UPDATED 2024 ABFM HEALTH
COUNSELING AND PREVENTIVE CARE
,UPDATED 2024 ABFM HEALTH
COUNSELING AND PREVENTIVE CARE
Available screening tests for dementia, such as the Mini-Mental State Examination (MMSE), the
Functional Activities Questionnaire (FAQ), the Montreal Cognitive Assessment (MoCA), and others, have
good sensitivity but only fair specificity for diagnosing dementia and other neurocognitive disorders. The
positive and negative predictive value of these instruments will vary depending on the practice setting
and the prevalence of dementia in the patient population (SOR A). In populations with a high prevalence
of dementia, such as patients over the age of 85, positive predictive values can be >50%. In populations
with a lower prevalence, such as unselected patients age 65-74, the positive predictive value may be
closer to 20%. The sensitivity and specificity of these tools is typically lower for mild cognitive
impairment than for dementia. The MoCA may be a more sensitive screening tool than the MMSE for
mild cognitive impairment.In 2011 Medicare began covering screening for cognitive impairment as part
of the annual wellness visit. In 2018 the American Academy of Neurology published recommendations
to perform screening with a validated instrument and not rely on subjective assessment of memory to
diagnose mild cognitive impairment. If patients are diagnosed with mild cognitive impairment a search
for reversible causes should be undertaken because a subset of patients will show improvement in
function over time with appropriate intervention and with exercise. Patients should be assessed for
functional impairment before being given a diagnosis of dementia.The U.S. Preventive Services Task
Force has concluded that the current evidence is insufficient to assess the balance of benefits and harms
of screening for cognitive impairment in older adults.
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 - CORRECT 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 - CORRECT 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 - CORRECT 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
COUNSELING AND PREVENTIVE CARE
,UPDATED 2024 ABFM HEALTH
COUNSELING AND PREVENTIVE CARE
Available screening tests for dementia, such as the Mini-Mental State Examination (MMSE), the
Functional Activities Questionnaire (FAQ), the Montreal Cognitive Assessment (MoCA), and others, have
good sensitivity but only fair specificity for diagnosing dementia and other neurocognitive disorders. The
positive and negative predictive value of these instruments will vary depending on the practice setting
and the prevalence of dementia in the patient population (SOR A). In populations with a high prevalence
of dementia, such as patients over the age of 85, positive predictive values can be >50%. In populations
with a lower prevalence, such as unselected patients age 65-74, the positive predictive value may be
closer to 20%. The sensitivity and specificity of these tools is typically lower for mild cognitive
impairment than for dementia. The MoCA may be a more sensitive screening tool than the MMSE for
mild cognitive impairment.In 2011 Medicare began covering screening for cognitive impairment as part
of the annual wellness visit. In 2018 the American Academy of Neurology published recommendations
to perform screening with a validated instrument and not rely on subjective assessment of memory to
diagnose mild cognitive impairment. If patients are diagnosed with mild cognitive impairment a search
for reversible causes should be undertaken because a subset of patients will show improvement in
function over time with appropriate intervention and with exercise. Patients should be assessed for
functional impairment before being given a diagnosis of dementia.The U.S. Preventive Services Task
Force has concluded that the current evidence is insufficient to assess the balance of benefits and harms
of screening for cognitive impairment in older adults.
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 - CORRECT 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 - CORRECT 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 - CORRECT 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
