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ABFM HEALTH COUNSELING AND PREVENTIVE CARE EXAM QUESTIONS AND ANSWERS
ABFM HEALTH COUNSELING AND PREVENTIVE CARE EXAM QUESTIONS AND ANSWERS
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ABFM HEALTH COUNSELING AND PREVENTIVECARE EXAM QUESTIONS AND ANSWERS
You are counseling a 45-year-old male with elevated LDL-cholesterol. When
discussing dietary changes to promote healthy lipid levels, which one of the
following would be accurate advice?
He should minimize his consumption of nuts
The Dietary Approaches to Stop Hypertension (DASH) diet recommended for
reducing hypertension will help lower his LDL-cholesterol level
Saturated fats should comprise 15% or less of his caloric intake
He should aim for a fiber intake of 25 g daily
He should record what he has eaten in a food diary at the end of each day -
-B
In 2013, the American Heart Association (AHA) issued lifestyle management
guidelines designed to reduce cardiovascular risk. For adult patients with
elevated LDL-cholesterol levels the AHA advises following diet plans such as
the Dietary Approaches to Stop Hypertension (DASH) diet, the AHA diet, or
the USDA Food Pattern. The AHA specifically recommends reducing the
percentage of calories from saturated fat, aiming for a goal of 6%-7% of
calories from this source. The AHA also recommends a diet that emphasizes
the consumption of fruits, vegetables, and whole grains, and which includes
fish, poultry, low-fat dairy products, legumes, nontropical vegetable oils, and
nuts. Consumption of red meat, sweets, and sugar-sweetened beverages
should be discouraged.Although dietary fiber has been shown to have
several beneficial health effects, the average daily intake for most Americans
is 15 g daily, which is much lower than the recommended amount. The
recommended daily fiber intake for males age 14-50 is 38 g daily. For other
populations the recommended amount is lower, and varies according to age
and sex. Several randomized, controlled trials have shown a reduction of
LDL-cholesterol with higher fiber consumption. A food diary is an important
aspect of dietary behavior change but it is most accurate if entries are made
immediately after food is consumed.
-A 24-year-old female sees you for a preconception visit and removal of her
IUD. This will be her first pregnancy and she tells you that she has smoked
¼-½ pack of cigarettes a day for the past 5 years.Which one of the following
would be appropriate advice regarding the risks from smoking?
Smoking during pregnancy increases the risk of
attention-deficit/hyperactivity disorder
Smoking during pregnancy increases the risk of clubfoot
Smoking during pregnancy increases the risk of congenital atrial septal
defects
,Stopping smoking now will reduce the increased risk of orofacial defects in
her infant
Reducing smoking now will reduce the risk of preterm delivery - -D
There are many reproductive problems related to smoking, including
conception delay and both primary and secondary infertility; an increased
risk of ectopic pregnancy and spontaneous abortion; an increased risk of
abruption, preterm rupture of membranes, placenta previa, and premature
delivery; and increased perinatal morbidity and mortality, including stillbirth,
low birth weight, and SIDS-related deaths. The 2001 Surgeon General's
Report on women and smoking makes it clear that stopping smoking during
pregnancy reduces and sometimes eliminates many of these
consequences.Small for gestational age (SGA) infants are a dose-dependent
outcome of maternal smoking, with an odds ratio (OR) of 2.11 when women
smoke throughout pregnancy. Risks for prematurity (OR 1.15) and fetal
death (OR 1.15) are also increased. The risk of having an SGA infant is
avoided if smoking is reduced, but the risks for prematurity and increased
fetal death are not.In 2014 the U.S. Surgeon General issued a new report on
the health consequences of smoking that noted that the evidence was strong
enough to infer a causal link between maternal smoking and orofacial clefts.
This was still true when the Surgeon General issued a report on smoking
cessation in 2020. No link could be inferred, however, between smoking and
other congenital defects, including clubfoot, gastroschisis, and atrial septal
defects. There is no evidence that maternal smoking leads to increased rates
of childhood attention-deficit/hyperactivity disorder.
-A 55-year-old male expresses concern about his inability to maintain an
erection that allows for satisfactory sexual intercourse with his wife. He takes
over-the-counter diphenhydramine (Benadryl) at night for sleep and takes a
daily multivitamin. He says he drinks one 12-ounce beer 2-3 times per week.
A physical examination is normal, including his blood pressure.Which one of
the following would you tell him?
Most cases of erectile dysfunction (ED) have a psychogenic etiology
Diphenhydramine has little impact on his ED
Abstaining from alcohol use will improve his symptoms
Erectile dysfunction may be an early indication of vascular disease
About 5% of men his age experience ED - -D
Erectile dysfunction (ED) is common, affecting an estimated 30 million men
in the United States, and becomes more common with advancing age. The
Health Professionals Follow-up Study reported moderate to severe ED in 12%
of men younger than 59, 22% of men ages 60-69, and 30% of men older
than 69.It was previously thought that the majority of cases of ED were
caused by psychogenic factors such as family or occupational stress.
