A50-year old male presents to the office for prostate cancer screening because he saw a TV show recommending that men get tested. He has no significant medical history, takes no medications, and has no genitourinary symptoms. There is no family history of prostate cancer. How would you advise him regarding prostate cancer screening?
A. All men over the age of 50 should have a PSA test every year.
B. As blood tests are very safe, there is no harm associated with PSA screening.
C. Only men with symptoms of prostate enlargement should have PSA screening.
D. A PSA level of less than 4.0 ng/mL rules out the diagnosis of prostate cancer.
E. Certain medications may alter PSA level.
Correct Answer: E Section: (none)
Explanation:
Screening for prostate cancer with the PSA test is a controversial area. Some advocate routine screening of most men over the age of 50 while others recommend selective screening or no routine screening at all. The USPSTF gives prostate cancer screening an "I" recommendation, stating that there is insufficient evidence to recommend for or against this intervention. Prostate cancer is the second most common cause of cancer death in men (behind lung cancer). PSA screening does not help to prevent prostate cancer but it does increase the likelihood of detection of prostate cancer. However, many prostate cancers are slow growing and many with prostate cancer die of other causes. PSA screening has not been shown to reduce all cause mortality. While the mortality from prostate cancer has been decreasing over the years, the reason for this is not yet clear. PSA screening may play a role in this but improvements in the treatment of prostate cancer may also be responsible. The PSA also has significant rates of false positive and false negative readings. Benign conditions such as prostatic hyperplasia or prostatitis can elevate PSA readings and prostate cancer can exist in men with normal PSA readings. Another factor that can interfere with PSA readings is the presence of medications. Finasteride and dutasteride, which are widely used in the treatment of benign prostatic hyperplasia, can lower PSA readings, even in the presence of prostate cancer. If PSA screening is chosen by the patient and his physician, selection of appropriate patients for screening is important. The presence of symptoms related to the prostate may influence one's decision to perform a PSA test. However, many prostate cancers are asymptomatic, so the absence of symptoms may not be a reason to withhold testing. Most authorities would not recommend the routine screening of men with significant comorbidities that would result in them having a life expectancy of fewer than 10 years. One of the reasons for the controversy surrounding PSA screening is the risk of harm of testing. Elevated PSA levels frequently result in further--sometimes invasive--testing and may result in the detection of cancers that may or may not have become clinically significant.
Question 132:
A50-year old male presents to the office for prostate cancer screening because he saw a TV show recommending that men get tested. He has no significant medical history, takes no medications, and has no genitourinary symptoms. There is no family history of prostate cancer. What can you tell him about prostate cancer and the PSA test?
A. PSA testing has been proven to reduce all-cause mortality in men over 50.
B. In spite of PSA testing, the diseasespecific mortality from prostate cancer has not changed in the past 30 years.
C. Prostate cancer is the only condition that causes an elevated PSA level.
D. PSA testing can prevent the development of prostate cancer.
E. PSA testing can increase the chances of detecting prostate cancer.
Correct Answer: E Section: (none)
Explanation:
Screening for prostate cancer with the PSA test is a controversial area. Some advocate routine screening of most men over the age of 50 while others recommend selective screening or no routine screening at all. The USPSTF gives prostate cancer screening an "I" recommendation, stating that there is insufficient evidence to recommend for or against this intervention. Prostate cancer is the second most common cause of cancer death in men (behind lung cancer). PSA screening does not help to prevent prostate cancer but it does increase the likelihood of detection of prostate cancer. However, many prostate cancers are slow growing and many with prostate cancer die of other causes. PSA screening has not been shown to reduce all cause mortality. While the mortality from prostate cancer has been decreasing over the years, the reason for this is not yet clear. PSA screening may play a role in this but improvements in the treatment of prostate cancer may also be responsible. The PSA also has significant rates of false positive and false negative readings. Benign conditions such as prostatic hyperplasia or prostatitis can elevate PSA readings and prostate cancer can exist in men with normal PSA readings. Another factor that can interfere with PSA readings is the presence of medications. Finasteride and dutasteride, which are widely used in the treatment of benign prostatic hyperplasia, can lower PSA readings, even in the presence of prostate cancer. If PSA screening is chosen by the patient and his physician, selection of appropriate patients for screening is important. The presence of symptoms related to the prostate may influence one's decision to perform a PSA test. However, many prostate cancers are asymptomatic, so the absence of symptoms may not be a reason to withhold testing. Most authorities would not recommend the routine screening of men with significant comorbidities that would result in them having a life expectancy of fewer than 10 years. One of the reasons for the controversy surrounding PSA screening is the risk of harm of testing. Elevated PSA levels frequently result in further--sometimes invasive--testing and may result in the detection of cancers that may or may not have become clinically significant.
