Administration of fluoride is known to prevent dental caries.
Which one of the following is the most effective community health measure for the provision of fluorides?
Correct Answer D:
Fluoridation of public water supplies is a safe, economical, and effective measure to prevent dental caries. Physicians should know the fluoride content of local drinking water supplies, educate patients to prevent excessive fluoride intake, and be knowledgeable about the health risks and benefits associated with fluoride. Dietary fluoride supplements should be considered for children from ages 6 months through 16 years when drinking water levels are suboptimal.
The guidelines for prevention of dental caries in preschool children recommend which one of the following?
Correct Answer B:
It is recommended that oral fluoride supplementation for children beginning at 6 months of age, if their drinking water is deficient in fluoride concentration. Some areas fluoridate their water, while others do not. In certain abutting neighborhoods, it may be difficult for the physician to tell which water system a house uses. Physicians must make sure that each family is aware of their water source.
Fluoride can also be found in natural well water. If a community has pockets of natural fluoride concentration in well water, home fluoride quantitation kits should be obtained for the family and sent to the state before fluoride supplementation is begun. Topical fluoride applications are an adjunct to oral supplementation and should not take their place.
In studies of prognosis, a cohort of patients should be studied to provide accurate information on survival.
This cohort is best assembled by enrolling:
Correct Answer E:
A cohort is a group of people, identified by a common characteristic, which are studied over a period of time as part of a scientific or medical investigation. The survival time is considered to be from symptom onset to death. Survival rates are important for prognosis. For any study of prognosis, it is important to identify patients at an early and uniform point in the course of their disease.
A nicotine patch is contraindicated in which of the following:
Correct Answer A:
The nicotine patch is contraindicated in the following:
Pregnancy - Pregnant smokers should first be encouraged to quit without pharmacologic treatment. The Nicotine Patch should be used during pregnancy only if the likelihood of smoking abstinence, with its potential benefits, outweighs the risk of nicotine replacement and potential concomitant smoking. A nicotine patch is contraindicated during pregnancy because it causes vasoconstriction, and pre eclampsia.
CONTRAINDICATIONS for Nicotine Patches:
Use with CAUTION:
You are the attending physician at a long-term care facility. A new resident, an 85-year-old female, presents for an initial visit. Upon reviewing her history, you find that she is on 18 different medications. While attempting to obtain additional history and medical information, you decide to stop or decrease some of her medications and monitor her response.
Which one of the following would be most appropriate to stop or decrease initially?
Polypharmacy is a term commonly associated with physicians’ prescribing tendencies for the elderly population. Although the term carries a negative connotation, the use of numerous medications is necessary in some elderly patients. However, some medications have been identified as having a considerably higher potential to cause problems when prescribed to elderly patients.
The older antihistamines, primarily diphenhydramine, cause many adverse CNS effects such as cognitive slowing and delirium in older patients. This effect is more pronounced in elderly patients with some degree of preexisting cognitive impairment. The anticholinergic properties of older antihistamines produce effects such as dry mouth, constipation, blurred vision, and drowsiness. Thus, the use of antihistamines as sleeping agents or for symptomatic relief often leads to problems in elderly patients. The sedative effect of older antihistamines also increases older patients’ risks of falls. Hip fracture and subsequent death have been reported in patients who use older antihistamines such as diphenhydramine. Thus, the acetaminophen/diphenhydramine would be an appropriate medication to stop initially.
→ Sertraline is an SSRI, a preferred class for the treatment of depression in the elderly as compared to the tricyclic antidepressants, which are associated with several side effects.
→ When used in elderly patients with congestive heart failure, digoxin should be given in a dosage no greater than 0.125 mg daily; the low dose used in this individual is not inappropriate until the reason for its use is clarified.
→ Fexofenadine is one of the newer nonsedating antihistamines that is recommended for treating allergy symptoms in the elderly. For seasonal allergies the recommended dose for adults and children 12 years or older is 60 mg twice daily or 180 mg once daily.
→ Short-acting dipyridamole may cause orthostatic hypotension. Do not consider the long-acting dipyridamole (which has better properties than the short-acting in older adults) except with patients with artificial heart valves. Do not stop before obtaining full medical history.
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