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Consumed by Consumption
Eat Your Spinach! (and other vitamins)
Chronic Disease Potpourri
Small Adults
From Mars or Venus
100
Regarding tuberculosis, screening is indicated for which of the following populations? A) In all persons HIV positive B) Immigrants from Asia, Latin America, and the Caribbean C) IV drug abusers D) All of the above
What is D. Tuberculosis screening is indicated for close contacts with: known or suspected TB populations with a high rate of infection residents and workers in institutions HIV positive persons those with medical risk factors known to increase risk for TB medically underserved populations alcoholics IV drug abusers.
100
Night blindness, xerophthalmia, and Bitot's spots are common clinical signs of vitamin ____ deficiency. A) A B) B C) C D) D
What is A. Vitamin A deficiency has been a significant public health problem in many areas of lesser developed countries. Clinical signs include night blindness, xerophthalmia (dryness and thickening of the lining membrane of the lid and eyeball) and commonly in young children Bitot's spots (foamy white accumulations of sloughed cells typically occurring on the temporal quadrant of the conjunctiva). Clinical manifestations are often accompanied by low concentrations of serum retinol (less than 0.35 mmol/L).
100
Regarding renal disease, which of the following statements is NOT CORRECT? A) Hypertension is the leading cause of end stage renal disease in the U.S. B) Blacks adults are more likely to develop renal diseases than whites C) Men are 20-30% more likely than women to develop renal disease D) Previous streptococcal infection is a significant cause of glomerulonephritis
What is A. Diabetes mellitus is the leading cause of end stage renal disease, followed by hypertension and glomerulonephritis.
100
Neonatal mortality is defined as: A) Death of a live born infant before 1 year of age B) Fetal or infant death between 28 weeks gestation and 1 week postnatal, with weight > 500 grams C) Death of a live born infant within 28 days of age D) Death of a live born infant within 48 hours of delivery
What is C Neonatal mortality consists of deaths of live born infants within 28 days of age.
100
Estrogen-containing oral contraceptives have been found to increase the risk of: A) Ovarian cancer B) Vaginal cancer C) Osteoporosis D) Deep venous thrombosis
What is D The increased risk for deep venous thrombosis and pulmonary embolism ranges from two- to twelve-fold in women who take oral contraceptives.
200
All of the following statements about tuberculosis (TB) are true EXCEPT: A) Isoniazid(INH) treatment is recommended for infected persons under age 35 B) Children ages 3 to 15 usually have a brief, asymptomatic primary pulmonary infection C) The immunosuppression of HIV infection can precipitate the reactivation of latent TB D) A Mantoux reaction of 10 mm or more induration is considered positive in persons with HIV infection
What is D. A reaction of 5 mm or more is considered positive in persons with HIV infection.
200
The fat-soluble vitamins include all of the following EXCEPT: A) A B) B C) K D) D
What is B. Vitamin B is not a fat-soluble vitamin. The fat-soluble vitamins are transported in the chylomicrons of the lymph; vitamin A undergoes a preliminary step of esterification with free fatty acid (usually palmitic acid) in the gastrointestinal mucosa, and is then transported via the chylomicrons of the lymph. To remember the fat-soluble vitamins, use the mnemonic AADEK.
200
Regarding chronic obstructive pulmonary disease (COPD), which of the following statements is NOT CORRECT? A) Primary prevention appears to be the only effective approach to COPD B) Chest x-rays are a cost-effective screening tool for identification of individuals with COPD C) Forced expiratory volume over 1 second (FEV1) is the most useful screening test for COPD D) Cigarette smoking is the most important cause of COPD
What is B. Chest x-rays have not been proven to be cost-effective as a screening method for identification of individuals with COPD.
200
Which of the following IS NOT classified as a spontaneous abortion? A) Fetal death in utero B) Failure of embryonic development C) Expulsion of a fetus weighing 700 grams D) Expulsion of all products of conception before 20 weeks gestation
What is C. Expulsion of a fetus weighing under 500 grams is classified as a spontaneous abortion. Spontaneous death of a fetus over 500 grams is classified as a stillbirth.