Question 133:
A 26-year-old G2P1 female comes to your office for her initial obstetric visit. The first day of her last menstrual period was 6 weeks ago. Other than some mild morning sickness, she is feeling fine. Her first pregnancy was 40 weeks in gestation and uncomplicated. She has no significant medical history. The result of the test that you ordered in question 60 is positive. What would be appropriate management for the neonate to reduce the risk of perinatal transmission of the hepatitis B virus?
A. hepatitis B vaccine within 2 days of birth
B. hepatitis B immune globulin within 2 days of birth
C. hepatitis B immune globulin and hepatitisB vaccine within 12 hours of birth
D. deliver the baby by scheduled caesarian section
E. advise the mother not to breast feed
Correct Answer: C Section: (none)
Explanation:
At the initial prenatal visit, a complete history and physical examination is performed along with a panel of laboratory studies. Routinely, a complete blood count, blood type, and Rh group with antibody screen, rubella antibody, rapid plasma reagin (RPR), HIV, pap smear, cervical swab for gonorrhea and chlamydia, urinalysis, and urine culture are performed. Pregnancy is one of the few conditions in which treatment of asymptomatic bacteruria would be recommended. Neither a basic metabolic panel nor a TSH measurement would be indicated unless the patient had an underlying medical condition that warranted further evaluation. Screening for gestational diabetes with a glucose measurement after ingestion of 50 g of glucose is performed in many pregnancies, but not until 2428 weeks' gestation. Routine screening for vaginal or rectal colonization with group B Streptococcus is also performed, but not until 34 weeks of gestation or later. It is recommended that all pregnant women be screened for hepatitis B at their initial prenatal visit by obtaining a hepatitis B surface antigen. This helps to determine if the woman has hepatitis B that could put her baby at risk for the infection. Hepatitis B surface antibody may be a sign of previous infection or of previous vaccination with the hepatitis B vaccine. The presence of core antibody and e antibody may be signs of previous infection. Testing for the e antigen is not useful for initial screening purposes but may be warranted if the patient were found to have chronic hepatitis B infection. If the mother tests positive for hepatitis B surface antigen during her pregnancy then the neonate should receive both hepatitis B immune globulin and the initial dose of the hepatitis B vaccine series. This combination has been shown to reduce risk of perinatal transmission from approximately 10% if the woman is surface antigen positive to less than 3%. There are currently no data to show that delivering a baby by caesarian section will reduce the risk of perinatal transmission of the infection. Breastfeeding has not been shown to increase the rate of transmission of infection to a nursing infant.
Question 134:
A 26-year-old G2P1 female comes to your office for her initial obstetric visit. The first day of her last menstrual period was 6 weeks ago. Other than some mild morning sickness, she is feeling fine. Her first pregnancy was 40 weeks in gestation and uncomplicated. She has no significant medical history. Which of the following tests is recommended as screening for hepatitis B in pregnancy?
A. hepatitis B surface antibody
B. hepatitis B surface antigen
C. hepatitis B core antibody
D. hepatitis B e antigen
E. hepatitis B e antibody
Correct Answer: B Section: (none)
Explanation:
At the initial prenatal visit, a complete history and physical examination is performed along with a panel of laboratory studies. Routinely, a complete blood count, blood type, and Rh group with antibody screen, rubella antibody, rapid plasma reagin (RPR), HIV, pap smear, cervical swab for gonorrhea and chlamydia, urinalysis, and urine culture are performed. Pregnancy is one of the few conditions in which treatment of asymptomatic bacteruria would be recommended. Neither a basic metabolic panel nor a TSH measurement would be indicated unless the patient had an underlying medical condition that warranted further evaluation. Screening for gestational diabetes with a glucose measurement after ingestion of 50 g of glucose is performed in many pregnancies, but not until 2428 weeks' gestation. Routine screening for vaginal or rectal colonization with group B Streptococcus is also performed, but not until 34 weeks of gestation or later. It is recommended that all pregnant women be screened for hepatitis B at their initial prenatal visit by obtaining a hepatitis B surface antigen. This helps to determine if the woman has hepatitis B that could put her baby at risk for the infection. Hepatitis B surface antibody may be a sign of previous infection or of previous vaccination with the hepatitis B vaccine. The presence of core antibody and e antibody may be signs of previous infection. Testing for the e antigen is not useful for initial screening purposes but may be warranted if the patient were found to have chronic hepatitis B infection. If the mother tests positive for hepatitis B surface antigen during her pregnancy then the neonate should receive both hepatitis B immune globulin and the initial dose of the hepatitis B vaccine series. This combination has been shown to reduce risk of perinatal transmission from approximately 10% if the woman is surface antigen positive to less than 3%. There are currently no data to show that delivering a baby by caesarian section will reduce the risk of perinatal transmission of the infection. Breastfeeding has not been shown to increase the rate of transmission of infection to a nursing infant.
