1|Page
ABFM HEALTH COUNSELING AND
PREVENTIVE CARE QUESTIONS AND
ANSWERS LATEST 2025
A systematic review of 53 randomized trials, including 9140 patients, found that
oral naltrexone increased abstinence rates (number needed to treat [NNT]=20)
and decreased heavy drinking (NNT=12) (SOR A). There is some evidence that
disulfiram reduces drinking days (SOR B), but little evidence for promoting
abstinence. Adherence is a key predictor of the success of disulfiram. In addition,
supervised use of disulfiram seems to have better outcomes. A systematic review
generally showed that pharmacologic treatment was more efficacious than
placebo in terms of controlling drinking, achieving abstinence, and reducing
drinking days, alcohol consumption, and craving. Naltrexone would be indicated in
a patient with normal liver enzyme levels, increased cravings, and possible binge
drinking.Acamprosate is contraindicated in patients with stage 4 kidney disease
(glomerular filtration rate <30 mL/min/1.73 m2) and disulfiram is contraindicated
in patients with coronary artery disease. Disulfiram is also contraindicated in
patients with a history of psychosis, because it can increase dopamine levels and
induce psychotic episodes in these patients.Gabapentin may also be used to treat
alcohol withdrawal, and there is some evidence that it can reduce cravings.
Lorazepam would not be indicated for long-term therapy. Although there are
studies showing some benefit to using SSRIs in patients with concomitant
depression and alcohol use disorder, an SSRI would not be indicated in a patient
with a low Patient Health Questionnaire-9 (PHQ-9) score.
,2|Page
An 18-year-old male presents with a cough and shortness of breath. He started
smoking at age 15. He is currently trying to stop smoking by using electronic
cigarettes (vaping).You counsel him that
vaping increases success rates in smoking cessation for adolescents
gradually lowering the dose of nicotine in vaping products helps attenuate
withdrawal effects
vaping causes less second-hand nicotine exposure than regular cigarettes
lung injury can occur even with occasional vaping use -correct-answer-D
Current evidence does not suggest that the use of electronic cigarettes (e-
cigarettes, or vaping products) for tobacco cessation is effective in adolescents.
Studies in adults have shown mixed results. In a meta-analysis of 29 articles, e-
cigarettes led to modest cessation rates, with benefits including behavioral and
sensory gratification. In other studies participants continued to use e-cigarettes to
maintain their habit instead of quitting. A total of 22 toxic substances apart from
nicotine were reported in the liquid used in vaping cartridges and in their
emissions. Vitamin E acetate, an additive in some vaping products, especially
those containing tetrahydrocannabinol, has been strongly linked to the
development of e-cigarette or vaping product use-associated lung injury (EVALI),
which causes cough, dyspnea, and often gastrointestinal symptoms. EVALI may
cause severe alveolar damage, and individuals as young as 15 have died from it.
Patients who vape should be asked about all substances they add to vaping
products and be counseled to stop.The evidence is insufficient to support the
claim that vaping causes less second-hand exposure than regular cigarettes. One
study showed that passive exposure to e-cigarette aerosol increased serum levels
of cotinine similar to those associated with passive exposure to conventional
cigarette smoke. There is no evidence that gradually lowering the nicotine dose in
vaping products attenuates nicotine withdrawal.
,3|Page
A 32-year-old pregnant female at 32 weeks gestation presents to your office for
prenatal care. Which one of the following is true regarding Tdap vaccine for this
patient?
She should receive Tdap even if she received it 14 months ago during her most
recent pregnancy
She should receive Tdap even if she received it at 16 weeks gestation when she
sustained a laceration
She does not need Tdap if she has received it in the past 3 years
She does not need Tdap if she received Td vaccine in the past 12 months -correct-
answer-A
A Tdap booster is recommended during every pregnancy. It should be given at 27-
36 weeks gestation if at all possible. This allows transmission of pertussis
antibodies to the fetus before birth and will protect the infant for the first 2-3
months before primary immunizations take effect. If the mother received Tdap
early in the pregnancy an additional dose is not required. Td vaccine does not
provide protection against pertussis.
