Tobacco Dependency

Chapter 7 Tobacco Dependency




Clinical Case Problem 1 A 40-Year-Old Who Smokes Three Packs of Cigarettes a Day


A 40-year-old executive who smokes three packs of cigarettes a day comes to your office for his routine health maintenance assessment. He states that he would like to quit smoking but is having great difficulty. He has tried three times before, but he says, “Pressures at work mounted up, and I just had to go back to smoking.”


The patient has a history of mild hypertension. His blood cholesterol level is normal. He drinks 1 or 2 ounces of alcohol per week. His family history is significant for premature cardiovascular disease and death.



Select the best answer to the following questions




1. Current evidence suggests that coronary artery disease (CAD) is strongly related to cigarette smoking. What percentage of deaths from CAD is thought to be directly related to cigarette smoking?


a. 5%

b. 10%

c. 20%

d. 25%

e. 30% to 40%

2. Which of the following diseases has (have) been linked to cigarette smoking?


a. carcinoma of the larynx

b. hypertension

c. abruptio placentae

d. Alzheimer disease

e. all of the above

3. Which of the following statements with respect to passive smoking is false?


a. spouses of patients who smoke are not at increased risk for development of carcinoma of the lung

b. sidestream smoke contains more carbon monoxide than mainstream smoke

c. infants of mothers who smoke absorb measurable amounts of their mothers’ cigarette smoke

d. children of parents who smoke have an increased prevalence of bronchitis, asthma, and pneumonia

e. the most common symptom arising from passive smoking is eye irritation

4. Of the following factors listed, which is the most important factor in determining the success of a smoking cessation program in an individual?


a. the desire of the patient to quit smoking

b. a pharmacologic agent as a part of the smoking cessation program

c. the inclusion of a behavior modification component to the program

d. physician advice to quit smoking

e. repeated office visits

5. Which of the following is (are) now considered a first-line pharmacologic agent(s) that reliably increase(s) long-term smoking abstinence rates?


a. bupropion SR

b. nicotine gum

c. nicotine inhalers or nasal sprays

d. nicotine patch

e. all of the above

6. Assuming patient interest in smoking cessation, which of the following smoking cessation methods results in the highest percentage of both short-term and long-term success?


a. transdermal nicotine

b. a patient education booklet

c. physician counseling and advice

d. a contract for a “quit date”

e. a combination of all of the above

7. One of the best individual targeted smoking cessation programs is the widely recommended 5 A’s approach (Ask, Advise, Assess, Assist, and Arrange) designed to identify and help the smoker who is willing to quit. Which of the following is true about this approach?


a. the approach includes implementation of an officewide system that ensures that for every patient at every visit, tobacco-use status is queried and documented

b. smokers should be approached intermittently and gently to avoid provoking anger

c. smokers from households with other smokers present should be advised to change domiciles

d. the approach fosters self-reliance without the support of any outside organizations or individuals

e. the use of pharmacotherapy is reserved for counseling failures

8. What is the approximate percentage of patients who relapse after successful cessation of smoking?


a. 10%

b. 50%

c. 75%

d. 85%

e. 99%

9. What is the most prevalent modifiable risk factor for increased morbidity and mortality in the United States?


a. hypertension

b. hyperlipidemia

c. cigarette smoking

d. occupational burnout

e. alcohol consumption

10. Nicotine replacement is especially important in which group(s) of patients who smoke cigarettes?


a. those patients who smoke when work-related stressors become unmanageable

b. those patients who smoke more than 20 cigarettes a day

c. those patients who smoke within 30 minutes of awakening

d. those patients who experience withdrawal symptoms

e. all of the above

f. b, c, and d

11. Which of the following statements regarding the economic burden of smoking is (are) true?


a. the economic burden of smoking is placed not only on the individual but also on society

b. in the United States, the costs related to cigarette smoking exceed $50 billion annually

c. smoking has a significant effect on work-related productivity

d. it would cost an estimated $10 billion annually to provide 75% of smokers aged 18 years and older with the cessation interventions of their choice

e. all of the above

12. Which of the following statements about cigarette smoking in the United States is false?


a. in 2008, 1 in 5 U.S. adults were smokers

b. the lowest prevalence of smoking is in the West

c. cigarette smoking continued to decline rapidly in the first decade of the 21st century so that by 2010, only 1 in 6 adults was a smoker

d. men are more likely than women to be current smokers

e. Medicaid enrollees have nearly twice the smoking rates of the general adult population

13. A Healthy People 2010 objective called for states to enact “comprehensive smoke-free laws” by 2010. Which of the following statements is true about these laws?


a. “comprehensive smoke-free laws” means forbidding smoking in public worksites and restaurants

b. “comprehensive smoke-free laws” means forbidding smoking in restaurants and bars

c. as of December 31, 2010, only 10 states had enacted comprehensive smoke-free laws

d. in 2000 no state had comprehensive smoke-free laws

e. none of the above


Answers




1. d. Of deaths from CAD, 25% are directly attributable to smoking. The incidence of myocardial infarction and death from CAD is two to four times more likely in cigarette smokers than in nonsmokers. In the United States, 18% of all deaths are caused by cigarette smoking.


2. e. The health consequences of smoking are enormous. The major processes involved include active smoking, passive smoking, addiction, and accelerated aging. The following disease categories have been directly linked to smoking: cancer, respiratory diseases, and cardiovascular diseases. Pregnancy and infant health and other miscellaneous conditions also are affected by smoking.


The actual diseases involved include the following:


a. Cancer: (1) lung, (2) larynx, (3) mouth, (4) pharynx, (5) stomach, (6) liver, (7) pancreas, (8) bladder, (9) uterine cervix, (10) breast, and (11) brain, and (12) bone marrow

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Tobacco Dependency

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