ABFM HEALTH COUNSELING AND PREVENTIVE CARE
QUESTIONS AND ACCURATE SOLUTIONS
You are counseling a 45-year-old male with elevated LDL-cholesterolrh 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 riskrh 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 Patternrh The AHA specifically
recommends reducing the percentage of calories from saturated fat, aiming for a goal of 6%-
7% of calories from this sourcerh 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 nutsrh Consumption of red meat,
sweets, and sugar-sweetened beverages should be discouragedrhAlthough 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 amountrh The
recommended daily fiber intake for males age 14-50 is 38 g dailyrh For other populations the
recommended amount is lower, and varies according to age and sexrh Several randomized,
controlled trials have shown a reduction of LDL-cholesterol with higher fiber consumptionrh
A food diary is an important aspect of dietary behavior change but it is most accurate if
entries are made immediately after food is consumedrh
,A 24-year-old female sees you for a preconception visit and removal of her IUDrh 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 yearsrhWhich 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 deathsrh 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 consequencesrhSmall for gestational age
(SGA) infants are a dose-dependent outcome of maternal smoking, with an odds ratio (OR)
of 2rh11 when women smoke throughout pregnancyrh Risks for prematurity (OR 1rh15) and
fetal death (OR 1rh15) are also increasedrh The risk of having an SGA infant is avoided if
smoking is reduced, but the risks for prematurity and increased fetal death are notrhIn 2014
the UrhSrh 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 cleftsrh This was still true when the Surgeon General issued a report
on smoking cessation in 2020rh No link could be inferred, however, between smoking and
other congenital defects, including clubfoot, gastroschisis, and atrial septal defectsrh There is
no evidence that maternal smoking leads to increased rates of childhood attention-
deficit/hyperactivity disorderrh
A 55-year-old male expresses concern about his inability to maintain an erection that allows
for satisfactory sexual intercourse with his wiferh He takes over-the-counter
diphenhydramine (Benadryl) at night for sleep and takes a daily multivitaminrh He says he
drinks one 12-ounce beer 2-3 times per weekrh A physical examination is normal, including
his blood pressurerhWhich 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 agerh 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 69rhIt was previously thought that the majority of cases
of ED were caused by psychogenic factors such as family or occupational stressrh However,
evidence suggests that approximately 80% of ED is due to organic disease, which can be
divided into hormonal, vasculogenic, and neurogenic causesrh Vasculogenic etiologies are
the most common, with arterial or "inflow" disorders accounting for more problems than
venous disordersrh The patient should be advised that their ED is a risk factor for underlying
cardiovascular disease and that further evaluation may be appropriaterh 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 dysfunctionrhMany
medications can cause or contribute to EDrh It is estimated that as many as 25% of ED cases
are due to medication side effectsrh This highlights the crucial role of the primary care
physician in reviewing medication lists and modifying treatment regimens as part of
addressing EDrh Common offenders include antihistamines, antihypertensives and diuretics
such as hydrochlorothiazide and spironolactone, psychoactive medications including SSRIs,
and anti-epilepsy medicationsrh It is not clear whether low amounts of alcohol cause
erectile dysfunctionrh
A 42-year-old female sees you for a routine health maintenance visitrh Her neighbor was just
diagnosed with ovarian cancer and has encouraged her to have her CA-125 level checkedrh
The patient asks about ovarian cancer risk factors, prevention, and screeningrh 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
Statesrh Risk factors associated with ovarian cancer include a positive family history and
having the BRCA1 or BRCA2 gene mutationrh A first or second degree relative with ovarian
cancer increases the risk by about threefoldrh 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 riskrhThe UrhSrh Preventive Services
Task Force does not currently recommend screening for ovarian cancer, as it is likely to have
a relatively low yield (D recommendation)rh Almost all women with a positive screening test
for CA-125 will not have ovarian cancerrh 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 cancerrh There are no current recommendations for ovarian
cancer screening by either transvaginal ultrasonography or pelvic examinationrh
A male who was born in 1970 comes to your office for a preoperative examination for an
orthopedic procedure on his kneerh He is otherwise healthy and does not take any
medications, but he has not seen a physician for 6 yearsrh 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 femalerh You use this opportunity to counsel him on preventive health screenings,
including hepatitis CrhWhich 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 UrhSrh 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 UrhSrh 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 testrh
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
