A 30-year-old male smoker with an 18-pack-year history comes to your office complaining of a dry, hacking cough. You perform a physical examination and obtain a chest X-ray to confirm that he does not have an active infection. You wish to educate the patient about smoking cessation and advise the patient to stop smoking.
Which of the following would be the most appropriate first step for intervention?
Correct Answer C:
Establishing a therapeutic relationship is important due to the chronic, relapsing nature of nicotine dependence. Advising a patient to stop smoking is best done in a supportive and non-judgmental manner. There are currently no studies to support that confrontational styles are effective for smoking cessation. Often smokers are ambivalent about quitting, and giving more personalized information and feedback on smoking cessation can increase motivation to change.
Each of the following statements about tobacco use is true, except:
Only 2-3% of dependent smokers succeed in quitting smoking. Tobacco use for many is a classical addictive disorder with the behavior pattern of compulsive drug use despite adverse psychosocial and health consequences. Dopamine is the key neurotransmitter of the mesolimbic system reinforced by nicotine stimulation. Some research suggests that the effects of nicotine may have similar results to antidepressants. This may explain the shared benefit of cessation. Both genetic and environmental factors are important to develop regular tobacco use. Those who persist smoking have a .70 genetic predisposition.
A male patient has decided to quit smoking and is gone cigarette free for a few weeks now. If he undergoes smoking withdrawal, which of the following is the most likely symptom he will have?
Correct Answer A:
The first few weeks after quitting smoking are usually the most difficult and it's safe to say that it normally takes at least 8-12 weeks before a person starts to feel comfortable with their new lifestyle change of being an ex-smoker. The most common symptoms of nicotine withdrawal are impaired concentration, irritability, tension, disturbed sleep or drowsiness, intense longing for a cigarette/nicotine, headaches, and an increased appetite leading to weight gain.
Which one of the following would be a major contraindication to using bupropion (Wellbutrin) for smoking cessation?
Medications to help patients with tobacco cessation are not without dangers. Bupropion has a good record of success in assisting patients to stop smoking. However, major contraindications to its use include a history of seizures, an eating disorder, or recent MAO inhibitor use. The other conditions listed should always be considered, but are not usually a major contraindication to bupropion use.
Dysfunction within the pictured darkened areas of the brain are associated with which psychiatric disturbance?
Correct Answer E:
The limbic system is a set of brain structures including the hippocampus, amygdala, anterior thalamic nuclei, septum, limbic cortex and fornix. The darkened areas represent the cortical components of the limbic system. The common feature shared by limbic system dysfunction is an emotional disturbance. Psychosis, mood disorders, obsessive compulsive behavior, personality alternations, and disturbances of sexual behavior are linked to limbic system dysfunction.
Click to expand