of serious low back pain episodes and disability. A) True B) False Question Title * 20. What are definite causes of low back pain? A) Fractures B) Tumors C) Infection D) All of the above E) None of the above Question Title * 21. Which type of trauma is most often associated with low back pain? A) Falls B) Motor Vehicle accidents C) Sports D) Lifting or twisting Question Title * 22. In the results of the 10-year analysis of low back pain what were the main predictor(s) of disability. A) Psychosocial issues B) Smoking C) Chronic Pain D)All of the above E) None of the above Question Title * 23. The AMA Guides Fifth Edition does not encourage combining disability from different regions to arrive at an impairment rating. A) True B) False Question Title * 24. The Kite case resulted in the injured worker receiving an impairment rating of 20% whole person impairment for each hip. A) True B) False Question Title * 25. In the Kite case, the evaluator found that there was a synergistic effect of the injury to the same body part bilaterally versus body parts from different regions of the body. A) True B) False Question Title * 26. Opinions on whether two disabilities should be added or combined should include: A) Detailed discussion B) Whether there is adverse synergistic effect between the two disabilities C) Which method is most accurate under all of the circumstances D) All of the above E) None of the above Question Title * 27. Why do you want to write like an attorney? Your audience is made up of: A) Claims administrators B) Defense and applicant attorneys C) Judges D) Injured workers E) All of the above F) Only A, B and C G) Only B and C Question Title * 28. What are the elements of a Medical-Legal Report? A) Identify the issues B) Indicate the rules/guidelines applicable to the case being evaluated C) Show how the rules/guidelines apply D) Provide your expert conclusions E) All of the above F) None of the above Question Title * 29. Most reports are deficient in which area? A) Identify the issues B) Providing an expert conclusion C) Showing how the rules/guidelines apply to the case being evaluated. D) Identifying the applicable rules/guidelines Question Title * 30. It is not a good idea to reference back to the discussions/analysis section of your report to support your findings. A) True B) False Question Title * 31. The number of AMEs are increasing to keep up with the demand for AMEs. A) True B) False Question Title * 32. A Joint letter is important for the QME/AME to understand which issues are in dispute. A) True B) False Question Title * 33. What are the biggest mistakes that a QME/AME makes when being deposed? A) Not listening to the question B) Rambling on C) Not answering the question asked D) Speculating E) All of the above F) None of the above Question Title * 34. It is not important for the QME/AME to understand the medicine behind the evaluation - they only need to address the legal issues. A) True B) False Question Title * 35. If the injured worker has a loss of both eyes, loss of both hands, suffered an injury that has resulted in practically total paralysis, or suffered a brain injury resulting in incurable mental incapacity or insanity, there is a presumption of total disability. A) True B) False Question Title * 36. For chronic pain, opioids are always superior in decreasing pain or disability compared to 1) NSAIDS, acetaminophens, 2) tricyclic antidepressants or 3) anticonvulsant drugs. A) True B) False Question Title * 37. Which of the following are opioid-induced side effects: A) Depression B) Constipation C) Nausea and vomiting D) Hormonal Changes E) A, B and C F) All of the above G) None of the above Question Title * 38. What are the risk factors for injured worker misuse and abuse of opioids? A) History of addiction to opioids, alcohol, and/or other drugs B) Personal or family substance abuse history C) Adverse childhood experiences - neglect or physician and emotional D) Comorbid psychiatric disorders E) All of the above F) None of the above Question Title * 39. The DWC MTUS Opioid Guidelines should be used as the first line of treatment for pain. A) True B) False Question Title * 40. The following are guidelines for the managing opioid use for injured workers. A) Use screening tools for risk factors and addiction B) Implement an opioid treatment guideline with the injured worker C) Do random drug testing D) Prescription drug monitoring program (use the CA Controlled Substance Utilization Review and Evaluation System (CURES) E) All of the above F) None of the above Question Title * 41. What are the warning signs of substance abuse? A) Reports of lost or stolen prescriptions B) Failure to achieve pain reductionr C) Failure to improve in function D) Acquiring opioids from several prescribers E) Failed urine drug testing F) A, B and E G) B, C and E H) All of the above I) None of the above Question Title * 42. The DWC MTUS Drug Formulary allows for prescribing of 4 days of certain opioid medications during the perioperative period without prior authorization. A) True B) False Question Title * 43. What are important steps in reducing an injured worker’s dependence on opioid medications? A) Weaning or tapering off of opioids B) Abruptly stopping the use of opioid medications C) Immediately prescribing an alternative medication D) Communicating to the injured worker that you have been directed to stop their opioid medications per the MTUS Pain Guidelines. Question Title * 44. What are alternative treatments to opioid medications for pain control? A) Non-opioid medications B) Psychological evaluation and cognitive behavior therapy C) Physical therapy - exercise and work conditioning D) Acupuncture E) Aquatic therapy F) Yoga G) A, B, D and F H) A, B, D and E I) All of the above J) None of the above Done
