Preventive Medicine Quizzes - Part 2 (14 test)

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Preventive Medicine-2

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Question 1

You are doing a preoperative history and physical examination on a 58-year-old woman who will be undergoing a cholecystectomy later in the She is obese, sedentary with type 2 diabetes, hyperlipidemia and a history of congestive heart failure in the past. She reports that she is unable to walk four blocks without stopping to rest. She denies chest pain with activity. Which of her historical features is not a risk factor for adverse post- operative outcomes?

A	Obesity
B	Functional capacity
C	Type 2 diabetes
D	Hyperlipidemia
E	Congestive heart failure

Question 1 Explanation:

urprisingly, obesity is not a risk factor for adverse postoperative outcomes. Type 2 diabetes, hyperlipidemia, and congestive heart failure may all require additional preoperative testing. Poor functional capacity is defined as being unable to walk four blocks or up two flights of steps. Persons with poor functional capacity have more than twice as many adverse outcomes than their counterparts with better functional capacity.18 Family Medicine Smetana GW. Preoperative medical evaluation of the healthy patient. Available at http://www.utdol.com/utd/content/topic.do?topicKey=med_ cons/6474&view=print. Accessed November 30, 2006.

Question 2

You are doing a routine preoperative clearance for an otherwise healthy 60-year-old man undergoing a knee Which of the fol- lowing laboratory tests should be ordered?

A	Hemoglobin
B	Electrolytes
C	Blood glucose
D	Serum creatinine
E	Urinalysis

Question 2 Explanation:

Random preoperative laboratory testing can increase costs, have little benefit, and a high rate of false-positive tests. Therefore, selective use of laboratory tests is a more prudent approach. In general, guidelines suggest a hemoglobin or hemotacrit for surgery with expected major blood loss and electrolytes only if the patient has a history that increases the likelihood of an abnormality (diuretic use). Routine blood glucose and urinalysis measurements are not recommended. Serum creatinine should be tested if the surgery is major, hypotension is expected, nephrotoxic drugs will be used or the patient is above 50. Smetana GW. Preoperative medical evaluation of the healthy patient. Available at http://www.utdol.com/utd/content/topic.do?topicKey=med_ cons/6474&view=print. Accessed November 30, 2006.

Question 3

A 50-year-old male patient is presenting for preoperative testing before undergoing arthroscopic knee Which of the following is true regarding ordering a preoperative ECG for this patient?

A	The patient should have a preoperative ECG done regardless of history or phys- ical examination
B	The patient should have a preoperative ECG done if he has a family history of hypertension
C	The patient should have a preoperative ECG done if he has a family history of coronary artery disease
D	The patient should have a preoperative ECG done if he is found to have ele- vated blood pressure during the preoperative evaluation
E	The patient should have a preoperative ECG done if he has a history of tobacco use

Question 3 Explanation:

Most experts agree that a preoperative ECG should be performed routinely in: • Men older than 45 years • Women older than 55 years • Patients with a history of known cardiac disease • Patients with a clinical history suggesting cardiac disease • Patients at risk for electrolyte abnormalities, such as those using diuretics • Patients with systemic disease associated with unrecognized cardiac disease, such as hypertension or diabetes • Patients undergoing major surgical procedures In the case above, the patient’s age indicated he would have an ECG regardless of the other factors identified in the history or physical. Smetana GW. Preoperative medical evaluation of the healthy patient. Available at http://www.utdol.com/utd/content/topic.do?topicKey=med_ cons/6474&view=print. Accessed November 30, 2006.

Question 4

You are counseling a patient who is planning a trip with his wife to cel- ebrate their 30th They are going on an African Safari, and wonder about health risks associated with international travel. What would you tell him is the most common cause of death among interna- tional travelers?

A	Infections
B	Accidents
C	Homocide
D	Heart disease
E	Vascular disease (i.e., deep venous thrombosis and pulmonary embolus)

Question 4 Explanation:

Heart disease is the most common cause of death while traveling, likely because it is such a common cause of death in general. The second most common cause of death is accidents. People traveling engage in risky behavior that they otherwise might not while on vacation. Dangerous recreation activities, increased drinking, driving in foreign countries all contribute to causing accidents. Discussing accident prevention is therefore the key when counseling patients planning to travel abroad.

