An 84-year-old white female presents to your office with symptoms of an upper respiratory infection and a hacking cough. She admits to smoking one pack of cigarettes daily since she was 21 years of age.
Which one of the following is true with regard to her tobacco use?
Correct Answer D:
Sustained-release bupropion has been shown to reduce the relapse rate for smoking cessation and blunt weight gain for 12 months. Beneficial effects of smoking cessation are seen even among older smokers. Evidence has now shown that smokers who switch to low-tar or low-nicotine cigarettes do not significantly decrease their health risks. The approved Food and Drug Administration medications for smoking cessation (sustained-release bupropion, nicotine patch, nicotine gum, nicotine inhaler, and nicotine nasal spray) have been shown to be safe and should be recommended for all patients without contraindications who are trying to quit smoking. The nicotine patch, in particular, is safe, and has been shown not to cause adverse cardiovascular effects.
Which one of the following is true concerning the use of tobacco?
Correct Answer E:
Nicotine causes both physical dependence and tolerance. Withdrawal from nicotine can last several weeks or months. Physicians’ advice to stop smoking increases the rate of stopping smoking by about 30%. Bupropion is no more or less effective than other products for smoking cessation. Nicotine replacement therapy is safe in patients with stable angina.
A 45-year-old male asks about using nicotine replacement therapy (NRT) to help him quit smoking.
You tell him that recent evidence shows that:
Correct Answer A:
A Cochrane meta-analysis of nicotine replacement therapy (NRT) found that it almost doubles a smoker’s chances of quitting (SOR A). There was no benefit to tapering NRT as compared to abrupt discontinuation. Treatment for 8 weeks was as effective as a longer course. No one type of NRT is significantly more effective, but combining several types may aid a relapsed smoker in his or her next quit attempt.
The best way to remove a tick is to:
Correct Answer B:
The best way to remove a tick is by manual extraction with blunt forceps. Improper removal may cause harm by allowing the tick to regurgitate infection material. Heat and petrolatum are ineffective.
When advising women about the need for breast cancer screening, which one of the following statements is accurate regarding risk factors and the need for screening?
Most women with breast cancer have no identifiable risk factors (choice A).
→ Hereditary breast cancer is more common in premenopausal women (choice B is incorrect).
→ The risk is increased three- to fourfold in women with a first degree relative who has had breast cancer. Having several second degree relatives with breast cancer results in increased risk, but this risk has not been quantified (choice C is incorrect).
→ Even women with hereditary breast cancer on the paternal side are at some increased risk (choice D is incorrect).
→ Women of Ashkenazi Jewish descent have a higher risk of developing breast cancer (choice E is incorrect). This is because about 1 in 40 Ashkenazi Jewish women carry a BRCA gene mutation, while only 1 in 500 women in the general population have it.
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