Question 135:
A 26-year-old G2P1 female comes to your office for her initial obstetric visit. The first day of her last menstrual period was 6 weeks ago. Other than some mild morning sickness, she is feeling fine. Her first pregnancy was 40 weeks in gestation and uncomplicated. She has no significant medical history. Which of the following tests is recommended for the initial obstetric visit?
A. TSH
B. blood glucose measurement 1 hour after a 50 g glucose load
C. urine culture
D. vaginal culture for group B Streptococcus
E. basic metabolic panel (Chem-7)
Correct Answer: C Section: (none)
Explanation: At the initial prenatal visit, a complete history and physical examination is performed along with a panel of laboratory studies. Routinely, a complete blood count, blood type, and Rh group with antibody screen, rubella antibody, rapid plasma reagin (RPR), HIV, pap smear, cervical swab for gonorrhea and chlamydia, urinalysis, and urine culture are performed. Pregnancy is one of the few conditions in which treatment of asymptomatic bacteruria would be recommended. Neither a basic metabolic panel nor a TSH measurement would be indicated unless the patient had an underlying medical condition that warranted further evaluation. Screening for gestational diabetes with a glucose measurement after ingestion of 50 g of glucose is performed in many pregnancies, but not until 2428 weeks' gestation. Routine screening for vaginal or rectal colonization with group B Streptococcus is also performed, but not until 34 weeks of gestation or later. It is recommended that all pregnant women be screened for hepatitis B at their initial prenatal visit by obtaining a hepatitis B surface antigen. This helps to determine if the woman has hepatitis B that could put her baby at risk for the infection. Hepatitis B surface antibody may be a sign of previous infection or of previous vaccination with the hepatitis B vaccine. The presence of core antibody and e antibody may be signs of previous infection. Testing for the e antigen is not useful for initial screening purposes but may be warranted if the patient were found to have chronic hepatitis B infection. If the mother tests positive for hepatitis B surface antigen during her pregnancy then the neonate should receive both hepatitis B immune globulin and the initial dose of the hepatitis B vaccine series. This combination has been shown to reduce risk of perinatal transmission from approximately 10% if the woman is surface antigen positive to less than 3%. There are currently no data to show that delivering a baby by caesarian section will reduce the risk of perinatal transmission of the infection. Breastfeeding has not been shown to increase the rate of transmission of infection to a nursing infant.
Question 136:
A 39-year-old woman presents to the office for the evaluation of a mole on her left arm. It has been present and enlarging over the past 6 months. It itches and occasionally bleeds. How would you advise this patient regarding sun exposure?
A. A cotton T-shirt worn while swimming provides adequate protection from the sun for the chest and back.
B. Melanomas are more highly associated with intermittent sunburns than cumulative sun exposure.
C. Tanning booths are recommended for persons desiring a suntan, as they are not associated with an increased risk of skin cancer.
