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Family Medicine Aquifer Cases Exam| Questions AND 100% Correct Verified Answers
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Family Medicine Aquifer Cases Exam|Questions AND 100% Correct Verified
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The patient described above underwent a total hysterectomy (total removal of the
uterus and cervix with or without oophorectomy) for benign reasons (fibroids). USPSTF
guidelines recommend against continued cervical cancer screening in patients whose
uterus has been removed for benign disease and evidence showed cytologic screening
to be very low yield and poor evidence that screening to detect vaginal cancers
improves health outcomes in women after hysterectomy for benign disease. Cervical
cancer screening should begin at the age of 21 and women between the ages of 65 and
70 who have had three or more normal Pap tests in the past ten years may choose to
stop cervical cancer screening. Not being sexually active; age 63; only having had
normal PAP smears and years since menopause are not reasons to stop screening for
cervical cancer.
A 47-year-old woman comes into your office for a health care maintenance exam. She
has hypertension and type 2 diabetes. She is not sexually active and has not yet
experienced menopause. There is no family history of cancer. Her blood pressure is
118/78, her BMI is 34 and the remainder of her physical exam is within normal limits.
Her vaccinations are up-to-date, she has a PAP smear today and will have labs
drawn. According to USPSTF, which of the following is the best recommendation to
give her concerning mammography?
A. Should have started at age 40 and every year thereafter
,B. Should have started at age 40 and every 2 years thereafter
C. Start at age 50 and every year thereafter
D. Start at age 50 and every 2 years thereafter
E. Should have started at age 45 and every year thereafter - ANSWER The correct
answer is D.
Mammography has a sensitivity of 60% to 90% for detecting breast cancer and
decreases breast cancer mortality. According to the most recent USPSTF guidelines,
routine mammography is not indicated for women younger than 50 years old except as
based on patient context (history) and beliefs about risks/benefits. The USPSTF
recommends biennial testing for women between the ages of 50 and 74. There is
insufficient evidence to assess the benefits versus risk of screenings in women after the
age of 75. Other groups such as the American Cancer Society (ACS) and American
College of Obstetricians and Gynecologists (ACOG) recommend yearly mammograms
starting at age 40, continuing as long as the woman is in good health.
A 27-year-old woman comes into your office because she heard from her friend about
a vaccination against cervical cancer and would like one. She has no medical problems
and has had a Mirena IUD for three years. She has an allergy to latex and penicillin.
She began having sex at the age of 18 and is currently sexually active with one
partner. She occasionally uses condoms. She smokes half a pack of cigarettes per
day. Her mother had endometrial cancer several years ago and had a total
hysterectomy. Why is the patient not an ideal candidate for the Gardasil vaccination?
A. Age
B. Sexual activity
C. Mirena IUD
D. Allergy to penicillin
E. Tobacco use - ANSWER The correct answer is A.
,Gardasil9 is a vaccination against 9 HPV types and is approved for females ages 9 to
26. While the recommendation is to end at age 26, that does not mean it is dangerous;
it just hasn't been studied and will not likely be covered by insurance. Activity (B) is not
a contraindication to Gardasil vaccination. The other choices are not contraindications
to vaccinations.
Which of the following is correct regarding breast self-examination? Choose the
single best answer.
A. Most women regularly perform breast self-examination.
B. The practice of regular breast self-examination by trained female patients reduces
mortality.
C. Breast self-examination increases the number of biopsies performed.
D. It's recommended to teach women breast self-examination - ANSWER The
correct answer is C.
The USPSTF and the American Cancer Society (ACS) both do not
recommend physicians teach patients to do breast self-exams (BSEs).
Similarly, in 2015 the ACS made a recommendation against clinical breast exam for
screening purposes, citing the extremely low sensitivity and high false positive rate of
physician-performed clinical breast exams in asymptomatic patients. The USPSTF
does not currently make a recommendation about clinical breast exams.
What are the risk factors for developing breast cancer in the general population? Select
all that apply.
A. Family history of breast cancer in first-degree relative
B. Prolonged exposure to estrogen
C. Genetic factors
D. Age
, E. Post-menopausal obesity
F. Excessive alcohol intake - ANSWER The correct answers are A, B, C, D, E, F.
Which of the following are risk factors for osteoporosis? Select all that apply.
A. Early menopause
B. BMI > 30
C. Sedentary lifestyle
D. African American people
E. History of previous fracture as an adult - ANSWER The correct answers are A, C, E.
Risk factors for osteoporosis are mainly due to low estrogen states.
Low estrogen states may be caused by early menopause (i.e., before age 45 years),
prolonged premenopausal amenorrhea, and low weight and body mass index.
Lack of physical activity and inadequate calcium intake (which could be attributable
to poor nutrition or alcoholism) are also associated with osteoporosis.
Other risk factors include:
Family history of osteoporotic fracture
Personal history of previous fracture as an adult
Cigarette smoking
White race
Obesity (BMI >30) is associated with a high estrogen level and can be protective
against menopausal symptoms and osteoporosis.
A 60-year-old obese woman with history of hypertension and dyslipidemia and
family history of cardiac disease. She has burning chest pain,
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