What is the most important advice to give to a traveler to prevent transmission of cholera?
Correct Answer C: Cholera is an acute infection of the small bowel by Vibrio cholerae, which secretes a toxin that produces copious watery diarrhea, leading to dehydration, oliguria, and collapse. Infection is typically through contaminated water or seafood. Diagnosis is by culture or serology. Treatment is vigorous rehydration and electrolyte replacement along with doxycycline.
To control cholera, human excrement must be properly disposed of and water supplies purified. Drinking water should be boiled or chlorinated and vegetables and fish cooked thoroughly.
The causative organism of cholera, Vibrio cholerae, has been recognized for 100 years. Outbreaks of cholera often reach epidemic proportions, the history of seven pandemics can now be traced.
Which one of the following is the spread of this infection, enhanced by modern transportation?
Correct Answer C:
Cholera is an acute infection of the small intestine caused by the bacterium Vibrio cholerae and characterized by extreme diarrhea with rapid and severe depletion of body fluids and salts. Cholera has often risen to epidemic proportions in sub-Saharan Africa and South Asia, particularly in India and Bangladesh. In the past two centuries, seven pandemics (global epidemics) of cholera have been reported.
Cholera is typically transmitted by either contaminated food or water.
Which one of the following is an effective screening method for ovarian cancer in elderly females at average risk?
Correct Answer D:
Two large European trials studied the use of CA-125 and CA-125 with transvaginal ultrasonography (TVU) as screening methods for ovarian cancer. TVU has been reviewed separately. None of these methods is effective as a screening test. No major organization recommends screening women at average risk. The Cancer Society does not recommend routine screening; the College of Obstetricians and Gynecologists recommends against population-based screening; an NIH consensus conference recommended obtaining a family history and performing annual pelvic examinations. The Preventive Services Task Force graded routine screening for ovarian cancer as a “D”, meaning that there is fair evidence to recommend excluding ovarian cancer screening as a part of the periodic health examination. This recommendation reflects both a lack of benefit from screening and the fact that a significant number of women have to undergo exploratory surgery to find a single case.
A 32-year-old female is concerned about ovarian cancer. She has no symptoms at this time. However, she has a close friend who was recently diagnosed with ovarian cancer at an advanced stage. This friend told the patient that a “simple blood test” for CA-125 could detect ovarian cancer at a curable stage.
As part of your discussion, you inform the patient that which one of the following is true?
Correct Answer B:
One of the tragedies of ovarian cancer is that it is often found in otherwise healthy women at an advanced stage. The measurement of serum CA-125 is a convenient and inexpensive test. However, there has been no conclusive evidence that finding ovarian cancer at an earlier stage using this test will result in an improved chance of a woman surviving this condition. CA 125 testing alone has a low sensitivity, particularly for early-stage ovarian cancer, and a low overall specificity. The specificity is particularly low in premenopausal women. In addition, it is mainly useful in postmenopausal women. Furthermore, since the incidence of ovarian cancer is low, 99% of average-risk women with high values of CA-125 will not have ovarian cancer. For these reasons, most consensus opinions recommend against measuring this antigen in average-risk women.
Which one of the following best characterizes the current recommendations on screening asymptomatic women for ovarian cancer?
In 2004, current evidence regarding ovarian cancer was reevaluated, and recommendations were made against routine screening of asymptomatic women. “Fair evidence” was cited that screening could lead to harmful outcomes and that this risk outweighed the potential benefit of screening. (Rating of D).
The incidence of ovarian cancer is higher in women over 60 years of age but it occurs throughout the age spectrum; therefore, there is no recommendation for screening particular age groups. While there is some evidence to support the screening of women with a positive family history of ovarian cancer, there is not yet sufficient evidence from ongoing clinical trials to evaluate the potential benefit of doing so.
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