D. To protect against skin cancer, a sunscreen needs to inhibit only UV-B rays.
E. Waterproof sunscreen does not need to be reapplied after swimming.
Correct Answer: B Section: (none)
Explanation:
The mnemonic "ABCDE" is often used to remember some of the attributes of skin lesions that would make them more suspicious for being malignancies. "A" is for asymmetry; "B" for border that is irregular or indistinct from the surrounding skin; "C" for color such as dark black or variations in colors within the same lesion; "D" for diameter greater than 6 mm, or larger than the size of a pencil eraser; "E" for elevation of lesion with surface irregularity. Of the choices in question 56, the presence of a diameter of greater than 6 mm would be considered a higher-risk attribute. Primary skin malignancies are divided into three major categories--basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinomas may grow large and be locally destructive, but they have the lowest metastatic potential of the three types of skin cancer. Basal cell carcinomas are more common in persons with fair complexions but they occur in all skin types and colors. Squamous carcinomas of the skin have a metastatic potential greater than basal cell carcinomas and less than malignant melanomas. Squamous carcinomas most commonly occur in sun-exposed areas but are also associated with other etiologies, such as human papilloma virus (HPV), and can occur anywhere on the body. Malignant melanoma has the highest metastatic potential of the primary skin malignancies. Melanoma can occur in any skin type, but is more common in skin types I and II (fair skin). Obtaining a tissue sample for pathologic studies of suspicious skin lesions is critical for diagnosis and planning of appropriate treatment of melanoma. The thickness of the lesion is an important factor in these decisions. Therefore, shave biopsy would be inappropriate for the evaluation of a pigmented lesion. Complete excisional biopsy would be preferable, or, when that is not possible, full-thickness punch biopsy is an acceptable alternative. While sun exposure is an important risk factor for all types of skin cancers, for melanomas there is some evidence that intermittent, intense sun exposure and sunburning is more of a risk than cumulative sun exposure. Actinic keratoses are sun-induced skin lesions that are considered risks for the development of squamous carcinomas. They can be treated with local destructive methods, such as cryosurgery or the topical chemotherapeutic agent 5-fluorouracil. Protection of susceptible skin from excessive sun exposure from childhood is important in reducing the risk of developing skin cancer. Precautions such as wearing broad-brimmed hats, long sleeved clothing, and avoidance of intense midday sunlight are helpful. Using chemical sunscreens with SPF of greater than 15 with frequent reapplication is also beneficial. Even "waterproof" sunscreens need to be reapplied after bathing or swimming. Awet cotton T-shirt provides very little, if any, protection from ultraviolet light exposure. Both the UV-A and UV-B rays play roles in skin damage from the sun and it is important to use sun protection products, which block both types of rays. Sun tanning booths are also considered risks for the induction of skin damage and skin cancer as they expose skin to potentially damaging ultraviolet rays.
Question 137:
A 39-year-old woman presents to the office for the evaluation of a mole on her left arm. It has been present and enlarging over the past 6 months. It itches and occasionally bleeds. Which of the following statements regarding skin cancer is true?
A. Skin types III and IV are more prone to developing melanoma.
B. Squamous cell carcinoma only occurs in sun-exposed areas.
C. Basal cell carcinomas do not occur in persons of African descent.
D. Squamous cell carcinomas of the skin have a higher metastatic potential than basal cell carcinomas.
E. A shave biopsy is recommended for the evaluation of suspicious pigmented lesions.
Correct Answer: D Section: (none)
Explanation:
The mnemonic "ABCDE" is often used to remember some of the attributes of skin lesions that would make them more suspicious for being malignancies. "A" is for asymmetry; "B" for border that is irregular or indistinct from the surrounding skin; "C" for color such as dark black or variations in colors within the same lesion; "D" for diameter greater than 6 mm, or larger than the size of a pencil eraser; "E" for elevation of lesion with surface irregularity. Of the choices in question 56, the presence of a diameter of greater than 6 mm would be considered a higher-risk attribute. Primary skin malignancies are divided into three major categories--basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinomas may grow large and be locally destructive, but they have the lowest metastatic potential of the three types of skin cancer. Basal cell carcinomas are more common in persons with fair complexions but they occur in all skin types and colors. Squamous carcinomas of the skin have a metastatic potential greater than basal cell carcinomas and less than malignant melanomas. Squamous carcinomas most commonly occur in sun-exposed areas but are also associated with other etiologies, such as human papilloma virus (HPV), and can occur anywhere on the body. Malignant melanoma has the highest metastatic potential of the primary skin malignancies. Melanoma can occur in any skin type, but is more common in skin types I and II (fair skin). Obtaining a tissue sample for pathologic studies of suspicious skin lesions is critical for diagnosis and planning of appropriate treatment of melanoma. The thickness of the lesion is an important factor in these decisions. Therefore, shave biopsy would be inappropriate for the evaluation of a pigmented lesion. Complete excisional biopsy would be preferable, or, when that is not possible, full-thickness punch biopsy is an acceptable alternative. While sun exposure is an important risk factor for all types of skin cancers, for melanomas there is some evidence that intermittent, intense sun exposure and sunburning is more of a risk than cumulative sun exposure. Actinic keratoses are sun-induced skin lesions that are considered risks for the development of squamous carcinomas. They can be treated with local destructive methods, such as cryosurgery or the topical chemotherapeutic agent 5-fluorouracil. Protection of susceptible skin from excessive sun exposure from childhood is important in reducing the risk of developing skin cancer. Precautions such as wearing broad-brimmed hats, long sleeved clothing, and avoidance of intense midday sunlight are helpful. Using chemical sunscreens with SPF of greater than 15 with frequent reapplication is also beneficial. Even "waterproof" sunscreens need to be reapplied after bathing or swimming. Awet cotton T-shirt provides very little, if any, protection from ultraviolet light exposure. Both the UV-A and UV-B rays play roles in skin damage from the sun and it is important to use sun protection products, which block both types of rays. Sun tanning booths are also considered risks for the induction of skin damage and skin cancer as they expose skin to potentially damaging ultraviolet rays.
