ABFM HEALTH COUNSELING AND PREVENTIVE CARE EXAM
QUESTIONS AND ANSWERS/VERIFIED/CORRECT {Graded A+}
1. You are counseling a B
45-year-old male with
elevated LDL-choles- In 2013, the American Heart Association (AHA) is-
terol. When discussing sued lifestyle management guidelines designed to
dietary changes to pro- reduce cardiovascular risk. For adult patients with
mote healthy lipid lev- elevated LDL-cholesterol levels the AHA advises
els, which one of the following diet plans such as the Dietary Approaches
following would be ac- to Stop Hypertension (DASH) diet, the AHA diet,
curate advice? or the USDA Food Pattern. The AHA specifically
recommends reducing the percentage of calories
He should minimize his from saturated fat, aiming for a goal of 6%-7% of
consumption of nuts calories from this source. The AHA also recom-
The Dietary Approach- mends a diet that emphasizes the consumption of
es to Stop Hyper- fruits, vegetables, and whole grains, and which in-
tension (DASH) diet cludes fish, poultry, low-fat dairy products, legumes,
recommended for re- nontropical vegetable oils, and nuts. Consumption
ducing hypertension of red meat, sweets, and sugar-sweetened bever-
will help lower his ages should be discouraged.Although dietary fiber
LDL-cholesterol level has been shown to have several beneficial health
Saturated fats should effects, the average daily intake for most Americans
comprise 15% or less is 15 g daily, which is much lower than the rec-
of his caloric intake ommended amount. The recommended daily fiber
He should aim for a intake for males age 14-50 is 38 g daily. For other
fiber intake of 25 g daily populations the recommended amount is lower, and
He should record what varies according to age and sex. Several random-
he has eaten in a food ized, controlled trials have shown a reduction of
diary at the end of each LDL-cholesterol with higher fiber consumption. A
day food diary is an important aspect of dietary behavior
change but it is most accurate if entries are made
immediately after food is consumed.
2. A 24-year-old female D
sees you for a precon-
ception visit and re- There are many reproductive problems related to
moval of her IUD. This smoking, including conception delay and both pri-
will be her first preg- mary and secondary infertility; an increased risk
nancy and she tells you of ectopic pregnancy and spontaneous abortion;
that she has smoked an increased risk of abruption, preterm rupture of
¼-½ pack of cigarettes membranes, placenta previa, and premature deliv-
, ABFM HEALTH COUNSELING AND PREVENTIVE CARE
a day for the past ery; and increased perinatal morbidity and mortality,
5 years.Which one of including stillbirth, low birth weight, and SIDS-relat-
the following would be ed deaths. The 2001 Surgeon General's Report on
appropriate advice re- women and smoking makes it clear that stopping
garding the risks from smoking during pregnancy reduces and sometimes
smoking? eliminates many of these consequences.Small for
gestational age (SGA) infants are a dose-depen-
Smoking during dent outcome of maternal smoking, with an odds
pregnancy increas- ratio (OR) of 2.11 when women smoke throughout
es the risk pregnancy. Risks for prematurity (OR 1.15) and fetal
of attention-deficit/hy- death (OR 1.15) are also increased. The risk of hav-
peractivity disorder ing an SGA infant is avoided if smoking is reduced,
Smoking during preg- but the risks for prematurity and increased fetal
nancy increases the death are not.In 2014 the U.S. Surgeon General
risk of clubfoot issued a new report on the health consequences
Smoking during preg- of smoking that noted that the evidence was strong
nancy increases the enough to infer a causal link between maternal
risk of congenital atrial smoking and orofacial clefts. This was still true when
septal defects the Surgeon General issued a report on smoking
Stopping smoking now cessation in 2020. No link could be inferred, how-
will reduce the in- ever, between smoking and other congenital de-
creased risk of orofa- fects, including clubfoot, gastroschisis, and atrial
cial defects in her in- septal defects. There is no evidence that maternal
fant smoking leads to increased rates of childhood at-
Reducing smoking tention-deficit/hyperactivity disorder.
now will reduce the risk
of preterm delivery
3. A 55-year-old male ex- D
presses concern about
his inability to main- Erectile dysfunction (ED) is common, affecting an
tain an erection that estimated 30 million men in the United States,
allows for satisfacto- and becomes more common with advancing age.
