Coronary artery disease (CAD) is more common in men compared to women.
Which of the following is also true?
Correct Answer C: Men run a higher risk of developing the disease than premenopausal women. After menopause, the incidence of CAD in women increases, and can be equal to men.
Coronary artery disease is a leading cause of death of women throughout the world. Women have unique risk factors for heart disease. These risk factors include hormone replacement therapy, birth control pills, and pregnancy-related problems.
Unfortunately, many more women than men display "atypical" patterns when they develop CAD, and these atypical patterns all too often lead to missed diagnoses and inadequate therapy, and therefore, to worse outcomes.
Diagnostic tests that work quite well in men can be misleading in women. The most common problem is seen with stress testing - in women, the electrocardiogram (ECG) during exercise can often show changes suggesting CAD, whether CAD is present or not, making the study difficult to interpret.
Among survivors, 18% of men and 34% of women have a second MI within 6 years, 7% of men and 6% of women die suddenly, 22% of men and 46% of women are disabled with CHF, and 8% of men and 11% of women have a stroke.
A 71-year-old male dies in the hospital. He was admitted into the hospital 4 days ago because of acute small bowel obstruction. He underwent abdominal surgery for adhesion lysis. He had been recovering fairly well when he developed a massive pulmonary embolus 12 hours ago that was confirmed by ventilation-perfusion scan. His past medical history is significant for diverticulitis 15 years ago, COPD diagnosed 12 years ago ,and small cell lung carcinoma diagnosed 6 months with metastases to the brain confirmed 3 months ago.
What is the immediate cause of death?
Correct Answer A: Physicians are called upon to pronounce and certify the deaths of patients in various settings, including acute care hospitals, long-term care facilities, and patients’ homes. Some physicians report being uncomfortable with this duty but this need not be.
Medical certification of death has two parts on section for the cause of death:
This person died of a pulmonary embolism that resulted from post-operative bed rest and abdominal surgery for acute small bowel obstruction. Pulmonary embolism is the immediate cause of death (choice A), while abdominal surgery and acute small bowel obstruction are conditions leading to the immediate cause of death. COPD and Small cell lung carcinoma are conditions that contributed to the patient's cause of death.
→ Acute small bowel obstruction (choice B) is a condition leading to the immediate cause of death to be written under pulmonary embolism but it is not the immediate cause of death to enter on Part I.
→ Abdominal surgery (choice C) is also another condition leading to the immediate cause of death that should be written under pulmonary embolism, but itself is not the immediate cause of death.
→ Small cell lung carcinoma (choice D) contributed to the pro-thrombotic state of the patient but it is not the immediate cause of death.
→ COPD (choice E) is also a contributing condition to the cause of death but not the immediate cause of death.
Key Point:Cause of death on medical certificate of death has two parts: Part I has The immediate cause of death with conditions leading to it or antecedent causes right under the immediate cause. Part II has diseases in past medical history that contributed to the cause of death.
The risk of heat wave-related death to elderly patients is highest in those who:
Correct Answer E: All persons are at risk for hyperthermia when exposed to a sustained period of excessive heat; however, factors that increase the risk for hyperthermia and heat-related death include age (e.g., the elderly), chronic health conditions (e.g., cardiovascular disease or respiratory diseases), mental illness (e.g., schizophrenia), social circumstances (e.g., living alone), and other conditions that might interfere with the ability to care for oneself.
Other risk factors are alcohol consumption, which may cause dehydration, previous heatstroke, physical exertion in exceptionally hot environments, the use of medications that interfere with the body's heat regulatory system, such as neuroleptics (e.g., antipsychotics and major tranquilizers), and medications with anticholinergic effects (e.g., tricyclic antidepressants, antihistamines, some antiparkinsonian agents, and some over-the-counter sleep medication). Persons working in hot indoor or outdoor environments should take 10-14 days to acclimate to high temperatures. Although adequate salt intake is important, salt tablets are not recommended and can be hazardous to some persons. Although the use of fans may increase comfort at temperatures <90 F (<32.2 C), fans are not protective against heatstroke when temperatures reach > 90 F (> 32.2 C) and humidity exceeds 35%.
Measures for preventing heat-related illness and death during a heat wave include spending time in air conditioned environments, increasing nonalcoholic fluid intake, exercising only during cooler parts of the day, and taking cool baths. Elderly persons should be encouraged to take advantage of air conditioned environments (e.g., shopping malls, senior centers, and public libraries), even for part of the day. Public health information about exceptionally high temperatures should be directed toward persons aged > 65 years and < 5 years.
For a 52-year-old sedentary, normotensive, non-smoking white male who is not overweight, drinks 60 mL of whiskey per day and plays golf occasionally, which one of the following conditions is most likely to cause death within the next 10 years?
Correct Answer E: In a male over the age of 50 with low risk factors, the most common cause of morbidity is due to ischemic heart disease.
Ischemic heart disease (IHD), or myocardial ischemia, is a disease characterized by reduced blood supply to the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolemia (high cholesterol levels), diabetes, hypertension (high blood pressure) and is more common in men and those who have close relatives with ischemic heart disease.
It is the most common cause of death in most Western countries, and a major cause of hospital admissions. There is limited evidence for population screening, but prevention (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk of complications.
If a child develops diphtheria now, the mortality is almost the same as it was 50 years ago.
But now the disease is not so common because:
Correct Answer A: Prevalence is the number of events in a population at a designated time. Incidence is the number of new events arising within a specified time period. The incidence of diphtheria has been significantly decreased because of routine immunization.
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