Smoking

Question 1

Does smoking really deserve its own chapter in this book?

Answer 1

Smoking is the single most significant source of preventable morbidity and premature death in the United States.

*this is a recurrent theme on the USMLE, so whenever you are not sure which risk fac- tor to choose to reduce morbidity or mortality, smoking is a safe guess*

Question 2

How is smoking related to heart disease?

Answer 2

Smoking is responsible for 30% to 45% of such cardiac-related deaths in the US.

This risk is decreased by 50% within 1 year of quitting, and by 15 years after quitting, the risk is the same as for someone who has never smoked.

Question 3

What cancers are more likely in smokers?

Answer 3

Almost every part of the body:

• lung (smoking causes 85%-90% of cases)
• oral cavity (90% of cases)
• larynx
• pharynx
• esophagus (70%-80% of cases)
• stomach
• colon
• rectum
• bladder (30%-50% of cases)
• kidney (20%-30%)
• pancreas (20%-25%)
• cervix

Question 4

Describe the effect of smoking on the lung.

Answer 4

• Lung cancer
• chronic obstructive pulmonary disease (COPD; emphysema, chronic bronchitis, and bronchiectasis)
  
  • Emphysema almost always results from smoking; if the patient is very young or has no smoking history, you should consider alpha1-antitrypsin deficiency. Although the changes of emphysema are irreversible, the risk of death still decreases if the patient stops smoking.

Question 5

What about second-hand smoke?

Answer 5

Second-hand smoke is a proven risk factor for lung cancer and other lung disease; risk increases linearly with increasing exposure.

When parents smoke, their exposed children are at an increased risk for asthma and URIs, including otitis media.

Question 6

What other bad things does smoking do?

Answer 6

Smoking

• retards the healing of PUD
• increase risk of Buerger disease (thromboangiitis obliterans - vasculitis of small/medium sized arteries and veins, results in ischemic claudication of extremities and may subsequently lead to paresthesias/ulceration/gangrene)
• increases the risk of low birth weight, prematurity, spontaneous abortion, stillbirth, and infant mortality
• Cessation of smoking pre-op is the best way to decrease the risk of post-op pulmonary complications, especially if it is stopped at least 8 weeks before surgery.

Question 7

True or false: Women who smoke cannot take birth control pills.

Answer 7

True!!

if the woman is > 35 yo + smokes OR< 35 years + smokes > 15/day, the risk of thromboembolism is increased sharply if they take OCPs.

Postmenopausal women, however, can take estrogen therapy regardless of smoking status.

Question 8

So what is the bottom line for the boards?

Answer 8

Smoking is a very dangerous habit that should be avoided.