Question 138:
A 39-year-old woman presents to the office for the evaluation of a mole on her left arm. It has been present and enlarging over the past 6 months. It itches and occasionally bleeds. Which of the following attributes would be considered high risk for skin cancer?
A. diameter of greater than 6 mm
B. a sharply demarcated, regular border
C. a uniform coloration
D. a symmetric, circular shape
E. a flat lesion
Correct Answer: A Section: (none)
Explanation:
The mnemonic "ABCDE" is often used to remember some of the attributes of skin lesions that would make them more suspicious for being malignancies. "A" is for asymmetry; "B" for border that is irregular or indistinct from the surrounding skin; "C" for color such as dark black or variations in colors within the same lesion; "D" for diameter greater than 6 mm, or larger than the size of a pencil eraser; "E" for elevation of lesion with surface irregularity. Of the choices in question 56, the presence of a diameter of greater than 6 mm would be considered a higher-risk attribute. Primary skin malignancies are divided into three major categories--basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinomas may grow large and be locally destructive, but they have the lowest metastatic potential of the three types of skin cancer. Basal cell carcinomas are more common in persons with fair complexions but they occur in all skin types and colors. Squamous carcinomas of the skin have a metastatic potential greater than basal cell carcinomas and less than malignant melanomas. Squamous carcinomas most commonly occur in sun-exposed areas but are also associated with other etiologies, such as human papilloma virus (HPV), and can occur anywhere on the body. Malignant melanoma has the highest metastatic potential of the primary skin malignancies. Melanoma can occur in any skin type, but is more common in skin types I and II (fair skin). Obtaining a tissue sample for pathologic studies of suspicious skin lesions is critical for diagnosis and planning of appropriate treatment of melanoma. The thickness of the lesion is an important factor in these decisions. Therefore, shave biopsy would be inappropriate for the evaluation of a pigmented lesion. Complete excisional biopsy would be preferable, or, when that is not possible, full-thickness punch biopsy is an acceptable alternative. While sun exposure is an important risk factor for all types of skin cancers, for melanomas there is some evidence that intermittent, intense sun exposure and sunburning is more of a risk than cumulative sun exposure. Actinic keratoses are sun-induced skin lesions that are considered risks for the development of squamous carcinomas. They can be treated with local destructive methods, such as cryosurgery or the topical chemotherapeutic agent 5-fluorouracil. Protection of susceptible skin from excessive sun exposure from childhood is important in reducing the risk of developing skin cancer. Precautions such as wearing broad-brimmed hats, long sleeved clothing, and avoidance of intense midday sunlight are helpful. Using chemical sunscreens with SPF of greater than 15 with frequent reapplication is also beneficial. Even "waterproof" sunscreens need to be reapplied after bathing or swimming. Awet cotton T-shirt provides very little, if any, protection from ultraviolet light exposure. Both the UV-A and UV-B rays play roles in skin damage from the sun and it is important to use sun protection products, which block both types of rays. Sun tanning booths are also considered risks for the induction of skin damage and skin cancer as they expose skin to potentially damaging ultraviolet rays.