QUESTIONS AND ACCURATE SOLUTIONS
You are counseling a 45-year-old male with elevated LDL-cholesterolrh 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 riskrh 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 Patternrh The AHA specifically
recommends reducing the percentage of calories from saturated fat, aiming for a goal of 6%-
7% of calories from this sourcerh 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 nutsrh Consumption of red meat,
sweets, and sugar-sweetened beverages should be discouragedrhAlthough 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 amountrh The
recommended daily fiber intake for males age 14-50 is 38 g dailyrh For other populations the
recommended amount is lower, and varies according to age and sexrh Several randomized,
controlled trials have shown a reduction of LDL-cholesterol with higher fiber consumptionrh
A food diary is an important aspect of dietary behavior change but it is most accurate if
entries are made immediately after food is consumedrh
,A 24-year-old female sees you for a preconception visit and removal of her IUDrh 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 yearsrhWhich 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 deathsrh 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 consequencesrhSmall for gestational age
(SGA) infants are a dose-dependent outcome of maternal smoking, with an odds ratio (OR)
of 2rh11 when women smoke throughout pregnancyrh Risks for prematurity (OR 1rh15) and
fetal death (OR 1rh15) are also increasedrh The risk of having an SGA infant is avoided if
smoking is reduced, but the risks for prematurity and increased fetal death are notrhIn 2014
the UrhSrh 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 cleftsrh This was still true when the Surgeon General issued a report
on smoking cessation in 2020rh No link could be inferred, however, between smoking and
other congenital defects, including clubfoot, gastroschisis, and atrial septal defectsrh There is
no evidence that maternal smoking leads to increased rates of childhood attention-
deficit/hyperactivity disorderrh
A 55-year-old male expresses concern about his inability to maintain an erection that allows
for satisfactory sexual intercourse with his wiferh He takes over-the-counter
diphenhydramine (Benadryl) at night for sleep and takes a daily multivitaminrh He says he
drinks one 12-ounce beer 2-3 times per weekrh A physical examination is normal, including
his blood pressurerhWhich 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 agerh 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 69rhIt was previously thought that the majority of cases
of ED were caused by psychogenic factors such as family or occupational stressrh However,
evidence suggests that approximately 80% of ED is due to organic disease, which can be
divided into hormonal, vasculogenic, and neurogenic causesrh Vasculogenic etiologies are
the most common, with arterial or "inflow" disorders accounting for more problems than
venous disordersrh The patient should be advised that their ED is a risk factor for underlying
cardiovascular disease and that further evaluation may be appropriaterh 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 dysfunctionrhMany
medications can cause or contribute to EDrh It is estimated that as many as 25% of ED cases
are due to medication side effectsrh This highlights the crucial role of the primary care
physician in reviewing medication lists and modifying treatment regimens as part of
addressing EDrh Common offenders include antihistamines, antihypertensives and diuretics
such as hydrochlorothiazide and spironolactone, psychoactive medications including SSRIs,
and anti-epilepsy medicationsrh It is not clear whether low amounts of alcohol cause
erectile dysfunctionrh
A 42-year-old female sees you for a routine health maintenance visitrh Her neighbor was just
diagnosed with ovarian cancer and has encouraged her to have her CA-125 level checkedrh
The patient asks about ovarian cancer risk factors, prevention, and screeningrh 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
Statesrh Risk factors associated with ovarian cancer include a positive family history and
having the BRCA1 or BRCA2 gene mutationrh A first or second degree relative with ovarian
cancer increases the risk by about threefoldrh 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 riskrhThe UrhSrh Preventive Services
Task Force does not currently recommend screening for ovarian cancer, as it is likely to have
a relatively low yield (D recommendation)rh Almost all women with a positive screening test
for CA-125 will not have ovarian cancerrh 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 cancerrh There are no current recommendations for ovarian
cancer screening by either transvaginal ultrasonography or pelvic examinationrh
A male who was born in 1970 comes to your office for a preoperative examination for an
orthopedic procedure on his kneerh He is otherwise healthy and does not take any
medications, but he has not seen a physician for 6 yearsrh 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 femalerh You use this opportunity to counsel him on preventive health screenings,
including hepatitis CrhWhich 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 UrhSrh 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 UrhSrh 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 testrh
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
