ABFM HEALTH COUNSELING
AND PREVENTIVE CARE
A 45-year-old female sees you for counseling on smoking cessation.
You tell her that stopping smoking
reduces the risk of lung cancer almost immediately
reduces the risk of laryngeal cancer within 5 years
reduces the risk of bladder cancer within 5 years
reduces the risk of certain types of leukemia - ANSWERS-D
The 2004 U.S. Surgeon General's Report expanded the list of
smoking-related cancers, noting that the evidence either suggested or
was strong enough to infer causal relationships between smoking and
cancers of the lung, larynx, oral cavity, pharynx, esophagus, stomach,
liver, pancreas, colon and rectum, uterine cervix, kidney, and bladder,
as well as other sites. Smoking was also causally linked to adult
myeloid leukemia. In 2014 the Surgeon General released a report
marking 50 years since the first Surgeon General's report on smoking.
This report also examined links between smoking and cancer, and
discussed causal links to lung cancer, liver cancer, and colorectal
cancer, as well as evidence suggesting a link between breast cancer
and smoking. The 2014 report also notes that smoking does not cause
prostate cancer. The evidence did show that smoking increases the
risk of dying in patients with cancer, including those with breast or
prostate cancer.The risk of cancer from smoking shows a clear
relationship to both the number of cigarettes smoked each day and the
duration of smoking; the earlier one begins to smoke, the higher the
,risk. While the increased risk of lung cancer due to smoking starts to
decline within about 5 years among persons who stop smoking, the
residual risk may persist for several decades. Stopping smoking
before middle age greatly decreases the risk of lung cancer, and
cessation sharply reduces the risk of laryngeal cancer within 10 years.
The risk of bladder cancer, on the other hand, persists much longer
after cessation (level of evidence 2 for all findings).
A 66-year-old female sees you for the first time for a health
maintenance visit. She has read recently that there is a new shingles
vaccine that was better than the previous version, and she asks
whether she should get the new vaccine even though she received the
older vaccine at age 60.Which one of the following statements would
be accurate advice about the recombinant herpes zoster vaccine
(Shingrix)?
It is more than 90% effective for preventing herpes zoster and
postherpetic neuralgia
It contains live attenuated varicella virus and should not be given to
patients who are immunodeficient
It should not be given to patients who have had varicella zoster in the
previous 3 months
She should wait at least another 4 years to get the recombinant
vaccine
If a patient has no recollection of varicella in their lifetime then
testing for varicella antibodies is recommended before giving the
vaccine - ANSWERS-A
,The recombinant herpes zoster vaccine (Shingrix) is a recombinant
subunit vaccine that combines a lyophilized varicella zoster virus
glycoprotein E (gE) antigen and an adjuvant system. It does not
contain a live virus and is administered in two doses of 0.5 mL each,
with the second dose given 2-6 months after the initial dose. It has
been shown to be more than 90% effective in preventing herpes zoster
and postherpetic neuralgia. Its protective effect remains at 85% for at
least 4 years after administration, unlike the previous herpes zoster
vaccine (Zostavax), which contains a live attenuated varicella virus
and only reduces the risk of herpes zoster by 51% and the risk of
postherpetic neuralgia by 67%.The recombinant vaccine is indicated
for people over the age of 50, whereas the live attenuated vaccine was
recommended for people over the age of 60. The recombinant vaccine
is recommended for patients who have had shingles in the past, as
well as those who received the live attenuated vaccine in the past.
When the older vaccine was available the CDC recommended that
patients wait at least 8 weeks after receiving the live attenuated
vaccine before getting the recombinant vaccine.There is no specific
amount of time a patient who has had herpes zoster must wait before
receiving the recombinant vaccine, but it should not be administered
during an acute episode of zoster. When vaccinating adults age 50
years and older, there is no need to screen for a history of varicella
infection or to conduct laboratory testing for serologic evidence of
prior varicella infection. Testing is often a barrier to herpes zoster
vaccination, and false negatives are common. Worldwide, more than
99% of adults age 50 years and older have been exposed to varicella
zoster virus.
You provide care for an extended family that lives in the same
household and includes a 69-year-old female, her 44-year-old
daughter, her 23-year-old granddaughter, and the granddaughter's 15-
month-old infant. The family receives housing assistance and
, participates in the Supplemental Nutrition Assistance Program
(SNAP). All of the family members are asymptomatic. The
grandmother is a former smoker with a 30-pack-year smoking history.
The 23-year-old is not married and her only medication is an oral
contraceptive.Which one of the following would be recommended by
the U.S. Preventive Services Task Force?
Screening the 15-month-old for autism
Screening the 23-year-old for gonorrhea
Screening the 44-year-old for thyroid disease
Screening the 69-year-old for abdominal aortic aneurysm -
ANSWERS-B
The U.S. Preventive Services Task Force (USPSTF) recommends
screening for both gonorrhea and Chlamydia in sexually active
women 24 years of age and younger (B recommendation). The
USPSTF has found insufficient evidence for screening nonpregnant
asymptomatic adults for thyroid dysfunction (I recommendation).
Although the USPSTF recommends abdominal aortic aneurysm
(AAA) screening by ultrasonography in men 65-75 years of age who
have ever smoked, it found that current evidence is insufficient to
assess the balance of benefits and harms of screening for AAA in
women 65-75 years of age who have ever smoked (I
recommendation).It is important to screen all children for
developmental delays, especially those who are at a higher risk for
developmental problems due to preterm birth, low birth weight, or
having a sibling or parent with autism spectrum disorder (ASD). The
USPSTF has noted the need for more research around autism
screening. However, the CDC recommends that all children be
screened specifically for ASD with a validated tool during regular
AND PREVENTIVE CARE
A 45-year-old female sees you for counseling on smoking cessation.