An 11-year-old female is brought to your office by her mother because of
recurring headaches and abdominal pain. A detailed workup for her symptoms is
negative thus far. She lives with her mother and her mother's boyfriend. When
you ask permission and question the child alone in the room she tells you that her
mother's boyfriend yells at her and her mother. The mother reports that she is
, 4|Page
always in the house when the boyfriend is there.Which one of the following is true
in this situation?
The information provided by the mother makes it very unlikely that sexual abuse
has occurred
The child's age makes it unlikely that sexual abuse has occurred
The child's genital area should be examined if this was not already done
You should question the boyfriend about possible abuse
You should schedule a follow-up visit and reevaluate the child in 3-4 months -
correct-answer-C
Child abuse is common in the United States and should be considered when there
is apparent neglect of a child, or indications of sexual, emotional, or physical
abuse (SOR C). Specifically, child sexual abuse is defined by the Child Abuse
Prevention and Treatment Act as "the employment, use, persuasion, inducement,
enticement, or coercion of any child to engage in, or assist any other person to
engage in, any sexually explicit conduct or simulation of such conduct for the
purpose of producing a visual depiction of such conduct; or the rape, molestation,
prostitution, or other form of sexual exploitation of children, or incest with
children."Most cases of child sexual abuse are not reported, and less than 10% of
child sexual abuse cases that are substantiated are associated with physical signs
of abuse on examination. This figure highlights the great importance of careful
history taking and a high index of suspicion if risk factors are present.Risk factors
for child sexual abuse include female sex, parental alcoholism or substance abuse,
intimate partner violence (domestic violence) in the home, and poor parental
attachment. Children who have experienced one type of abuse are at risk for
other types of abuse or neglect. Social isolation doubles the risk of abuse in girls.
Other factors that place a child at increased risk of abuse or neglect include a
history of prematurity, behavioral problems, medical fragility, and other special
ABFM HEALTH COUNSELING AND
PREVENTIVE CARE QUESTIONS AND
ANSWERS LATEST 2025
A systematic review of 53 randomized trials, including 9140 patients, found that
oral naltrexone increased abstinence rates (number needed to treat [NNT]=20)
and decreased heavy drinking (NNT=12) (SOR A). There is some evidence that
disulfiram reduces drinking days (SOR B), but little evidence for promoting
abstinence. Adherence is a key predictor of the success of disulfiram. In addition,
supervised use of disulfiram seems to have better outcomes. A systematic review
generally showed that pharmacologic treatment was more efficacious than
placebo in terms of controlling drinking, achieving abstinence, and reducing
drinking days, alcohol consumption, and craving. Naltrexone would be indicated in
a patient with normal liver enzyme levels, increased cravings, and possible binge
drinking.Acamprosate is contraindicated in patients with stage 4 kidney disease
(glomerular filtration rate <30 mL/min/1.73 m2) and disulfiram is contraindicated
in patients with coronary artery disease. Disulfiram is also contraindicated in
patients with a history of psychosis, because it can increase dopamine levels and
induce psychotic episodes in these patients.Gabapentin may also be used to treat
alcohol withdrawal, and there is some evidence that it can reduce cravings.
Lorazepam would not be indicated for long-term therapy. Although there are
studies showing some benefit to using SSRIs in patients with concomitant
depression and alcohol use disorder, an SSRI would not be indicated in a patient
with a low Patient Health Questionnaire-9 (PHQ-9) score.
,2|Page
An 18-year-old male presents with a cough and shortness of breath. He started
smoking at age 15. He is currently trying to stop smoking by using electronic
cigarettes (vaping).You counsel him that
vaping increases success rates in smoking cessation for adolescents
gradually lowering the dose of nicotine in vaping products helps attenuate
withdrawal effects
vaping causes less second-hand nicotine exposure than regular cigarettes
lung injury can occur even with occasional vaping use -correct-answer-D
Current evidence does not suggest that the use of electronic cigarettes (e-
cigarettes, or vaping products) for tobacco cessation is effective in adolescents.
