Occupational hearing loss is characterized by:
Correct Answer A:
Occupational (Noise-induced) hearing loss is a high-frequency sensorineural hearing deficit caused by chronic exposure to excessive sound levels. Avoiding noise exposure stops further progression of the damage. Once exposure to damaging noise levels is discontinued, further significant progression of hearing loss stops.
Conductive hearing loss is usually due to some blockage such as a tumor, cerumen or foreign body.
Which of the following is not a risk factor for pancreatic cancer?
Correct Answer A: Estimates indicate that 40% of pancreatic cancer cases are sporadic in nature. Another 30% are related to smoking, and 20% may be associated with dietary factors. Only 5-10% are hereditary in nature.
→ Smoking is the most common environmental risk factor for pancreatic carcinoma. Estimates indicate that smoking accounts for up to 30% of cases of pancreatic cancer. People who smoke have at least a 2-fold greater risk for pancreatic cancer than do nonsmokers.
→ In a number of studies, obesity, especially central, has been associated with a higher incidence of pancreatic cancer. → Diabetes mellitus may be associated with a 2-fold increase in the risk of developing pancreatic cancer.
→ Long-standing, chronic pancreatitis is a substantial risk factor for the development of pancreatic cancer. The risk of pancreatic cancer is even higher in patients with hereditary pancreatitis.
→ Approximately 5-10% of patients with pancreatic carcinoma have some genetic predisposition to developing the disease.
→ Alcohol consumption does not appear to be an independent risk factor for pancreatic cancer unless it is associated with chronic pancreatitis.
A 43-year-old man comes for an annual physical exam. He has no significant past medical history but he does have a strong family history of cancer and heart disease. His father and his brother both had myocardial infarctions before age of 60, and his sister, mother, and aunt had breast cancer. He exercises regularly and eats well, with most of his diet being low in saturated fat and cholesterol. He smokes one pack of cigarettes per week.
Which of the following is an age-appropriate screening test in this patient?
The current recommendations for routine, age-appropriate screening is that, at least every 5 years, a lipid panel should be checked. Prostate examinations are recommended annually after age 50. Flexible sigmoidoscopy is indicated every 5 years or colonoscopy every 10 years for people aged 50 or older with no other risk factors.
Which one of the following is best (most sensitive) initial screening test for hereditary hemochromatosis?
Correct Answer B:
The diagnosis of hereditary hemochromatosis is based on a combination of clinical, laboratory, and pathologic criteria. Serum transferrin saturation is the best initial screening value.
→ Serum ferritin concentration is a sensitive measure of iron overload, but ferritin is an acute-phase reactant and is therefore elevated in a variety of infectious and inflammatory conditions in the absence of iron overload. Ferritin levels are less sensitive than transferrin saturation in screening tests for hemochromatosis.
→ Genetic tests for the C282Y and H63D mutations are widely available. Detection of hemochromatosis-associated mutations is conducted to confirm the diagnosis or to discover asymptomatic patients. Genetic testing for the HFE mutation is indicated in all first-degree relatives of patients with hemochromatosis and also in patients with evidence of iron overload.
→ Hemoglobin electrophoresis is used as a screening test to identify variant and abnormal hemoglobins, and has no implication in diagnosis of hemochromatosis.
→ Computed tomography scanning is neither sensitive nor specific for the detection of mild hepatic iron overload. Magnetic resonance imaging may be more sensitive, but this modality has not been validated as a diagnostic test to help confirm hemochromatosis.
Current guidelines for periodic health examinations strongly recommend which one of the following for women?
Correct Answer C:
Current guidelines strongly recommend screening all sexually active females age 25 or younger and other women at increased risk for chlamydial infection (choice C).
→ Papanicolaou test (choice A) is strongly recommended at least every 3 years for all women (who are or have been sexually active) between the ages of 21 and 70 and have a cervix.
→ For women with a strong family history of ovarian cancer, there is insufficient evidence to recommend for or against annual pelvic ultrasonography (choice B).
→ There is insufficient evidence to recommend for or against routine screening for human papillomavirus (choice D).
→ Screening for hepatitis B, although strongly recommended for pregnant women, is not recommended for the general asymptomatic population (choice E).
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