A worker complains of paresthesias, numbness, and tingling that started distally in the lower extremities but that is starting to affect his hands. He is developing muscle weakness. He feels tired, and has a headache and complains of memory deficit. Electromyographic abnormalities suggest axonal degeneration and demyelination. Exposure to which of the following is the most suspect cause of this clinical picture?
Answer(s): D
Carbon disulfide causes sensorimotor peripheral neuropathy. Central nervous system (CNS) effects and optic neuritis are also common. Long-term exposure may increase cardiovascular risk. Lower sperm counts and more abnormal spermatozoa are observed than in unexposed subjects.
A 20-year-old asymptomatic college student presents to your clinic for contraception. She states that she has been sexually active for 2 years with one partner, and that they usually use condoms. Along with a Papanicolaou (Pap) smear and pelvic examination, which of the following should you also recommend?
Answer(s): B
The USPSTF strongly recommends that clinicians routinely screen all sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection.
You have performed annual examinations on a young mother for the last 3 years. She and her husband are considering having another child in 5 years, and she would like to restart oral contraceptive pills. You review her medical record and find that she had a normal Pap smear at last year's examination and also the year prior to that.You recommend that her next Pap smear be performed when?
After two normal Pap smears, women with normal risk can be screened every 3 years. The USPSTF has found no evidence that annual screening provides better outcomes than screening every 3 years. The majority of cervical cancers in the United States occur in women who have never been screened, those who did not receive appropriate follow-up after an abnormal Pap smear, or those who have not been screened within the past 5 years.
A 30-year-old asymptomatic male presents to your office because his father just had a heart attack. He is concerned that he may have inherited his father's condition because a cholesterol level test done at his work site last year was 220 mg/dL. You review his history and find that he smokes 25 cigarettes a day, eats mostly at fast food restaurants, sits at a desk job, and has no regular moderate intensity physical activities. His blood pressure is 130/85 mmHg and his body mass index (BMI) is 26. Which of the following is the most effective step to successfully help the patient quit smoking?
Answer(s): C
Whereas all of the interventions have a positive effect on smoking cessation, the bupropion hydrochloride has the greatest effect at 6-month follow-up.
Jehovah's Witnesses usually refuse to consider a recommended blood transfusion. A 5-yearold child with hemophilia and dangerously low hemoglobin levels needs such a transfusion, but the Jehovah's Witness parents refuse to accept the recommendation. How are principles of autonomy best resolved?
The law has generally recognized that the parents do not necessarily exercise autonomy appropriately on behalf of their child. It also recognizes that children cannot exercise autonomy for themselves, and that children should not be required to make complicated decisions about their own care. For children, and for adults who are unable to make medical decisions, a surrogate decision maker is normally named by a court of appropriate jurisdiction.
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