Question 5

You are performing a physical examination on a student traveling to Mexico with her college Spanish class. She is concerned about traveler’s diarrhea, and asks about antibiotic prophylaxis. Which of the following best represents the current guideline from the Centers for Disease Control (CDC) for prevention of traveler’s diarrhea?

A	The CDC does not have an antibiotic guideline regarding antibiotic prophylaxis for traveler’s diarrhea
B	Trimethoprim-Sulfamethoxazole
C	Doxycycline
D	Ciprofloxacin
E	Metronidazole

Question 5 Explanation:

The CDC does not recommend antibiotic chemoprophylaxis for traveler’s diarrhea because of the development of resistant organisms. Most times, the condition is self-limited. The CDC does recommend using common sense regarding food and water, eating nothing unless it is boiled, peeled, or cooked.

Question 6

You are discussing vaccinations for a patient who is traveling interna- Due to a significant fear of needles, he is unwilling to obtain any vaccination unless he feels there is significant risk of acquiring the condi- tion. Which of the following vaccine preventable illness is the most com- mon one acquired by travelers?

A	Yellow fever
B	Polio
C	Hepatitis A
D	Cholera
E	Typhus

Question 6 Explanation:

Hepatitis A is the most common vaccine preventable illness acquired by travelers. Yellow fever is the only legally required immunization (and then, only for some countries). A single inactivated polio vaccine (IPV) booster is recommended for adult travelers who have had primary polio immunization, but who will be traveling to an area where polio is endemic. Cholera and typhus are generally not required immunizations for travelers.

Question 7

One of your patients is a medical student planning a mission trip to equatorial He is asking about the yellow fever vaccine and the risks of complications from the vaccine. Which of the following is true regarding yellow fever vaccination?

A	The yellow fever vaccine is a killed vaccine, and therefore has minimal associ- ated side effects
B	The yellow fever vaccine is a live vaccine, and does not have clinically signifi- cant risks associated with its use
C	The complications associated with the vaccine are rarer than the risk of devel- oping yellow fever in equatorial Africa
D	The risk of yellow fever vaccine associated encephalitis is higher than the risk of becoming infected with yellow fever, therefore vaccination is not recommended
E	The risk of developing a syndrome resembling wild-type yellow fever after vac- cination is higher than the risk of becoming infected with yellow fever, there- fore vaccination is not recommended

Question 7 Explanation:

Yellow fever is a mosquito-borne viral infection and is endemic in equatorial Africa and areas of South America. Two rare complications of yellow fever can occur—encephalitis, and a syndrome resembling wild-type yellow fever. The risk of developing yellow fever for the unvaccinated traveler is 1 in 1000 while the risk of complication is 2.5–6 per 1 million vaccinations. Weller PF. Immunizations for travel. Available at http://www.utdol. com/utd/content/topic.do?topidKey+immunize/6150&view=print. Accessed November 30,

Question 8

You are discussing required vaccinations for an HIV infected Which of the following vaccines is recommended for immunodeficient patients?

A	Yellow fever vaccine
B	Inactivated polio vaccine
C	Cholera vaccine
D	Oral typhoid vaccine
E	MMR vaccine

Question 8 Explanation:

Vaccines that contain live, attenuated viruses (yellow fever, oral polio, oral typhoid, and MMR vaccines) should not be given to immunocompromised patients. Inactivated polio is safe, as is the parenteral typhoid vaccine. Cholera immunization is no longer recommended for travelers.

Question 9

You are re-evaluating a 32-year-old woman in your You started her on combination oral contraceptives (COCs) 3 months ago, and at each of three visits since then, her blood pressure has been elevated. Which of the following is an appropriate next step?

