Many patients you see in your practice live in homes built prior to 1977. In compliance with the Centers for Disease Control and Prevention (CDC) guidelines, at which of the following ages will you start the relevant routine lead screening of the children?
Answer(s): C
Lead-based paint was banned from use in residential homes in 1977, and children exposed to environments built before that time should be screened for lead. The age at which children most frequently ingest the largest amounts of lead is during the crawling and walking stage, which is also the oral-anal stage of development that occurs between the ages of 6 months and 2 years. Until children are mobile, they are unlikely to come into contact with objects that might have been coated with lead-based paint.Current guidelines recommend screening beginning at 1 year of age in high-risk populations. Lead levels generally peak at about 2 years of age. After 2 years, children normally have less tendency to put unusual objects and soiled fingers in their mouths.
A young woman who works full time doing manual work in a factory, but who also has secretarial skills, is making her first prenatal visit to your office. Her work involves climbing high ladders, with the risk of falling.Which of the following is the best recommendation regarding this patient's job?
Answer(s): B
The situation described in the question calls for clinical judgment. Restrictions should be specific and should pertain to what the patient may actually be asked to do. A company may not interdict a woman from performing a job just because she is pregnant. You should offer your best advice to a pregnant woman concerning her health and the health of the fetus. Advice should be given to patients and not to their employers. The vast majority of women can continue to do their jobs without restrictions. Telling a patient to simply avoid risk is impractical, difficult to interpret, and cannot be applied effectively. Advise and offer to write task-specific restrictions, such as, "not to climb ladders and not to lift, push, or pull with more than 20 lbs of force," or "not to work at unprotected heights such as on high ladders." The patient is well advised to discuss her needs with her employer. The physician should not communicate directly with the employer unless that is requested by the patient.
A study finds that the incidence of asthma in your community is higher than expected, and that 40% of the homes in your community are heated with forced air. Which of the following best describes this study design?
Answer(s): A
Ecological studies compare groups not individuals. The unit of observation in the above study was a community not individuals. A cross-sectional study design would have looked at the incidence of asthma in those who also owned the particular home heating system at a particular point in time. A cohort study would have taken disease-free individuals in the community who also owned the home heating system and followed them over time to see who developed disease. A case-control approach would have taken individuals with and without asthma and identified how many from each group also had the particular home heating system
A particular community is found to have high rates of dental caries. The health commissioner is attempting to institute a program to prevent further dental caries in his community. Which of the following is the most cost-effective method of preventing dental caries within a community?
Community fluoridation is a very costeffective method of preventing dental caries; in fact, it is actually a cost-saving practice. Implementation requires no additional effort on the part of the community in terms of health care utilization and reimbursement. Promoting dental hygiene in and of itself has not been found to be effective in preventing dental caries. Therefore, regular visits to dental hygienists or having dental hygienists visit schools will not by itself prevent dental caries. Sealants are very effective in protecting against dental carries in populations which have deep pits and grooves on the dental surfaces. It is not as effective on smooth dental surfaces. Therefore, it is costeffective but only in a subset of the population.Semiannual topical application of fluoride by a professional, although effective, will be an expensive program to institute especially in populations that do not have dental coverage.
A 1-year-old child in a large nursery school develops fever, irritability, confusion, a possible stiff neck, and a petechial rash, over the course of several hours. Which of the following agents is recommended for others in the nursery school who have had contact with the child, to control a possible outbreak?
Rifampin, ciprofloxacin, and ceftriaxone have been recommended for the chemoprophylaxis of close contacts of cases of meningococcal meningitis. Gamma globulin has not been shown to be effective for the prevention of meningococcal disease. Most outbreaks are caused by strains of groups A, B, C, Y, and W- 135. Most outbreaks in children less than 1 year old are caused by group B (for which there is no vaccine).Avaccine for groups A, C, Y, and W-135 is available but is used only when the source has been isolated and typed, which is rarely the case when prophylaxis must be started immediately. The immunogenicity of vaccines for groups Aand C is poor, especially in children. Meningococcal vaccine has been recommended for high-risk groups, including military troops and students living in dormitories. The search continues for a widely applicable vaccine.
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