Question 31#

Which one of the following strategies for osteoporosis screening is supported by current clinical evidence?

A. Begin universal screening 5 years after the date of the last menstrual period

Correct Answer C:
No single study has evaluated the effectiveness of osteoporosis screening. Universal screening (with bone mineral density test) is recommended for: 

- All women and men 65 years or older.

- Postmenopausal women and men 50 - 64 with risk factors for fracture including: 

• Fragility fracture after age 40
• Vertebral fracture or low bone mass identified on x-ray
• Parental hip fracture
• High alcohol intake
• Current smoking
• Low body weight, i.e. less than 132 lbs or 60 kg
• Weight loss since age 25 greater than 10%
• High risk medication use: prolonged glucocorticoid use, aromatase inhibitors for breast cancer, androgen deprivation therapy for prostate cancer
• Rheumatoid arthritis
• Other disorders that may contribute to bone loss 

Younger men or women (under 50) with a disease or condition associated with low bone mass or bone loss: 

• Fragility fractures
• High-risk medication use (steroid use, aromatase inhibitors, androgen deprivation therapy)
• Rheumatoid arthritis
• Other chronic inflammatory conditions
• Cushing’s disease
• Malabsorption syndrome
• Uncontrolled hyperthyroidism
• Primary hyperparathyroidism
• Hypogonadism; Early menopause (< 45)
• Other disorders associated with rapid bone loss/fractures 

Question 32#

Which one of the following is true regarding adolescent idiopathic scoliosis?

A. Routine annual screening for all adolescents is recommended

Correct Answer D:

Current guidelines recommend against the routine screening of asymptomatic adolescents for idiopathic scoliosis. The forward bending test, with or without scoliometer use, has a variable ability to detect idiopathic scoliosis. Also, there is evidence of poor follow-up in adolescents with idiopathic scoliosis who are identified during these screening programs. Fair evidence was found that only a small portion of adolescents that are treated for idiopathic scoliosis receive health benefits. Most cases of scoliosis that require aggressive treatment are likely to be detected without community screenings.  

Question 33#

What is the current recommendation regarding lung cancer screening strategy in smokers?

A. Helical CT every 5 years

Correct Answer E:

Examples of screening tests for lung cancer include: 

• Chest X-rays
• Sputum cytology
• Spiral (helical) CT scans of the lungs  

There is fair evidence that low-dose CAT scans, chest X-rays, and sputum cytology can find cancers earlier than they would be found without screening, but there is little evidence that these screening tests actually prevent people from dying from lung cancer. 

Experts do not know if the benefits of screening outweigh the potential harms. For these reasons, experts do not currently recommend for or against lung cancer screening. Screening for lung cancer with chest X-rays was once promoted by some experts, but researchers found out that people who were screened did not have a lower death rate than people who were not screened.

Question 34#

False-positive urine screens for drug abuse can occur as a result of:  

A. Passive inhalation of crack cocaine

Correct Answer C:

Eating as little as one poppy seed muffin can produce amounts of morphine and codeine detectable by immunoassay, as well as by gas chromatography and mass spectrometry. Passively inhaled crack cocaine or marijuana (unless an extreme amount is inhaled), and ingested products containing hemp or other common herbal preparations do not produce positive urine drug screens.  

In addition to poppy seeds, substances reported to cause false-positive urine drug screens include selegiline, Vicks inhalers, NSAIDs, oxaprozin, fluoroquinolones, rifampin, venlafaxine, and dextromethorphan. 

Question 35#

According to recent guidelines, which one of the following patients should be screened for an abdominal aortic aneurysm?

A. A 52-year-old male with type 2 diabetes mellitus

Correct Answer B:

The current guidelines (The Preventive Care Checklist Form update by Duerksen et al in the January 2012 issue; AAA screening has been supported by the US Preventive Services Task Force, the Canadian Society for Vascular Surgery, and the Ontario Health Technology Advisory Committee) for abdominal aortic aneurysm (AAA) recommend one-time screening with ultrasonography for AAA in men 65-75 years of age who have ever smoked. 

→ Individualized investigation of women > 65 years old with multiple risk factors for AAA (smoking history, cerebrovascular disease, family history of AAA) may be beneficial.

→ Screening men or women < 65 years old is not likely to be beneficial.

→ Screening provides borderline to no benefit for men 75 to 80 years old.