You tell her that stopping smoking
reduces the risk of lung cancer almost immediately
reduces the risk of laryngeal cancer within 5 years
reduces the risk of bladder cancer within 5 years
reduces the risk of certain types of leukemia - ANSWERS-D
The 2004 U.S. Surgeon General's Report expanded the list of
smoking-related cancers, noting that the evidence either suggested or
was strong enough to infer causal relationships between smoking and
cancers of the lung, larynx, oral cavity, pharynx, esophagus, stomach,
liver, pancreas, colon and rectum, uterine cervix, kidney, and bladder,
as well as other sites. Smoking was also causally linked to adult
myeloid leukemia. In 2014 the Surgeon General released a report
marking 50 years since the first Surgeon General's report on smoking.
This report also examined links between smoking and cancer, and
discussed causal links to lung cancer, liver cancer, and colorectal
cancer, as well as evidence suggesting a link between breast cancer
and smoking. The 2014 report also notes that smoking does not cause
prostate cancer. The evidence did show that smoking increases the
risk of dying in patients with cancer, including those with breast or
prostate cancer.The risk of cancer from smoking shows a clear
relationship to both the number of cigarettes smoked each day and the
duration of smoking; the earlier one begins to smoke, the higher the
,risk. While the increased risk of lung cancer due to smoking starts to
decline within about 5 years among persons who stop smoking, the
residual risk may persist for several decades. Stopping smoking
before middle age greatly decreases the risk of lung cancer, and
cessation sharply reduces the risk of laryngeal cancer within 10 years.
The risk of bladder cancer, on the other hand, persists much longer
after cessation (level of evidence 2 for all findings).
A 66-year-old female sees you for the first time for a health
maintenance visit. She has read recently that there is a new shingles
vaccine that was better than the previous version, and she asks
whether she should get the new vaccine even though she received the
older vaccine at age 60.Which one of the following statements would
be accurate advice about the recombinant herpes zoster vaccine
(Shingrix)?
It is more than 90% effective for preventing herpes zoster and
postherpetic neuralgia
It contains live attenuated varicella virus and should not be given to
patients who are immunodeficient
It should not be given to patients who have had varicella zoster in the
previous 3 months
She should wait at least another 4 years to get the recombinant
vaccine
If a patient has no recollection of varicella in their lifetime then
testing for varicella antibodies is recommended before giving the
vaccine - ANSWERS-A
,The recombinant herpes zoster vaccine (Shingrix) is a recombinant
subunit vaccine that combines a lyophilized varicella zoster virus
glycoprotein E (gE) antigen and an adjuvant system. It does not
contain a live virus and is administered in two doses of 0.5 mL each,
with the second dose given 2-6 months after the initial dose. It has
been shown to be more than 90% effective in preventing herpes zoster
and postherpetic neuralgia. Its protective effect remains at 85% for at
least 4 years after administration, unlike the previous herpes zoster
vaccine (Zostavax), which contains a live attenuated varicella virus
and only reduces the risk of herpes zoster by 51% and the risk of
postherpetic neuralgia by 67%.The recombinant vaccine is indicated
for people over the age of 50, whereas the live attenuated vaccine was
recommended for people over the age of 60. The recombinant vaccine
is recommended for patients who have had shingles in the past, as
well as those who received the live attenuated vaccine in the past.
When the older vaccine was available the CDC recommended that
patients wait at least 8 weeks after receiving the live attenuated
vaccine before getting the recombinant vaccine.There is no specific
amount of time a patient who has had herpes zoster must wait before
receiving the recombinant vaccine, but it should not be administered
during an acute episode of zoster. When vaccinating adults age 50
years and older, there is no need to screen for a history of varicella
infection or to conduct laboratory testing for serologic evidence of
prior varicella infection. Testing is often a barrier to herpes zoster
vaccination, and false negatives are common. Worldwide, more than
99% of adults age 50 years and older have been exposed to varicella
zoster virus.
You provide care for an extended family that lives in the same
household and includes a 69-year-old female, her 44-year-old
daughter, her 23-year-old granddaughter, and the granddaughter's 15-
month-old infant. The family receives housing assistance and
, participates in the Supplemental Nutrition Assistance Program
(SNAP). All of the family members are asymptomatic. The
grandmother is a former smoker with a 30-pack-year smoking history.
The 23-year-old is not married and her only medication is an oral
contraceptive.Which one of the following would be recommended by
the U.S. Preventive Services Task Force?
Screening the 15-month-old for autism
Screening the 23-year-old for gonorrhea
Screening the 44-year-old for thyroid disease
Screening the 69-year-old for abdominal aortic aneurysm -
ANSWERS-B
The U.S. Preventive Services Task Force (USPSTF) recommends
screening for both gonorrhea and Chlamydia in sexually active
women 24 years of age and younger (B recommendation). The
USPSTF has found insufficient evidence for screening nonpregnant
asymptomatic adults for thyroid dysfunction (I recommendation).
Although the USPSTF recommends abdominal aortic aneurysm
(AAA) screening by ultrasonography in men 65-75 years of age who
have ever smoked, it found that current evidence is insufficient to
assess the balance of benefits and harms of screening for AAA in
women 65-75 years of age who have ever smoked (I
recommendation).It is important to screen all children for
developmental delays, especially those who are at a higher risk for
developmental problems due to preterm birth, low birth weight, or
having a sibling or parent with autism spectrum disorder (ASD). The
USPSTF has noted the need for more research around autism
screening. However, the CDC recommends that all children be
screened specifically for ASD with a validated tool during regular