Studies in adults have shown mixed results. In a meta-analysis of 29 articles, e-
cigarettes led to modest cessation rates, with benefits including behavioral and
sensory gratification. In other studies participants continued to use e-cigarettes to
maintain their habit instead of quitting. A total of 22 toxic substances apart from
nicotine were reported in the liquid used in vaping cartridges and in their
emissions. Vitamin E acetate, an additive in some vaping products, especially
those containing tetrahydrocannabinol, has been strongly linked to the
development of e-cigarette or vaping product use-associated lung injury (EVALI),
which causes cough, dyspnea, and often gastrointestinal symptoms. EVALI may
cause severe alveolar damage, and individuals as young as 15 have died from it.
Patients who vape should be asked about all substances they add to vaping
products and be counseled to stop.The evidence is insufficient to support the
claim that vaping causes less second-hand exposure than regular cigarettes. One
study showed that passive exposure to e-cigarette aerosol increased serum levels
of cotinine similar to those associated with passive exposure to conventional
cigarette smoke. There is no evidence that gradually lowering the nicotine dose in
vaping products attenuates nicotine withdrawal.
,3|Page
A 32-year-old pregnant female at 32 weeks gestation presents to your office for
prenatal care. Which one of the following is true regarding Tdap vaccine for this
patient?
She should receive Tdap even if she received it 14 months ago during her most
recent pregnancy
She should receive Tdap even if she received it at 16 weeks gestation when she
sustained a laceration
She does not need Tdap if she has received it in the past 3 years
She does not need Tdap if she received Td vaccine in the past 12 months -correct-
answer-A
A Tdap booster is recommended during every pregnancy. It should be given at 27-
36 weeks gestation if at all possible. This allows transmission of pertussis
antibodies to the fetus before birth and will protect the infant for the first 2-3
months before primary immunizations take effect. If the mother received Tdap
early in the pregnancy an additional dose is not required. Td vaccine does not
provide protection against pertussis.
An 11-year-old female is brought to your office by her mother because of
recurring headaches and abdominal pain. A detailed workup for her symptoms is
negative thus far. She lives with her mother and her mother's boyfriend. When
you ask permission and question the child alone in the room she tells you that her
mother's boyfriend yells at her and her mother. The mother reports that she is
, 4|Page
always in the house when the boyfriend is there.Which one of the following is true
in this situation?
The information provided by the mother makes it very unlikely that sexual abuse
has occurred
The child's age makes it unlikely that sexual abuse has occurred
The child's genital area should be examined if this was not already done
You should question the boyfriend about possible abuse
You should schedule a follow-up visit and reevaluate the child in 3-4 months -
correct-answer-C
Child abuse is common in the United States and should be considered when there
is apparent neglect of a child, or indications of sexual, emotional, or physical
abuse (SOR C). Specifically, child sexual abuse is defined by the Child Abuse
Prevention and Treatment Act as "the employment, use, persuasion, inducement,
enticement, or coercion of any child to engage in, or assist any other person to
engage in, any sexually explicit conduct or simulation of such conduct for the
purpose of producing a visual depiction of such conduct; or the rape, molestation,
prostitution, or other form of sexual exploitation of children, or incest with
children."Most cases of child sexual abuse are not reported, and less than 10% of
child sexual abuse cases that are substantiated are associated with physical signs
of abuse on examination. This figure highlights the great importance of careful
history taking and a high index of suspicion if risk factors are present.Risk factors
for child sexual abuse include female sex, parental alcoholism or substance abuse,
intimate partner violence (domestic violence) in the home, and poor parental
attachment. Children who have experienced one type of abuse are at risk for
other types of abuse or neglect. Social isolation doubles the risk of abuse in girls.
Other factors that place a child at increased risk of abuse or neglect include a
history of prematurity, behavioral problems, medical fragility, and other special
