NMS Q&A Family Medicine

Care and Prevention, Ages 21 to 40 Years 273Examination Answers1. The answer is C. 30, the BMI at or above which definesobesity. 25 or above is overweight; 35 or above is morbidobesity as defined for risk of obstructive sleep apnea intruck drivers. BMI is calculated as weight in Kg/height inmeters squared; that is, Kg/m 2 .2. The answer is C. Obese people with first degree familyhistories of diabetes. Each of the other choices constitutesa significant risk factor for diabetes but does not rise to thelevel of an indication for screening in the eyes of the TaskForce. Though now, the USPSTF is a living documentpublished on the Net, its basic approach has not changed.3. The answer is B. Accidental injuries is the most commoncause of death in the age group of 45 years.4. The answer is B. Breast cancer is the leading cause ofcancer death in the 25–44 year group. This is astoundingsince the statistic applies to both sexes. In fact, for all ages ,breast and prostate cancers are virtually tied for thirdranking causes of death in causation, well behind lungcancer and the second cause, colorectal cancer. Be that asit may, the ages of onsets of the four most incident cancersin the U.S. population lend a perspective. Lung canceris the greatest killer, but, while the cause of that cancer islaid down in the period between 16 and 40, the cancerdoes not generally strike until the 50s and 60s. Colorectalcancer is the second leading cause of cancer deaths and,like lung cancer, strikes nearly equally each sex but notuntil the 50s or later except in unusual cases. Prostate canceralso does not strike until the 50s in the most aggressivecases and most often well into the 60s and 70s.5. The answer is C. Begin at 35 years of age screeningmen for cholesterol and other lipids, assuming no increasein risk for atherosclerotic disease (previous heart disease,hypertension, diabetes); USPSTF recommends lipid measurementin women beginning at age 45. Most practitionersconsider this to be overly conservative and wouldfavor such screening in the early adult years before settingout a recommended frequency of testing for each patientindividually.6. The answer is D. A tetanus booster, usually given as aTd vaccine, should be administered every 10 years.7. The answer is A. Breast cancer is the least likely amongthe listed screenings to be positive in a 30-year-old womanwith no particular personal or familial risk factors. Breastcancer, though the second-ranking cancer killer of women,is not screened routinely until a woman reaches the age of40, or at an age 10 years younger than a first-degree relativewho has or has had breast cancer. This question is amatter of intuition to an experienced practitioner but hasnot been posed in the literature in this manner. The Papsmear is recommended annually in a woman who is sexuallyactive, reduced to every 3 years after three negativesmears. Blood pressure is recommended by the USPSTFfor all patients at all visits. A complete blood count has ahigher chance of revealing an iron-deficiency anemia in amenstruating female than discovery of breast cancer atthis age. Physicians are expected to become involved inenvironmental risk factors, thus, asking about smokedetector. The same with carbon monoxide detectors in agas heated. Some physicians, particularly some psychiatristsand pediatricians, feel patients should be askedabout guns being kept in the home and how they mightbe stored safely. Drug or alcohol abuse should also beexplored in all adult patients.8. The answer is A. Malignant neoplasms, heart disease,and accidents easily comprise the ranking causes of deathin the decade of life from 35 to 44, averaging 36.8, 31, and29.7, respectively, over the 3 years of 1999, 2000, and 2001.These data present a stark contrast to those of the previousdecade and portend a significant change in the risksof life over that 10-year period. In fourth place is homicideat 14 deaths per 100,000. Thus, cancer and vasculardisease virtually burst upon the scene, whereas accidentsremain significant, but markedly decreased, as causes ofdeath.9. The answer is C. The incorrect statement is that thosewho have made previous ostensible attempts are at nomore risk for suicide than the population at large.Although the suicidal “gesture” has become notorious inemergency rooms, anyone who makes such a gesture orattempt falls along a spectrum of attention getting at oneend and determination at the other. Virtually no one inthat group who has gone so far as to “rehearse” the actis without a level of intent or serious considerationfor suicide.Matching the numbered immunizations with the letteredconditions10. Td booster: The answer is D, all adults every10 years.11. MMR vaccine: The answer is B, those born after 1956who lack evidence of immunity.