NMS Q&A Family Medicine

242 NMS Q&A Family Medicine(A) It is too late to reduce his risk of lung cancer,as the cumulative maximum smoking volumefor reversibility of the odds for lung cancer is10 pack-years of smoking.(B) It is too late for practical purposes because onemust quit smoking for at least 40 years beforethe risk of lung cancer is significantly reduced.(C) Actually, the risk of lung cancer begins tosubside significantly at 10 years after cessationof smoking, and the vast majority of lungcancer patients have smoked for more than20 years before contracting the disease.(D) One must quit for 20 years and have smoked forfewer than 15 years to benefit from cessation toreduce risk of lung cancer.(E) If the man stops smoking, he need not fear lungcancer after a period of 5 years.7 You are counseling a 50-year-old man who has beensmoking for 20 years. He has decided to quit smoking.In which of the following situations would he bethe best candidate to benefit from a nicotine withdrawalprogram such as a patch or varenicline(Chantix) to assist in smoking cessation?(A) He has his first cigarette before breakfast.(B) He smokes approximately a half-pack, in socialsituations such as while at clubs or parties, onceor twice per week and not at other times.(C) He smokes for solace or reward, usually at work,but seldom on weekends.(D) He relapsed after being exposed to a situationthat made him want to smoke.(E) He clearly has a psychological but not aphysiological addiction.8 Which of the following represents a contraindicationto the use of a nicotine patch in the previous patient?(A) He would sometimes note pruritus at the patchsite when he tried the patches 5 years ago.(B) He has a history of hypertension and poorlycontrolled diabetes mellitus.(C) He is currently being treated with oralsustained-release buproprion for smokingcessation.(D) He had some erythema at patch sites when heused the patches 5 years ago.(E) He suffered a myocardial infarction 2 weeks ago.9 A 45-year-old man who smokes a pack per day tendsto smoke most heavily at his office, where he is asenior architect. His first cigarette of the day is usuallymidmorning, after he has completed a phase of adesign and is ready to present it to colleagues (or afterhe becomes discouraged and must start again at a differentpoint in a project). On weekends he relaxes byplaying golf or fishing at a local river, during whichtimes he seldom smokes more than 10 cigarettes perday. He wishes to quit. Because you consider him notto be addicted, you discuss with him forgoing nicotinereplacement therapy in favor of bupropriontherapy. Which of the following would constitute acontraindication to bupropion in this patient?(A) History of symptomatic coronary insufficiency(B) History of asthma(C) History of chronic obstructive pulmonarydisease(D) History of seizures(E) History of peptic ulcer disease10 A heavily smoking 45-year-old woman stops smokingand starts on the nicotine patches. She is applyinga new patch each day. How long must she wait beforeshe reuses a skin site where she had previously applieda patch?(A) 1 day(B) 2 days(C) 3 days(D) 1 week(E) 2 weeks