••• Chapter 42^ Ethics, Psychosocial, and Psychiatric Pearls^423
❍ What health concerns have been found to be more prevalent in lesbians than in heterosexual females?
Depression and drug and alcohol abuse.
❍ True or False: It is not necessary to test lesbian females for STDs because these infections are only
transmitted between a man and a woman.
False. Lesbians should still be routinely tested for STDs because female-to-female transmission is possible for many
infections. Lesbians are particularly susceptible to bacterial vaginosis, candidiasis, herpes, and HPV.
❍ Should lesbians be tested for HIV?
Yes. Although there are no documented cases of HIV transmission between two lesbians, female-to-female
transmission is feasible and should still be tested.
❍ What are the potential dangers with the use of two-dimensional or three-dimensional ultrasonography for
nonmedical purposes, such as keepsake photographs or videos?
(1) Possibly adverse effects of ultrasonography cannot be totally ruled out, thus such imaging should be limited to
medical indications only.
(2) A false reassurance of fetal well-being may be implied by an aesthetically pleasing sonogram and can be
misinterpreted as a diagnostic test.
(3) Abnormalities, if detected, may create an undue sense of alarm if the personnel performing the scan are not
trained to discuss their implications.
(4) Abnormalities detected may be lost to follow-up when the scan is performed outside an integrated prenatal
care delivery system.
❍ What is the 5-A approach to smoking counseling for pregnant women?
(1) ASK about smoking status in multiple choice format:
(a) never smoked?
(b) smoked before pregnancy but not now?
(c) smoked after discovering pregnancy but not now?
(d) smokes now but less than before pregnancy?
(e) smokes now with the same number of cigarettes as before pregnancy?
(2) ADVISE about the benefits of quitting and the impact of smoking and quitting on the woman and her fetus.
(3) ASSESS the willingness to quit within 30 days.
(4) ASSIST by providing skills and methods, as well as support groups, for smoking cessation.
(5) ARRANGE for follow-up evaluation of smoking status and the impact of the proposed interventions.
❍ What is the prevalence of alcoholism in the United States?
10% to 15% lifetime prevalence.
❍ What laboratory changes are suggestive of alcoholism?
2:1 ratio of AST to ALT.
❍ What is the consequence if a glucose solution is administered to an alcoholic patient before thiamine has
been administered?
Wernicke encephalopathy.