A	Discontinue the oral contraceptive and recommend a barrier method
B	Change to a pill with a higher estrogen component
C	Change to a pill with a lower estrogen component
D	Change to a pill with a lower progestin component
E	Change to a progestin-only pill

Question 9 Explanation:

In some patients COCs cause a small increase in blood pressure. This risk increases with age. Both estrogen and progestin are known to cause blood pressure elevations, so changing formulations of COC or using progestin-only pills may not lead to problem resolution. Once COCs are discontinued, blood pressure usually resolves within 3 months.

Question 10

Which side effect of COCs is most frequently cited as the reason for discontinuing their use?

A	Nausea
B	Breast tenderness
C	Fluid retention
D	Headache
E	Irregular bleeding

Question 10 Explanation:

Side effects of COCs include androgenic effects (hair growth, male pattern baldness, nausea.) and estrogenic effects (nausea, breast tenderness, and fluid retention). Weight gain is thought to be a common side effect, but multiple studies have failed to show it to be a statistically significant side effect. The side effect most frequently cited as the reason for stopping use of COCs is irregular bleeding. It is common in the first 3 months of use, and generally diminishes over time.

Question 11

You are counseling a 23-year-old woman who is interested in starting COC Which of the following is true regarding risks associated with COC use?

A	Users of COC pills have an increased risk of ovarian cancer
B	Users of COC pills have an increased risk of endometrial cancer
C	Users of COC pills have an increased risk of thromboembolism
D	Users of COC pills have an increased risk of hemorrhagic stroke
E	Users of COC pills have an increased risk of diabetes mellitus

Question 11 Explanation:

The use of COC pills is associated with a threefold risk of venous thromboembolism. COCs have a protective effect against ovarian cancer and endometrial cancer. The risk of hemorrhagic stroke is not increased by the use of COCs, and they have not been shown in studies to impact carbohydrate metabolism in a statistically significant way

Question 12

A 29-year-old obese woman with type 2 diabetes mellitus is asking you about progestin-only pills as a method of Which of the following is true?

A	Progestin-only pills are contraindicated in women with diabetes
B	Progestin-only pills would increase her risk of thromboembolic events
C	Progestin-only pills are only Food and Drug Administration (FDA) approved for nursing women
D	Progestin-only pills increase her risk for ectopic pregnancy
E	Progestin-only pills should be taken every day of the month, without a hormone- free period

Question 12 Explanation:

Progestin-only pills prevent conception through suppression of ovulation, thickening of cervical mucus, alteration of the endometrium, and inhibition of tubal transport. The effectiveness of this method is dependent on consistency of use. In fact, if a pill is taken even 3 hours late, an alternative form of contraception should be used for 48 hours. There is no hormone-free period with these pills, and they should be taken every day. The pills do not carry an increased risk for thromboembolism, and the World Health Organization has reported this form of contraception to be safe for women with a history of venous thrombosis, pulmonary embolism, diabetes, obesity, or hypertension. Nursing women can use this pill, but there is FDA approval for use in others as well. In general, progestin-only pills protect against ectopicPreventive Medicine Answers 21 pregnancy by lowering the chance of conception. However, if progestinonly pill users get pregnant, the chance of ectopic pregnancy is 6–10%, higher than the rate found in women not using contraception. Therefore, users should be aware of the symptoms for ectopic pregnancy.

Question 13

You are counseling a patient regarding contraception She is 36-years-old, she smokes, weighs 145 lb, and has no other medical con- cerns. She is sexually active, but not in a monogamous relationship. Of the following, which is her best contraception option?

A	Combination oral contraceptive pills
B	An intravaginal ring system delivering estrogen and progestin
C	A transdermal contraceptive patch delivering estrogen and progestin
D	An injectable form of long-acting progestin
E	An intrauterine device (IUD)

Question 13 Explanation:

Oral contraceptive pills containing estrogen and progestin components are contraindicated in smokers over 35, due to an increased risk of thromboembolic events. An intravaginal ring or transdermal patch that releases estrogen and progestin are also contraindicated in smokers over 35 for the same reason. IUDs should not be used in women with more than one sexual partner, or in people whose partner has more than one partner. IUDs should not be used in people at high risk for developing a sexually transmitted infection, as women with an IUD are more likely to develop pelvic inflammatory disease after a sexually transmitted infection as compared with those using hormonal methods. An injectable long acting progestin would therefore be the best choice in this woman.

