1|Page
ABFM HEALTH COUNSELING AND
PREVENTIVE CARE QUESTIONS & SOLUTIONS
A 54-year-old male tells you that he has started an exercise program. His routine
consists of chest presses, biceps curls, shoulder presses, abdominal crunches, and
quadriceps extensions. He says he works out 3 days a week, completing two sets
of 10 repetitions for each exercise.Which one of the following adjustments to his
routine would you recommend?
The frequency of training should be increased to at least five times per week
He should strive for a target heart rate of 50%-60% of his maximum rate in the
middle of his routine
He should train the front and back of major muscle groups
He should increase the number of repetitions to 20-30 in each set
He should do fewer repetitions with heavier weights to maximum effort-correct-
answer-C
Although aerobic exercise has traditionally been emphasized for its health
benefits, research increasingly suggests that complementary resistance training
also has favorable effects on cardiovascular function, coronary risk factors, and
physical and psychosocial well-being. The American Heart Association
recommends the inclusion of resistance training for healthy persons of all ages,
and for many patients with chronic diseases, including cardiovascular disease (SOR
C). Programs that include a single set of 8-10 different exercises performed 2-3
days a week have been shown to be beneficial. Although a greater frequency of
training is an option, the additional gain is usually small.While the number of
,2|Page
exercises can be reduced, training the front and back of major muscle groups (e.g.,
chest/back, biceps/triceps) is recommended. A repetition range of 8-12 is
recommended for healthy participants younger than 50-60 years of age. To reduce
the risk for injury, 10-15 repetitions at a lower relative resistance is generally
recommended for cardiac patients and healthy participants over 50-60 years of
age. Higher-intensity efforts (fewer repetitions with heavier weights) increase the
risk of musculoskeletal injury.The American College of Sports Medicine
recommends that older adults perform the following each week: a minimum of
150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-
intensity aerobic activity, and two or more nonconsecutive days of moderate-
intensity strengthening activities, with 8-10 exercises involving the major muscle
groups and 8-12 repetitions of each exercise.
Which one of the following is an indication to offer abdominal ultrasonography to
screen for an abdominal aortic aneurysm (AAA)?
Hypertension and type 1 diabetes in a 60-year-old male
Hypertension and a 20-pack-year smoking history in a 65-year-old female who
quit smoking 4 years ago
A 5-pack-year smoking history in a 68-year-old male who quit smoking 40 years
ago
No recent AAA screening in a 74-year-old male whose last screening
ultrasonography 8 years ago was negative
A recent history of hemorrhagic stroke in a 75-year-old female-correct-answer-C
Smoking history (at least 100 cigarettes in a lifetime) and male sex are the major
risk factors for abdominal aortic aneurysm (AAA). The U.S. Preventive Services
,3|Page
Task Force (USPSTF) recommends one-time screening for AAA by ultrasonography
between the ages of 65 and 75 in men who have ever smoked (B
recommendation). The USPSTF also recommends that clinicians selectively offer
screening for AAA in men in this age group who have never smoked if indicated by
the patient's medical history, family history, other risk factors, or personal values
(C recommendation). An important risk factor in addition to age is a first degree
relative with AAA. Other risk factors include a history of other vascular aneurysms,
coronary artery disease, cerebrovascular disease, atherosclerosis,
hypercholesterolemia, obesity, or hypertension.The likelihood of finding an AAA
large enough to benefit from surgery is greatest between the ages of 65 and 75. In
patients older than 75 the likelihood of surviving surgery to repair an AAA is low
enough to preclude screening. The benefit of screening for women in this age
group is low due to the low number of AAA-related deaths in this population (SOR
B). The USPSTF recommends against routine screening for AAA in women (D
recommendation). The USPSTF does not make any recommendation regarding
testing those less than 65 years old.
A 24-year-old female in the second trimester of her first pregnancy is concerned
that she may contract influenza and endanger her baby's health. Her due date is in
December and she plans to breastfeed. She has not received influenza vaccine in
the past because she develops hives if she eats eggs.Which one of the following
would be an appropriate recommendation?