200
Regarding teenage pregnancy, which of the following statements is FALSE? A) Approximately 80% of pregnancies to women younger than age 20 were unplanned B) 10% of births to teenagers are repeat births C) Roughly 1 in 9 teenage women becomes pregnant each year D) Pregnancy rates for non-white teenagers are twice that for those who are white
What is B 25% of births to teenagers are repeat births.
300
Which of the following reactions would not be considered a positive PPD? A) 15 mm in a healthy individual B) 10 mm in a close recent contact of an infectious TB case C) 5 mm in a person with risk factors for HIV infection and unknown HIV antibody status D) All of the above are positive tests
What is D All of the choices are positive tests. Additionally, a reaction of 10 mm or more induration is considered positive for residents of long term care facilities.
300
Stomatitis, cheilosis, glossitis, irritability, confusion, and depression are all signs of severe and chronic deficiency of: A) Vitamin B-6 B) Vitamin B-12 C) Vitamin C D) Riboflavin
What is A. Vitamin B-6 deficiency typically occurs in association with deficiencies of other vitamins, particularly the water-soluble vitamins. Signs of severe vitamin B-6 deficiency include stomatitis (inflammation of the mouth), cheilosis (dry scaling fissures of the lips and redness at the angles of the mouth), glossitis (inflammation of the tongue), irritability, confusion, and depression.
300
All of the following statements about cerebrovascular disease are TRUE EXCEPT: A) Stroke mortality, which declined by 46% between 1968 and 1981, stabilized in the 1980's B) Auscultation for carotid bruits and non-invasive testing for carotid stenosis are routine screening procedures recommended by the U.S. Preventive Services Task Force (USPSTF) C) Advanced age is the most important risk factor for stroke D) Studies have shown increases in both stroke incidence and stroke mortality among smokers
What is B Screening for hypertension is recommended at regular intervals for men and women 16-64 years of age. However, the USPSTF found insufficient evidence to recommend for or against either auscultation for carotid bruits or non-invasive testing for carotid stenosis except in high-risk or symptomatic patients.
300
Which of the following can be detected by screening for alpha-fetoprotein (AFP) ? A) Phenylketonuria B) Spina bifida C) Niemann-Pick disease D) Homocystinuria
What is B A high maternal alpha-fetoprotein level is present in most cases of open neural tube defect, such as spina bifida.
300
At what age does the USPSTF recommend that males begin routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE)? A) 40 years-old B) 50 years-old C) 60 years-old D) None of the above
What is D The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE). The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes. Screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient's health. The USPSTF concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population.
400
Regarding tuberculosis (TB), which of the following control strategies provides the best control? A) Elimination of the reservoir B) Prevention of spread of disease by good handwashing and personal hygiene C) Avoidance of contact with potential reservoirs D) Administration of a chemoprophylactic agent to kill the agent
What is D Isoniazid prophylaxis is given to patients with a positive skin test for TB to prevent re-activation of latent infection and secondary spread to others.
400
All of the following are true regarding vitamin K EXCEPT: A) Rich sources include green leafy vegetables, such as broccoli, spinach, brussel sprouts, and turnip greens, B) Vitamin K deficiency may lead to hemorrhaging caused by hypoprothrombinemia, C) Vitamin K is a fat-soluble vitamin, D) Vitamin K deficiency is not a major cause of worldwide morbidity and mortality of breast-fed newborns
What is D. Newborn infants are at increased risk for vitamin K deficiency because breast milk is low in vitamin K, very little vitamin K is transported across the placenta, prothrombin production by the neonatal liver is immature, and the fetal gut is sterile so that the normal intestinal flora responsible for synthesizing vitamin K are not typically present during the first few days of life. Adults at risk for vitamin K deficiency include those with diseases interfering with fat absorption or on prolonged antibiotic or TPN therapy.
