ABFM HEALTH COUNSELING AND
PREVENTIVE CARE EXAM 2024/2025
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 - ANSWERSB
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 - ANSWERSD
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 - ANSWERSD
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 - ANSWERSC
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 - ANSWERSE
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?
Calling the QUIT LINE and using over-the-counter nicotine patches
Bupropion (Wellbutrin SR, Zyban)
PREVENTIVE CARE EXAM 2024/2025
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 - ANSWERSB
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 - ANSWERSD
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 - ANSWERSD
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 - ANSWERSC
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 - ANSWERSE
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?
Calling the QUIT LINE and using over-the-counter nicotine patches
Bupropion (Wellbutrin SR, Zyban)
