LMBR Study Grp: Tobacco & Alcohol

Question 1

Regarding Cigarette smoking in the US; select all options that are true.

A - Today’s smokers smoke fewer cigarettes, but have a greater risk of lung cancer. This is due to increased levels of carcinogens in cigarettes and changes to cigarette filters, allowing more vigorous inhalation, permitting carcinogens to penetrate deeper into lung tissue.
B - Tobacco products kill 1 in 3 of those people who use them.
C - Cigarette smoking causes 87% of lung cancer deaths (of which lung adenocarcinoma is the most common), 32% of coronary heart disease deaths, and 70% of all deaths from COPD.
D - Cigarette smoking may worsen erectile dysfunction, risk of bone fractures, DM, Rheumatoid Arthritis, reduced quality of life, Age related macular degeneration (6.6x the risk of neovascular AMD), reduced quality of life and poorer wound healing.
E - Most (just over 2/3rds) of cigarette smokers want to quit, however only 5% will be able to quit without assistance, “cold-turkey” is the least effective method and the most potent quit method is dual-therapy of counselling and medication.

Answer 1

Answer A, D, E are correct.

A – True p 289
B – False. Tobacco products kill 1 in 2 of those people who use them! P289
C – False.
- Cigarette smoking causes:
– 87% of lung cancer deaths (of which lung adenocarcinoma is the most common) = True,
– 32% of coronary heart disease deaths = True
– 70% of all deaths from COPD = False, it’s actually 80%, p289.
D – True. Cigarette smoking may worsen all of the mentioned conditions pg. 290.
Please regarding AMD risk is from Rotterdam Study doi:10.1001/archopht.1996.01100140393005
E –True p291

Question 2

The Five A’s in tobacco cessation, select all that are true.

A – Assess, Advise, Agree, Assist, Arrange
B – Ask, Advise, Assist, Agree, Arrange, or the shortened version if you have a busy clinic, is : Ask, Advise, Refer
C – Are the same in behaviour change as they are in tobacco cessation
D – Advise involves telling the patient that they will die if they continue smoking
E – Ask, Advise, Assess, Assist, Arrange

Answer 2

Answer - E.

A – False p295
B – False p295
C – False p295-296
D – False p 296 advise the patient to quit in a clear, strong and personalised manner e.g. continuing smoking will worsen your asthma 
E – True p295

Question 3

Which of the following statements is correct?

a. The AUDIT-C should be done on every patient annually.
b. The AUDIT-C is an evidenced based diagnostic tool.
c. The AUDIT-C comprises 3 questions.
d. The higher the score for the AUDIT-C plus AUDIT questionnaires the higher the specificity for Alcohol Use Disorder.

Answer 3

Answer: C

Rationale:

a. The AUDIT-C should be done on heavy drinkers/those you suspect of heavy drinking at every visit (BR video)
b. The AUDIT-C is an evidenced based screening tool
c. Correct answer
d. The higher the score the higher the sensitivity that the patient has AUD (p. 303)

Question 4

According to the USA guidelines on Alcohol, which of the following is true?

a. For women, a binge equates to 6 drinks in 2 hours.
b. There is no safe amount of alcohol for those diagnosed with colon cancer.
c. Excess alcohol is a risk factor for hypertension.
d. No alcohol is recommended for those < 18 years of age.

Answer 4

Answer: C

Rationale:

a. Women - binge drinking is 4 per 2 hours, men is 5 per 2 hours (p. 301)
b. No safe amount for those with breast or liver cancer
c. Correct
d. In the USA, no alcohol recommended for those < 21!

Question 5

Which of the statements about a landmark study of British physicians is true?

a. Smokers die approximately 15 years younger than non- smokers.
b. Quitting smoking at 30 led to a 10-year increase in life expectancy.
c. Quitting smoking at 60 led to a 5-year increase in life expectancy.
d. The study was conducted over a 30-year time span.

Answer 5

Answer: B

Rationale:

a. Smokers died 10 years younger https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298160/
b. Correct
c. Quitting at 60 lead to a 3-year increase (p. 290)
d. Study was conducted over a 50- year time span

Question 6

Regarding tobacco use which of the following statement is true?

a. Chewing and smoking tobacco poses the same risk profile.
b. 10 years after stopping smoking, CV disease is reduced by 50%.
c. Smoking adversely affect all phases of the atherothrombotic disease process.
d. After high cholesterol, tobacco use is the second largest cause of preventable death.

Answer 6

Answer: C

Rationale:

a. Smoking is more damaging than chewing
b. At 10 years the risk of lung cancer is reduced by 50% (p. 290)
c. Correct
d. Tobacco use is the number one cause of preventable death (p. 289)

Question 7

Which of the following refer to:

(a) Heavy alcohol use.
(b) At risk drinking.
(c) Alcohol Use Disorder.