She can safely receive trivalent inactivated influenza (TIV) vaccine prior to the
upcoming influenza season
She can safely receive live attenuated influenza vaccine (LAIV) prior to the
upcoming influenza season
She should not receive the vaccine this year due to her history of an allergic
reaction to eggs
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She should not take oseltamivir (Tamiflu) for prophylaxis if she is exposed to
influenza prior to delivery-correct-answer-A
The American College of Obstetricians and Gynecologists, the American Academy
of Family Physicians, and the CDC recommend influenza vaccine for all women
who will be pregnant during influenza season. It has been shown to reduce the
risk of influenza-associated acute respiratory infection in pregnant women by
about one-half and reduces a pregnant woman's risk of being hospitalized with
influenza by an average of 40%. The CDC recommends use of injectable influenza
vaccines, including inactivated influenza vaccines and recombinant influenza
vaccines. The nasal spray vaccine, which is a live attenuated influenza vaccine, is
not recommended during pregnancy. Influenza vaccine is also recommended for
women who are breastfeeding (SOR A). Current CDC guidelines recommend
oseltamivir as the preferred treatment for pregnant women with suspected
influenza.People with egg allergies such as hives, but no previous reaction to
influenza vaccine in the past, no longer need to be observed for an allergic
reaction for 30 minutes after receiving influenza vaccine. Monitoring for 30
minutes may be done if this is the first time the patient has received influenza
vaccine but is not mandatory according to the CDC. Any licensed and
recommended influenza vaccine that is otherwise appropriate for the recipient's
age and health status may be used.Patients who report reactions to egg involving
symptoms other than hives, such as angioedema, respiratory distress,
lightheadedness, or recurrent emesis, or who required epinephrine or another
emergency medical intervention, may also receive any licensed and recommended
influenza vaccine that is otherwise appropriate for the recipient's age and health
status. If an egg-based vaccine is used, it should be administered in an inpatient or
outpatient medical setting, including, but not necessarily limit
ABFM HEALTH COUNSELING AND
PREVENTIVE CARE QUESTIONS & SOLUTIONS
A 54-year-old male tells you that he has started an exercise program. His routine
consists of chest presses, biceps curls, shoulder presses, abdominal crunches, and
quadriceps extensions. He says he works out 3 days a week, completing two sets
of 10 repetitions for each exercise.Which one of the following adjustments to his
routine would you recommend?
The frequency of training should be increased to at least five times per week
He should strive for a target heart rate of 50%-60% of his maximum rate in the
middle of his routine
He should train the front and back of major muscle groups
He should increase the number of repetitions to 20-30 in each set
He should do fewer repetitions with heavier weights to maximum effort-correct-
answer-C
Although aerobic exercise has traditionally been emphasized for its health
benefits, research increasingly suggests that complementary resistance training
also has favorable effects on cardiovascular function, coronary risk factors, and
physical and psychosocial well-being. The American Heart Association
recommends the inclusion of resistance training for healthy persons of all ages,
and for many patients with chronic diseases, including cardiovascular disease (SOR
C). Programs that include a single set of 8-10 different exercises performed 2-3
days a week have been shown to be beneficial. Although a greater frequency of
training is an option, the additional gain is usually small.While the number of
,2|Page
exercises can be reduced, training the front and back of major muscle groups (e.g.,
chest/back, biceps/triceps) is recommended. A repetition range of 8-12 is
recommended for healthy participants younger than 50-60 years of age. To reduce
the risk for injury, 10-15 repetitions at a lower relative resistance is generally
recommended for cardiac patients and healthy participants over 50-60 years of
age. Higher-intensity efforts (fewer repetitions with heavier weights) increase the
risk of musculoskeletal injury.The American College of Sports Medicine
recommends that older adults perform the following each week: a minimum of
150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-
intensity aerobic activity, and two or more nonconsecutive days of moderate-
intensity strengthening activities, with 8-10 exercises involving the major muscle
groups and 8-12 repetitions of each exercise.
