To claim CME credit, complete this case-based posttest online at http://www.aad.org/JAAD/.

Note:
CME quizzes are available after the first of the month in which the article is published. A minimum score
of 70% must be achieved to claim CME credit. If you have any questions, please contact the Member
Resource Center of the American Academy of Dermatology at toll-free (866) 503-SKIN (7546), (847)
240-1280 (for international members), or by e-mailing mrc@aad.org.

CME examination
Identification No. JA0313

March 2013 issue of the Journal of the American Academy of Dermatology.

Questions 1-5, Nguyen TV, Hong J, Prose NS. J Am Acad Dermatol 2013;68:353-60.

Directions for questions 1-5: Choose the single best
response.
A 23-year-old woman presents with facial acne that is
unresponsive to over-the-counter face washes.
1. What are the correct steps to prepare for a successful
visit with the patient?
a. Remind yourself to pay attention before entering
the room, elicit all of her concerns at the beginning
of the visit, and stand during the entire visit
b. Remind yourself to pay attention before entering
the room, elicit all of her concerns at the beginning
of the visit, and sit during the entire visit
c. Discuss charting issues with your nurse manager
while checking your smartphone for the latest
news about Prince William and Kate Middleton,
take a quick sip of iced coffee, and then enter the
room to greet her
d. Prepare to pay attention before entering the room
and, in the interest of time, ask her to only talk
about issues related to acne
e. Enter the room and immediately begin lecturing to
her about acne vulgaris
2. During the visit, how can you enhance communica-
tion with the patient?
a. Review her concerns and set an agenda for the
visit, practice reflective listening, and show empa-
thy using the NURS approach (name, understand,
respect, support)
b. Let her know that there is no agenda for the visit.
Instead, you will address her concerns starting
from the top until time runs out
c. Repeat everything she says verbatim to show that
you are paying attention, even though some of her
statements do not make sense
d. Question everything she says to show that you are
paying attention, even though some of her state-
ments are crystal clear
e. If she expresses an emotion, you should wait until
the moment passes so as to avoid addressing an
emotional concern
3. Before making a joint decision with the patient to end
the visit, what is the best thing to say to her?
a. ‘‘Do you have any other questions for me?’’
b. ‘‘If you have any questions or concerns, please
state them now.’’
c. ‘‘I have to see other patients, so please save any
questions you might have until the next visit.’’
d. [Your hand is on the doorknob.] ‘‘Well, it was nice
meeting you today. Any questions before I head
out?’’
e. ‘‘What other questions do you have for me today?’’

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VOLUME 68, NUMBER 3
An established patient of yours presents with concerns that
her eczema is not improving despite strict compliance to
therapy. She appears to be upset.
4. What is the most appropriate initial step to handle the
patient’s anger?
a. Confront the patient directly: ‘‘I think you should
calm down. I cannot work with you when you are
angry!’’
b. Provide possible explanations for why her eczema
is not improving
c. Acknowledge the patient’s anger and explore its
possible causes
d. Ask a chaperone to be in the room with you in
case the patient becomes violent
e. Admit to the patient that you can no longer help
her, followed by a referral to your local eczema
expert
CME examination 363
After a lengthy conversation, the patient appears to be less
upset. She says, ‘‘Doctor, I am so miserable and disap-
pointed that there is nothing else you can do for my
eczema.’’
5. What words should you use to empathize with her
disappointment?
a. ‘‘I’m disappointed, too.’’
b. ‘‘I’m very sorry.’’
c. ‘‘Don’t be such a downer. Things will get better.’’
d. ‘‘I wish we had better treatments for your disease.’’
e. ‘‘I wish you had come to me before things got this
bad.’’