Question 14

A 28-year-old monogamous married woman comes to you for emer- gency She and her husband typically use condoms to pre- vent pregnancy, but when they had sex 2 evenings ago, the condom broke. She does not want to start a family at this time. Which of the following state- ments is true regarding the use of emergency contraception pills (ECPs)?

A	She is too late to use ECPs in this case
B	ECPs are 90–100% effective when used correctly
C	There are no medical contraindications to the use of ECPs, other than allergy or hypersensitivity to the pill components
D	ECPs disrupt the pregnancy, if given within days of implantation
E	Clinicians should perform a pregnancy test before prescribing ECPs

Question 14 Explanation:

Emergency contraception is appropriate when no contraception was used (including cases of sexual assault), or when there is contraceptive failure. They should be used within 72 hours of intercourse, well before implantation (implantation occurs 5–7 days after intercourse). ECPs involve limited hormonal exposure, and therefore have not been shown to increase the risk of venous thromboembolism, stroke or myocardial infarction. In fact, there are no medical contraindications to the use of emergency contraception pills. They do not disrupt an already implanted pregnancy and do not cause birth defects. Progestin ECPs prevent 85% of expected pregnancies when used correctly, and combined ECPs prevent 75% of expected pregnancies. They are not 100% effective in pregnancy prevention. There is no need to perform a pregnancy test when prescribing

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Part 1 | Part 2 |

II. Preview all questions below

1.You are doing a preoperative history and physical examination on a 58-year-old woman who will be undergoing a cholecystectomy later in the She is obese, sedentary with type 2 diabetes, hyperlipidemia and a history of congestive heart failure in the past. She reports that she is unable to walk four blocks without stopping to rest. She denies chest pain with activity. Which of her historical features is not a risk factor for adverse post- operative outcomes?

Obesity
Functional capacity
Type 2 diabetes
Hyperlipidemia
Congestive heart failure

2. You are doing a routine preoperative clearance for an otherwise healthy 60-year-old man undergoing a knee Which of the fol- lowing laboratory tests should be ordered?

Hemoglobin
Electrolytes
Blood glucose
Serum creatinine
Urinalysis

3. A 50-year-old male patient is presenting for preoperative testing before undergoing arthroscopic knee Which of the following is true regarding ordering a preoperative ECG for this patient?

The patient should have a preoperative ECG done regardless of history or phys- ical examination
The patient should have a preoperative ECG done if he has a family history of hypertension
The patient should have a preoperative ECG done if he has a family history of coronary artery disease
The patient should have a preoperative ECG done if he is found to have ele- vated blood pressure during the preoperative evaluation
The patient should have a preoperative ECG done if he has a history of tobacco use

Travel Medicine

4. You are counseling one of your patients who is planning a trip over- He is concerned about becoming ill while traveling. Which of the fol- lowing illnesses is the most common seen in international travelers?

Diarrhea
Upper respiratory infection
Parasitic infection
Malaria
Hepatitis

5. You are counseling a patient who is planning a trip with his wife to cel- ebrate their 30th They are going on an African Safari, and wonder about health risks associated with international travel. What would you tell him is the most common cause of death among interna- tional travelers?

Infections
Accidents
Homocide
Heart disease
Vascular disease (i.e., deep venous thrombosis and pulmonary embolus)

6. You are performing a physical examination on a student traveling to Mexico with her college Spanish class. She is concerned about traveler’s diarrhea, and asks about antibiotic prophylaxis. Which of the following best represents the current guideline from the Centers for Disease Control (CDC) for prevention of traveler’s diarrhea?