1. Impaired control over use.
2. Binge drinking on more than 5 days in the past month.
3. Exceeds the drinking guidelines (set by National Institutes of Health) for any day or week.
4. Cravings or preoccupations.

Answer 7

Answers:

1. c
2. a
3. b
4. c

p. 301

Question 8

Smoking related death in the US – which is correct?

a) Tobacco products kills 1 of every 2 people who use them.
b) 1 in 7 deaths per year.
c) 36% of CHD deaths.
d) 80% deaths from COPD.
e) A and D
f) None of the above.

Answer 8

A & D are correct

1 in 5 deaths
32% of CHD deaths
p.289

Question 9

What scenario fits the definition of At risk drinking:

a. 14 drinks in a week.
b. 8 cans of beer within 2 hours after footy game win, not otherwise.
c. 2 glasses of 12% red wine with dinner every day. On Friday night at the bar usually vodka shots with friends.
d. 1.5 oz vodka/week.

Answer 9

Answer c.

At risk drinking p301

Option b binge drinking.

Question 10

Alcohol misuse is associated with - choose the incorrect answer

1. 20% of all cancers
2. Stroke
3. High BP
4. 20% of unintentional injuries
5. 7% of all deaths

Answer 10

A.

p300

Question 11

Which medication/s are second-line medications for tobacco cessation (off-label use)?

a) Varenicline
b) Clonidine
c) Chantix
d) Naltrexone
e) Nortriptyline

Options:
A)	c & d
B)	a & b
C)	c & e
D)	b & e
E)	b, d and e

Answer 11

Correct answer: D

Clonidine and Nortriptyline are second-line medications.

(p.293)

Question 12

To meet the criteria of Alcohol Use Disorder – severe level how many signs and symptoms does a person need to have?

a) 4 – 5 over 6 months
b) > 6 over 6 months
c) 8+ over 12 months
d) 6+ over 12 months
e) 9+ over 12 months

Answer 12

Answer d.

p. 302

Question 13

Which medications for Alcohol Use Disorder is considered first-line anti-relapse medications?

a) Naltrexone & Gabapentin
b) Disulfiram & Topiramate
c) Acamprosate & Naltrexone
d) Acamprosate & Disulfiram
e) Gabapentin & Topiramate

Answer 13

Answer C

pg 305-306

Question 14

The most common form of chemical dependence in the US:

a. Tobacco
b. Heroin
c. Alcohol
d. Nicotine

Answer 14

Answer d

being the key drug in tobacco, pg 290

Question 15

Number of cancer deaths which can be prevented if no-one used tobacco products:

a. 1:3
b. 1:5
c. 1:10
d. 1:15

Answer 15

a. 1:3

Question 16

Which two statements are correct regarding tobacco use:

a. Acupuncture is an effective treatment for tobacco cessation.
b. Brief phone counselling sessions are ineffective in tobacco cessation-at least 4 in person sessions are needed.
c. Tobacco products kill 1/3 of people who use them F p 289 (it is 1 in 2 people).
d. Tobacco dependence treatments are very cost effective compared to interventions for other disorders.
e. Adults who buy e-cigarettes have a higher rate of quitting.
f. 1 in 5 deaths in the US is smoking related.
g. NRT seems to have a higher risk of birth defects than does pregnant women continuing to smoke.
h. When using nicotine patches, patients with acute CVD should use caution.

Answer 16

ANSWER d and f

a. F p 294
b. F p 291 4 in person sessions seem to be especially effective but minimal interventions (<3mins) still increase abstinence rates
c. Tobacco products kill 1/3 of people who use them
d. T
e. P 295 F (they tend to continue to smoke and use the e cigarettes)
f. T p 289
g. F p 294
h. F p 294 (No assoc between patches and acute CV events but caution recommended for NRT)

Question 17

Which of the following is incorrect:

A) 1L spirit is 24 drinks
B) 1 standard drink - 5oz (142g) table wine
C) 1 standard drink - 12 oz (290g) beer
D) 750ml wine – 5 drinks

Answer 17

Answer B.

Standard beer weight is 340g

Question 18

Which of the following statements is true? (multiple answers)

1) Smoking cessation reduces risk of MI by 50% after 1 year.
2) It takes 15 years to reduce lung cancer risk by 50%.
3) Someone who quits smoking at age 60 can expect to live 3 years longer.
4) Of people who quit smoking, 50% start again within a month.
5) 5% of people who want to quit are able to do so on their own.

Answer 18

Answer- 3, 5

Pg 290
1 is an immediate effect
2 takes 10 years
4 is within 2 weeks