We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |


Pamela A. Pappas, MD
JAMA. 1986;255(20):2813. doi:10.1001/jama.1986.03370200115041.
Text Size: A A A
Published online


The large brick house sat prominently, an island centered in a wide expanse of green grass. Everyone marveled at the lawn, which was meticulously mowed, raked, watered, and weeded. The man of the house had installed an intricate irrigation system the year before, and now his lawn was safe from drought.

Four gabled windows graced the upper floor, and brisk white paint shone on their trim. Part of the house sported olive vinyl siding. This the family chose for its neat looks and low-maintenance upkeep. It was, when you looked from the street, a pretty house. Even in its largeness, though, it was dwarfed by its neighbors. They were French Provincial mansions with wrought-iron fences. Ladies in tennis garb flocked to the mansions at lunchtime. They laughed warmly among themselves; outsiders could watch but not join. The brick house seemed quiet, even lonely, by comparison. It was a struggling distant


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.