Clinical Prevention

Chapter 6 Clinical Prevention




Clinical Case Problem 1 A 51-Year-Old Man Who Presents for an “Executive” Examination


A 51-year-old man comes to your office requesting an executive examination. He has been in the habit of receiving a yearly executive examination at work but recently has changed jobs. His new employer does not offer these services. The patient had been told by a health professional at his previous job that “a complete physical, head to toe, with lots of tests is the best method of ensuring maintenance of good health.” He recently heard a radio advertisement for a company that “specializes” in executive examinations but decided to see you instead.



Select the best answer to the following questions




1. With regard to the relative effectiveness of yearly executive examinations, which of the following statements is most accurate?


a. the efficacy of yearly executive examinations has been confirmed in randomized controlled clinical trials

b. the effectiveness of yearly executive examinations has been confirmed by anecdotal evidence

c. the efficacy of yearly executive examinations has been demonstrated in case-control trials

d. the efficacy of yearly executive examinations has been confirmed in population cohort studies

e. none of the above

2. Which of the following is (are) a criterion (criteria) for effective periodic health screening interventions?


a. the condition tested must have a significant effect on quality of life

b. the disease must have an asymptomatic phase during which detection and treatment significantly reduce morbidity and mortality

c. acceptable treatment methods must be available

d. tests must be available at a reasonable cost

e. all of the above

3. Good reasons to consider recommending a health maintenance visit for an asymptomatic adult include which of the following?


a. to learn the patient’s wishes regarding his or her health care

b. to perform or order preventive health service interventions

c. to maximize your income

d. a and b

e. a, b, c

4. Which of the following statements regarding a health maintenance visit is (are) true?


a. the visit in itself may be therapeutic and provide the patient with reassurance

b. the visit provides an opportunity to learn the patient’s wishes and to update information in the medical record

c. the visit can reinforce the primary care office as the patient’s medical home and best source for health care advice and guidance

d. the visit may establish and enhance the patient’s self-management skills

e. all of the above


Clinical Case Problem 2 A 52-Year-Old Male Technophile


A 52-year-old long-time “worried well” male patient of yours schedules an appointment to discuss a newspaper report of a new cancer screening test now being offered locally. He brings the article, which recommends a new imaging procedure to search for lung cancer in former smokers. Your patient is a former smoker, and he asks if he should have the test now available at the local imaging facility. The test costs $2000 and is not covered by insurance. Yet the article claims that the test picks up 80% of “even tiny lung cancers” not seen on other “screening tests.” He mentions that when he called the facility to ask the physician questions about the procedure, he was told, “Ask your family doctor.”



5. Which of the following statements regarding health screening interventions is (are) true?


a. health screening interventions such as mammography are a form of primary prevention

b. interventions that target low-prevalence conditions are acceptable if costs are low

c. if questions of an intervention’s efficacy exist, it is better to err on the side of commission than omission

d. many interventions fail to demonstrate a beneficial effect on mortality despite high sensitivity and specificity

e. none of the above

6. The U.S. Preventive Services Task Force (USPSTF) is an excellent source of screening recommendations for which of the following reasons?


a. the task force is made up of family physicians

b. the task force uses an expert opinion approach for issuing recommendations

c. the evidence for and against an intervention is weighed

d. recommendations are fixed in stone and will stand up in court

e. a and c

7. Which of the following statements is (are) true regarding false-positive findings of screening tests?


a. false-positive findings can create needless patient anxiety

b. false-positive findings often initiate an “intervention cascade”

c. false-positive findings place a substantial burden on the entire health care system

d. a and b

e. a, b, and c

8. Which of the following statements is true regarding patient perceptions of yearly executive examination and related laboratory tests?


a. many patients believe that a routine executive, complete physical examination, along with a complete laboratory profile, will diagnose the majority of illnesses

b. most patients understand the meaning of the term health maintenance examination

c. most patients understand the importance of a focused, regional examination

d. patients are generally sensitive to the costs of routine physical examinations and routine laboratory tests

e. none of the above


Clinical Case Problem 3 A 35-Year-Old Woman Who Presents for a Health Maintenance Examination


A 35-year-old woman has come to your office for a health maintenance examination. You examine the skin in an effort to identify dysplastic nevi, other unusual nevi, or other skin lesions.



9. Which of the following statements is true?


a. the examination for skin cancer in a health maintenance examination is highly sensitive and highly specific

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Clinical Prevention

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