However, evidence suggests that approximately 80% of ED is due to organic
,disease, which can be divided into hormonal, vasculogenic, and neurogenic
causes. Vasculogenic etiologies are the most common, with arterial or
"inflow" disorders accounting for more problems than venous disorders. The
patient should be advised that their ED is a risk factor for underlying
cardiovascular disease and that further evaluation may be appropriate. It is
important to remember, however, that even though the primary etiology of
ED is most often organic, psychological factors frequently coexist and play a
role in the dysfunction.Many medications can cause or contribute to ED. It is
estimated that as many as 25% of ED cases are due to medication side
effects. This highlights the crucial role of the primary care physician in
reviewing medication lists and modifying treatment regimens as part of
addressing ED. Common offenders include antihistamines, antihypertensives
and diuretics such as hydrochlorothiazide and spironolactone, psychoactive
medications including SSRIs, and anti-epilepsy medications. It is not clear
whether low amounts of alcohol cause erectile dysfunction.
-A 42-year-old female sees you for a routine health maintenance visit. Her
neighbor was just diagnosed with ovarian cancer and has encouraged her to
have her CA-125 level checked. The patient asks about ovarian cancer risk
factors, prevention, and screening. Which one of the following would be
appropriate advice?
A past history of oral contraceptive use increases the risk for ovarian cancer
Hormone replacement therapy after menopause decreases the risk for
subsequent ovarian cancer
CA-125 has a false-positive rate of 98% when used to screen for ovarian
cancer
Bimanual examinations are recommended to screen for ovarian cancer
Transvaginal ultrasonography is recommended to screen for ovarian cancer -
-C
Ovarian cancer is the fifth leading cause of cancer death among women in
the United States. Risk factors associated with ovarian cancer include a
positive family history and having the BRCA1 or BRCA2 gene mutation. A first
or second degree relative with ovarian cancer increases the risk by about
threefold. The use of oral contraceptives during the reproductive years, and
pregnancy, especially after age 35, reduce the risk of ovarian cancer, but
postmenopausal estrogen use may increase the risk.The U.S. Preventive
Services Task Force does not currently recommend screening for ovarian
cancer, as it is likely to have a relatively low yield (D recommendation).
Almost all women with a positive screening test for CA-125 will not have
ovarian cancer. In women at average risk, the positive predictive value of an
abnormal CA-125 is approximately 2%, so 98% of women with positive test
results will not have ovarian cancer. There are no current recommendations
for ovarian cancer screening by either transvaginal ultrasonography or pelvic
examination.
, -A male who was born in 1970 comes to your office for a preoperative
examination for an orthopedic procedure on his knee. He is otherwise
healthy and does not take any medications, but he has not seen a physician
for 6 years. He used illicit drugs for a brief period at age 23 but has not done
so since that time and has had three sexual partners, all of them female. You
use this opportunity to counsel him on preventive health screenings,
including hepatitis C.Which one of the following is true regarding screening
for hepatitis C?
The high cost of treatment outweighs the potential benefit of screening
The CDC recommends testing for hepatitis C virus every 3-5 years in patients
who have a history of drug injection
The U.S. Preventive Services Task Force recommends routine screening for
hepatitis C only for those born between 1945 and 1965
This patient should be screened with hepatitis C RNA polymerase chain
reaction (PC - -E
In 2019 the U.S. Preventive Services Task Force (USPSTF) recommended
screening all patients 18-79 years of age at least once for hepatitis C with
the anti-HCV antibody test. Detection of hepatitis C virus (HCV) RNA by
polymerase chain reaction (PCR) testing provides evidence of active HCV
infection, confirms the diagnosis, and is used in monitoring the antiviral
response to therapy. Quantitative PCR is used to determine viral load. The
CDC previously recommended screening for people born between 1945 and
1965, but that has been expanded.HCV is the most common chronic
bloodborne pathogen in the United States and a leading cause of
complications from chronic liver disease. Before the COVID pandemic, HCV
infection was associated with more deaths than the top 60 other reportable
infectious diseases combined, including HIV. The most important risk factor
for HCV infection is past or current injection drug use. In the United States an
estimated 4.1 million people have past or current HCV infection, based on a
positive test for the anti-HCV antibody. Approximately 2.4 million persons
with a positive antibody test have a current infection based on results of
molecular assays for HCV RNA and would be potential candidates for
treatment. Treatment results in very high levels of virus remission.Cases of
acute HCV infection increased approximately 3.5-fold between 2010 and
2017. The increased incidence has mostly affected young white people who
inject drugs, especially those living in rural areas. There has also been an
increase in the number of women age 15-44 years with HCV infection. There
is no recommended testing frequency for high-risk individuals at this time.
-You see a 45-year-old male who has smoked cigarettes for 25 years. He is
very interested in quitting but has not been able to do so despite many
attempts. He is interested in using medications to help.Which one of the
following would likely be most effective?
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