Which one of the following is an indication to offer abdominal ultrasonography to
screen for an abdominal aortic aneurysm (AAA)?
Hypertension and type 1 diabetes in a 60-year-old male
Hypertension and a 20-pack-year smoking history in a 65-year-old female who
quit smoking 4 years ago
A 5-pack-year smoking history in a 68-year-old male who quit smoking 40 years
ago
No recent AAA screening in a 74-year-old male whose last screening
ultrasonography 8 years ago was negative
A recent history of hemorrhagic stroke in a 75-year-old female-correct-answer-C
Smoking history (at least 100 cigarettes in a lifetime) and male sex are the major
risk factors for abdominal aortic aneurysm (AAA). The U.S. Preventive Services
,3|Page
Task Force (USPSTF) recommends one-time screening for AAA by ultrasonography
between the ages of 65 and 75 in men who have ever smoked (B
recommendation). The USPSTF also recommends that clinicians selectively offer
screening for AAA in men in this age group who have never smoked if indicated by
the patient's medical history, family history, other risk factors, or personal values
(C recommendation). An important risk factor in addition to age is a first degree
relative with AAA. Other risk factors include a history of other vascular aneurysms,
coronary artery disease, cerebrovascular disease, atherosclerosis,
hypercholesterolemia, obesity, or hypertension.The likelihood of finding an AAA
large enough to benefit from surgery is greatest between the ages of 65 and 75. In
patients older than 75 the likelihood of surviving surgery to repair an AAA is low
enough to preclude screening. The benefit of screening for women in this age
group is low due to the low number of AAA-related deaths in this population (SOR
B). The USPSTF recommends against routine screening for AAA in women (D
recommendation). The USPSTF does not make any recommendation regarding
testing those less than 65 years old.
A 24-year-old female in the second trimester of her first pregnancy is concerned
that she may contract influenza and endanger her baby's health. Her due date is in
December and she plans to breastfeed. She has not received influenza vaccine in
the past because she develops hives if she eats eggs.Which one of the following
would be an appropriate recommendation?
She can safely receive trivalent inactivated influenza (TIV) vaccine prior to the
upcoming influenza season
She can safely receive live attenuated influenza vaccine (LAIV) prior to the
upcoming influenza season
She should not receive the vaccine this year due to her history of an allergic
reaction to eggs
, 4|Page
She should not take oseltamivir (Tamiflu) for prophylaxis if she is exposed to
influenza prior to delivery-correct-answer-A
The American College of Obstetricians and Gynecologists, the American Academy
of Family Physicians, and the CDC recommend influenza vaccine for all women
who will be pregnant during influenza season. It has been shown to reduce the
risk of influenza-associated acute respiratory infection in pregnant women by
about one-half and reduces a pregnant woman's risk of being hospitalized with
influenza by an average of 40%. The CDC recommends use of injectable influenza
vaccines, including inactivated influenza vaccines and recombinant influenza
vaccines. The nasal spray vaccine, which is a live attenuated influenza vaccine, is
not recommended during pregnancy. Influenza vaccine is also recommended for
women who are breastfeeding (SOR A). Current CDC guidelines recommend
oseltamivir as the preferred treatment for pregnant women with suspected
influenza.People with egg allergies such as hives, but no previous reaction to
influenza vaccine in the past, no longer need to be observed for an allergic
reaction for 30 minutes after receiving influenza vaccine. Monitoring for 30
minutes may be done if this is the first time the patient has received influenza
vaccine but is not mandatory according to the CDC. Any licensed and
recommended influenza vaccine that is otherwise appropriate for the recipient's
age and health status may be used.Patients who report reactions to egg involving
symptoms other than hives, such as angioedema, respiratory distress,
lightheadedness, or recurrent emesis, or who required epinephrine or another
emergency medical intervention, may also receive any licensed and recommended
influenza vaccine that is otherwise appropriate for the recipient's age and health
status. If an egg-based vaccine is used, it should be administered in an inpatient or
outpatient medical setting, including, but not necessarily limit