Question 139:
A6-month-old boy is brought to the office for a routine check-up by his mother. They have recently moved to the area and are new to your practice. He is the product of an uncomplicated term pregnancy, has grown and developed appropriately for his age, and is up-to-date on his immunizations. He has had two cases of otitis media in his life. Neither of his parents has been diagnosed with any chronic medical conditions. Both of his parents smoke cigarettes, but "not in the same room" as the child. Which of the following statements is true?
A. Children of parents who smoke become smokers less often than children of nonsmokers.
B. Chemicals from cigarette smoke do not get into breast milk.
C. More than 95% of the smoke from a cigarette is out of a room within 30 minutes of smoking cessation.
D. The United States Environmental Protection Agency (EPA) does not consider secondhand smoke to be a carcinogen.
E. Parental smoking may be considered as a factor in assessing the "best interest" of a child in child custody hearings.
Correct Answer: E Section: (none)
Explanation:
Environmental tobacco smoke, or "secondhand smoke," consists of both "mainstream smoke" which is exhaled by the smoker and "sidestream smoke" which comes from the burning cigarette between puffs. About half of the smoke from a cigarette is sidestream smoke, which consists of the same chemicals as the mainstream smoke that is inhaled by the user. Nonsmokers exposed to secondhand smoke absorb nicotine, carcinogens, and other chemicals from the smoke just as the smoker does. While the concentration of the chemicals absorbed is less than in a smoker, the levels absorbed increase as exposure increases and there are significant health risks involved. The EPAconsiders secondhand smoke to be a class A carcinogen a substance that causes cancer in humans. Among the health risks are increased incidences of asthma, respiratory infections, otitis media, and SIDS in children exposed to secondhand smoke. Nursing mothers can pass harmful chemicals from cigarette smoke in breast milk. While separating smokers and nonsmokers in the same airspace may reduce the exposure to secondhand smoke, the exposure is not eliminated. It is estimated to take 3 hours to remove 95% of the cigarette smoke from a room once smoking is completed, so there is still significant risk for exposure even though the nonsmoker is not in the same room. Courts in the United States and Canada have considered the smoking behaviors of parents as factors in determining the "best interests" of a child during custody hearings. Finally, parental smoking is an important predictor of the smoking behaviors of their children as they become adolescents.
Question 140:
A6-month-old boy is brought to the office for a routine check-up by his mother. They have recently moved to the area and are new to your practice. He is the product of an uncomplicated term pregnancy, has grown and developed appropriately for his age, and is up-to-date on his immunizations. He has had two cases of otitis media in his life. Neither of his parents has been diagnosed with any chronic medical conditions. Both of his parents smoke cigarettes, but "not in the same room" as the child. What information about secondhand smoke could you provide to the parents?
A. The health risks of secondhand smoke are lower because it has a significantly different chemical composition than directly inhaled tobacco smoke.
B. Secondhand smoke exposure has been associated with the sudden infant death syndrome (SIDS).
C. Smoking in another room of the home eliminates the exposure to secondhand smoke.
D. The amount of carcinogens absorbed by household contacts of smokers is clinically insignificant.
E. When a cigarette is smoked, most of the smoke is inhaled and very little is released into the environment.
Correct Answer: B Section: (none)
Explanation:
Environmental tobacco smoke, or "secondhand smoke," consists of both "mainstream smoke" which is exhaled by the smoker and "sidestream smoke" which comes from the burning cigarette between puffs. About half of the smoke from a cigarette is sidestream smoke, which consists of the same chemicals as the mainstream smoke that is inhaled by the user. Nonsmokers exposed to secondhand smoke absorb nicotine, carcinogens, and other chemicals from the smoke just as the smoker does. While the concentration of the chemicals absorbed is less than in a smoker, the levels absorbed increase as exposure increases and there are significant health risks involved. The EPAconsiders secondhand smoke to be a class A carcinogen a substance that causes cancer in humans. Among the health risks are increased incidences of asthma, respiratory infections, otitis media, and SIDS in children exposed to secondhand smoke. Nursing mothers can pass harmful chemicals from cigarette smoke in breast milk. While separating smokers and nonsmokers in the same airspace may reduce the exposure to secondhand smoke, the exposure is not eliminated. It is estimated to take 3 hours to remove 95% of the cigarette smoke from a room once smoking is completed, so there is still significant risk for exposure even though the nonsmoker is not in the same room. Courts in the United States and Canada have considered the smoking behaviors of parents as factors in determining the "best interests" of a child during custody hearings. Finally, parental smoking is an important predictor of the smoking behaviors of their children as they become adolescents.
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