Regular breast self-examinations to screen for breast cancer:
Correct Answer E:
Most women do not regularly perform breast self-examinations, even though it allows motivated women to be in control of this aspect of their health care. Evidence from large, well-designed, randomized trials of adequate duration has shown that the performance of regular breast self-examinations by trained women does not reduce breast cancer specific mortality or all-cause mortality. The current guidelines have found insufficient evidence to recommend breast self-examinations. A Cochrane review concluded that breast self-examinations have no beneficial effect and increase the number of biopsies performed.
Which one of the following is true concerning breast cancer screening?
Correct Answer D:
Breast cancer screening has resulted in an increase in the diagnosis of localized disease without a commensurate decrease in the incidence of more widespread disease. Unfortunately, it cannot predict which of the discovered cancers are more aggressive, and cannot accurately detect premalignant lesions.
The decrease in the mortality rate of breast cancer is due both to earlier detection and better follow-up medical care.
Which one of the following treatments has been shown to produce the most benefit for patients with peripheral vascular disease?
Correct Answer A:
Patients with peripheral vascular disease who stops smoking have a twofold increase in their 5-year survival rate. Diet modification and lipid-lowering drugs can slow progression, but not as dramatically. Aspirin and pentoxifylline are minimally effective.
The most common hospital errors associated with preventable adverse drug effects are in the stage of:
Correct Answer A: Adverse drug events are common and are often preventable. Studies of the incidence of preventable adverse drug events reveal that 49% of errors occurred in the ordering stage, 11% in the transcription stage, 14% in the dispensing stage, and 26% in the administration stage. Errors are much more likely to be intercepted if they occur in an early stage. Wrong dose was the most common ordering error encountered, with other errors including wrong choice of medicine, known allergy, wrong frequency, and drug-drug interaction.
The economic implications of this study could potentially be important if prevention procedures are adhered to.
As a member of the local emergency response management team you are asked about the treatment of nerve gas (e.g., sarin) poisoning.
Which one of the following is most effective in reversing the symptoms of nerve gas toxicity?
Correct Answer C:
Nerve gas agents such as sarin resemble Organophosphate insecticides and inactivate Cholinesterase, leading to the accumulation of acetylcholine at nerve endings. Respiratory symptoms include rhinorrhea, bronchorrhea, bronchospasm, and respiratory muscle paralysis. gastrointestinal symptoms include nausea, vomiting, and diarrhea. Central nervous system symptoms include headache, vertigo, agitation, seizures, and coma. Exposed patients benefit from treatment with atropine, which competitively inhibits acetylcholine. Pralidoxime chloride and diazepam are also beneficial.
→ Although beta-agonists and corticosteroids are beneficial in the general treatment of bronchospasm, atropine is preferred in this situation.
→ Verapamil and ciprofloxacin have no role in the treatment of nerve gas exposure.
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