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ABFM HEALTH COUNSELING AND PREVENTIVE CARE /60 Questions And Answers Latest
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ABFM HEALTH COUNSELING AND PREVENTIVECARE /60 Questions And Answers Latest 2023-2024
Quiz :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 -
Answer :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.
Quiz :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 - Answer :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.
Quiz :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 - Answer :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.
Quiz :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 -
Answer :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.
Quiz :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 - Answer :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.
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