The CDC does not have an antibiotic guideline regarding antibiotic prophylaxis for traveler’s diarrhea
Trimethoprim-Sulfamethoxazole
Doxycycline
Ciprofloxacin
Metronidazole

7. You are discussing vaccinations for a patient who is traveling interna- Due to a significant fear of needles, he is unwilling to obtain any vaccination unless he feels there is significant risk of acquiring the condi- tion. Which of the following vaccine preventable illness is the most com- mon one acquired by travelers?

Yellow fever
Polio
Hepatitis A
Cholera
Typhus

8. One of your patients is a medical student planning a mission trip to equatorial He is asking about the yellow fever vaccine and the risks of complications from the vaccine. Which of the following is true regarding yellow fever vaccination?

The yellow fever vaccine is a killed vaccine, and therefore has minimal associ- ated side effects
The yellow fever vaccine is a live vaccine, and does not have clinically signifi- cant risks associated with its use
The complications associated with the vaccine are rarer than the risk of devel- oping yellow fever in equatorial Africa
The risk of yellow fever vaccine associated encephalitis is higher than the risk of becoming infected with yellow fever, therefore vaccination is not recommended
The risk of developing a syndrome resembling wild-type yellow fever after vac- cination is higher than the risk of becoming infected with yellow fever, there- fore vaccination is not recommended

9. You are discussing required vaccinations for an HIV infected Which of the following vaccines is recommended for immunodeficient patients?

Yellow fever vaccine
Inactivated polio vaccine
Cholera vaccine
Oral typhoid vaccine
MMR vaccine

Contraception

10. You are re-evaluating a 32-year-old woman in your You started her on combination oral contraceptives (COCs) 3 months ago, and at each of three visits since then, her blood pressure has been elevated. Which of the following is an appropriate next step?

Discontinue the oral contraceptive and recommend a barrier method
Change to a pill with a higher estrogen component
Change to a pill with a lower estrogen component
Change to a pill with a lower progestin component
Change to a progestin-only pill

11. Which side effect of COCs is most frequently cited as the reason for discontinuing their use?

Nausea

Breast tenderness

Fluid retention

Headache

Irregular bleeding

12. You are counseling a 23-year-old woman who is interested in starting COC Which of the following is true regarding risks associated with COC use?

Users of COC pills have an increased risk of ovarian cancer
Users of COC pills have an increased risk of endometrial cancer
Users of COC pills have an increased risk of thromboembolism
Users of COC pills have an increased risk of hemorrhagic stroke
Users of COC pills have an increased risk of diabetes mellitus

13. A 29-year-old obese woman with type 2 diabetes mellitus is asking you about progestin-only pills as a method of Which of the following is true?

Progestin-only pills are contraindicated in women with diabetes
Progestin-only pills would increase her risk of thromboembolic events
Progestin-only pills are only Food and Drug Administration (FDA) approved for nursing women
Progestin-only pills increase her risk for ectopic pregnancy
Progestin-only pills should be taken every day of the month, without a hormone- free period

14. You are counseling a patient regarding contraception She is 36-years-old, she smokes, weighs 145 lb, and has no other medical con- cerns. She is sexually active, but not in a monogamous relationship. Of the following, which is her best contraception option?

Combination oral contraceptive pills
An intravaginal ring system delivering estrogen and progestin
A transdermal contraceptive patch delivering estrogen and progestin
An injectable form of long-acting progestin
An intrauterine device (IUD)

15. A 28-year-old monogamous married woman comes to you for emer- gency She and her husband typically use condoms to pre- vent pregnancy, but when they had sex 2 evenings ago, the condom broke. She does not want to start a family at this time. Which of the following state- ments is true regarding the use of emergency contraception pills (ECPs)?

She is too late to use ECPs in this case
ECPs are 90–100% effective when used correctly
There are no medical contraindications to the use of ECPs, other than allergy or hypersensitivity to the pill components
ECPs disrupt the pregnancy, if given within days of implantation
Clinicians should perform a pregnancy test before prescribing ECPs

Preventive Medicine MCQ Preventive Medicine Quiz

Preventive Medicine Quizzes – Part 2 (14 test)

I. Start the exam by click the “Start” button

Preventive Medicine-2

II. Preview all questions below

Travel Medicine

Contraception

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