400
Noise exposure has been found to cause: A) Increased blood pressure B) Temporary increases in blood cholesterol levels C) Adrenal gland secretions D) All of the above
What is D Noise can increase catecholamine levels causing changes in heart rate and rhythm, increases in blood pressure, psychological stress, and temporary increases in cholesterol and adrenal gland secretions.
400
The following are risk factors for intrauterine grow retardation EXCEPT: A) Multiple gestation B) Substance abuse C) Smoking D) Work with video display terminals (VDTs)
What is D The scientific and medical literature has not established a causal association between VDTs and adverse pregnancy outcomes.
400
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians routinely screen all sexually active women aged ____ years and younger (and other asymptomatic women at increased risk for infection) for chlamydial disease. A) 24 B) 39 C) 34 D) 39
What is A The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians routinely screen all sexually active women aged 24 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection. The USPSTF found good evidence that screening women at risk for chlamydial infection reduces the incidence of pelvic inflammatory disease and fair evidence that community-based screening reduces prevalence of chlamydial infection. The USPSTF concludes that the benefits of screening substantially outweigh the potential harms. Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in the United States. There are estimated to be 3 million new infections each year. Chlamydial infection can cause urethritis, cervicitis, pelvic inflammatory disease (PID), and result in ectopic pregnancy, infertility, and chronic pelvic pain in women. In men, chlamydial infection can cause nongonococcal urethritis and acute epididymitis, and result in infertility, chronic prostatitis, reactive arthritis, and urethral strictures. In pregnant women, chlamydial infection is associated with adverse pregnancy outcomes, including preterm delivery and postpartum endometritis; perinatal transmission to infants can cause neonatal conjunctivitis and pneumonia. Chlamydial infection increases the risk of acquiring HIV infection. 70% to 90% of women and a large percentage of men with chlamydial infection are asymptomatic. The prevalence of asymptomatic infection varies widely depending on the population tested and individual characteristics and risk factors, ranging from 4% to 12% among female family planning clinic patients, 9% among female Army recruits, and 2% to 7% among female college students. Significant declines in prevalence have been noted over the last 10 years in areas where screening programs have been in place.
500
Prophylaxis with isoniazid (INH) for subclinical TB infection is recommended for all of the following groups EXCEPT: A) Individuals with AIDS or HIV infection B) Individuals with silicosis C) Nursing mothers D) Patients with unstable hepatic function
What is D. INH chemoprophylaxis is contraindicated in patients with unstable hepatic function or those taking in significant amounts of other hepatotoxins.
500
Symptoms of deficiency include progressive, symmetric paresthesias of the hands and feet, spasticity and ataxia of the legs, and loss of proprioception and vibratory senses.
What is vitamin B12. Pernicious anemia results from reduced absorption of vitamin B-12 (also referred to as cyanocobalamin) caused by impaired secretion of intrinsic factor from the gastric mucosa. Vitamin B-12 deficiency is associated with macrocytic anemia. The neurologic signs and symptoms are due to degenerative changes of the dorsal and lateral columns of the spinal cord. Dietary sources of vitamin B-12 include organ meats such as liver, shellfish such clams and oysters, certain fishes, poultry, eggs, and to some extent, milk and milk products.
500
The top 5 leading causes of death in the USA.
What are heart disease, cancer, COPD (chronic lower respiratory disease), stroke/CVA, accidents. Per CDC, 2011.
500
Considered an elevated blood lead level in children ages 1-5 years old (must also get units correct).
What is 5 micrograms per deciliter. CDC: Experts now use a reference level of 5 micrograms per deciliter to identify children with blood lead levels that are much higher than most children’s levels. This new level is based on the U.S. population of children ages 1-5 years who are in the highest 2.5% of children when tested for lead in their blood. This reference value is based on the 97.5th percentile of the National Health and Nutrition Examination Survey (NHANES)’s blood lead distribution in children.
500
USPSTF recommendation for biennial screening mammography for women aged 50 to 74 years.
What is a B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Grade: B recommendation.