Items 548 through 549

A 50-year-old man presents to a health center for routine care. His last visit was 5 years ago and he has no complaints. He has been smoking 1 pack of cigarettes a day since he was 15 years old. When counseled about his smoking, he says he has no intention to quit and feels fine. He drinks two alcoholic beverages per week. Records show that his blood cholesterol is 235 mg/dL, with a HDL level of 40 mg/dL and a LDL level of 140 mg/dL. The patient has no family history of coronary artery disease (CAD). His height is 5 ft, 10 in and he weighs 170 lbs. His blood pressure is 110/75 mm Hg.

5-48. What is the most appropriate approach to promote smoking cessation for this patient?

a. Refer him to classes for smoking cessation and reassess progress in 2 wk b. Provide self-help materials and reassess in 3 mo c. Prescribe nicotine replacement therapy and reassess progress in 2 wk d. Set a quit date with the patient and reassess his situation 2 days after this date e. Give clear, personalized advice to quit and readdress the issue at the next visit

5-50. A 50-year-old man presents with jaundice, right upper quadrant tenderness, spider angiomas, and ascites. He takes no medication but has been drinking alcohol heavily. Which of the following is most likely in this patient?

a. Jugular venous distention on physical examination b. SGPT much higher than SGOT (AST)

c. Mallory bodies on liver biopsy d. Rapid clinical recovery after abstinence

5-49. The patient's blood cholesterol test is repeated, and the results are the same. Which of the following is the most appropriate intervention for his lipid profile?

a. Repeat blood cholesterol in 1 year; no therapy is indicated b. Recommend one alcoholic drink per day c. Recommend dietary therapy d. Recommend dietary and drug therapy e. Recommend dietary therapy; if ineffective, add drug therapy

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