Question of the Week # 334

334) A 50 year old male nurse is evaluated in your office for a recently discovered lung nodule. About 1 month ago, he had whole body CT scans because he read over the internet that these can be helpful in early detection of cancer. A high resolution CT scan of chest revealed a 7 mm nodule with very smooth edges. The margins are well-defined and there is no calcification. The patient has never smoked in his life and he has no family history of cancer. He has no other risk factors for lung cancer.  He denies any night sweats, weightloss or chronic cough. His recent Tuberculin skin test was negative. Laboratory investigations including complete blood count and comprehensive metabolic panel are within normal limits.

Which of the following is the most appropriate management option?

A) Obtain a Positron Emission Tomography scan ( PET/CT scan)

B) No further follow-up

C) CT guided biopsy of the nodule

D) Follow-up CT scan at 6-12 months and then at 2 years if no change

E) Refer to Cardiothoracic surgery for Wedge Resection

Question of the Week # 273

273 ) A 58 year old man with history of chronic smoking and coronary artery disease is seen in your office for a second opinion regarding smoking cessation. He suffered an acute myocardial infarction two years ago and has had percutaneous coronary intervention with stent placement. He has not had any coronary events in the past 2 years. He denies any chest pain. He was recently placed on Nicotine patches for treatment of tobacco use by his primary care physician. The patient is concerned that the nicotine may increase his risk of having a coronary event and requests you for a second opinion regarding nicotine patch therapy. Physical examination is unremarkable. Which of the following is the most appropriate response?

A) Nicotine replacement  is contraindicated in patients with cardiovascular diseases

B) Periodic counselling alone is very effective for smoking cessation.

C) Nicotine patch is not an independent risk factor for acute myocardial infarction

D) Your doctor knows what is best for you and you should follow his recommendations.

E) Varenicline is completely safe smoking cessation strategy in patients with cardiovascular disease.

Question of the Week # 272

272 ) A 58 year old man with history of chronic obstructive pulmonary disease and seizure disorder is evaluated in your office during a follow-up visit. He uses tiotropium inhaler on a daily basis and his pulmonary symptoms are adequately controlled. However, he reports inability to comply with smoking cessation recommendations. He has tried counseling sessions and Nicotine replacement therapy in the past without any success. The patient has been counseled again during this visit. Which of the following recommendations is most appropriate for this patient?

A) Nortriptyline

B) Varenicline

C) Bupropion and Telephone Counseling

D) Group therapy

E) Topiramate

Question of the Week # 271

271 )  A 52 year old man is distressed about his inability to quit smoking despite several office-based counseling and telephone counseling sessions. He has tried alternative therapies such as hypnosis and acupuncture without any benefit. His history is significant for severe depression for which he has been on treatment with Fluoxetine. He was recently diagnosed with coronary artery disease and had a stent placed 4 months ago. He understands that his smoking behavior greatly increases his risk of having a coronary event. He says he feels increasingly depressed about his inability to quit smoking. He denies any suicidal ideation. Which of the following is the most appropriate recommendations for this patient?

A) Nicotine replacement therapy

B) Varenicline

C) Buporopion

D) Rimonabant

E) Group therapy

Question of the Week # 270

270 )  A 62 year old man presents with complaints of chronic cough for the past two years. Cough occurs mostly in the morning and is associated with mild sputum production. Lately, he has noticed mild shortness of breath on exertion. He denies any chest pain or weightloss. He has a 50 pack year history of smoking. He has been counselled against smoking several times in the past but he believes it is quite difficult for him to quit smoking. He is concerned about lung cancer and requests if he can placed on an annual screening protocol. A chest x-ray and a CT scan of the chest show changes consistent with chronic obstructive pulmonary disease. There is no evidence of malignancy. Which of the following is the most appropriate screening recommendation for this patient?

A) Sputum Cytology every 6 months

B) Chest X-ray annually

C) No Screening

D) Spiral CT scan annually

E) PET scan annually

Question of the Week #124

Q124) A 50 year old man comes for regular health checkup. His family history is significant for colon cancer in his grandfather at the age of 70 and prostate cancer in his father at age 75. His mother had breast cancer at age 65. The patient recently underwent colonoscopy which was normal. During his visit, he asks you if there are any pills or medications that he could use to prevent cancer.  Which of the following have been shown to prevent cancer in a prospective clinical trial?

A)     Vitamin D

B)      Selenium

C)      Beta Carotene

D)     Finasteride

E)      Vitamin B-complex

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