ry sexual intercourse The Health Professionals Follow-up Study reported
with his wife. He moderate to severe ED in 12% of men younger than
takes over-the-counter 59, 22% of men ages 60-69, and 30% of men older
diphenhydramine (Be- than 69.It was previously thought that the majority
nadryl) at night for of cases of ED were caused by psychogenic fac-
sleep and takes a daily tors such as family or occupational stress. However,
, ABFM HEALTH COUNSELING AND PREVENTIVE CARE
multivitamin. He says evidence suggests that approximately 80% of ED
he drinks one 12-ounce is due to organic disease, which can be divided
beer 2-3 times per into hormonal, vasculogenic, and neurogenic caus-
week. A physical exam- es. Vasculogenic etiologies are the most common,
ination is normal, in- with arterial or "inflow" disorders accounting for
cluding his blood pres- more problems than venous disorders. The patient
sure.Which one of the should be advised that their ED is a risk factor for
following would you underlying cardiovascular disease and that further
tell him? evaluation may be appropriate. It is important to
remember, however, that even though the primary
Most cases of erectile etiology of ED is most often organic, psychological
dysfunction (ED) have factors frequently coexist and play a role in the dys-
a psychogenic etiology function.Many medications can cause or contribute
Diphenhydramine has to ED. It is estimated that as many as 25% of ED
little impact on his ED cases are due to medication side effects. This high-
Abstaining from alco- lights the crucial role of the primary care physician
hol use will improve his in reviewing medication lists and modifying treat-
symptoms ment regimens as part of addressing ED. Com-
Erectile dysfunction mon offenders include antihistamines, antihyperten-
may be an early indi- sives and diuretics such as hydrochlorothiazide and
cation of vascular dis- spironolactone, psychoactive medications including
ease SSRIs, and anti-epilepsy medications. It is not clear
About 5% of men his whether low amounts of alcohol cause erectile dys-
age experience ED function.
4. A 42-year-old female C
sees you for a rou-
tine health mainte- Ovarian cancer is the fifth leading cause of cancer
nance visit. Her neigh- death among women in the United States. Risk
bor was just diagnosed factors associated with ovarian cancer include a
with ovarian cancer positive family history and having the BRCA1 or
and has encouraged BRCA2 gene mutation. A first or second degree
her to have her CA-125 relative with ovarian cancer increases the risk by
level checked. The pa- about threefold. The use of oral contraceptives dur-
tient asks about ovar- ing the reproductive years, and pregnancy, espe-
ian cancer risk fac- cially after age 35, reduce the risk of ovarian cancer,
tors, prevention, and but postmenopausal estrogen use may increase the
screening. Which one risk.The U.S. Preventive Services Task Force does
of the following would not currently recommend screening for ovarian can-
, ABFM HEALTH COUNSELING AND PREVENTIVE CARE
be appropriate advice? cer, as it is likely to have a relatively low yield (D
recommendation). Almost all women with a positive
A past history of oral screening test for CA-125 will not have ovarian can-
contraceptive use in- cer. In women at average risk, the positive predictive
creases the risk for value of an abnormal CA-125 is approximately 2%,
ovarian cancer so 98% of women with positive test results will not
Hormone replace- have ovarian cancer. There are no current recom-
ment therapy after mendations for ovarian cancer screening by either
menopause decreases transvaginal ultrasonography or pelvic examination.
the risk for subsequent
ovarian cancer
CA-125 has a
false-positive rate of
98% when used to
screen for ovarian can-
cer
Bimanual examina-
tions are recommend-
ed to screen for ovarian
cancer
Transvaginal ultra-
sonography is recom-
mended to screen for
ovarian cancer
5. A male who was born E
in 1970 comes to your
office for a preoper- In 2019 the U.S. Preventive Services Task Force
ative examination for (USPSTF) recommended screening all patients
an orthopedic proce- 18-79 years of age at least once for hepatitis C
dure on his knee. He is with the anti-HCV antibody test. Detection of hepati-
otherwise healthy and tis C virus (HCV) RNA by polymerase chain reac-
does not take any med- tion (PCR) testing provides evidence of active HCV
ications, but he has not infection, confirms the diagnosis, and is used in
seen a physician for monitoring the antiviral response to therapy. Quan-
6 years. He used il- titative PCR is used to determine viral load. The
licit drugs for a brief CDC previously recommended screening for people
period at age 23 but born between 1945 and 1965, but that has been
has not done so since expanded.HCV is the most common chronic blood-
QUESTIONS AND ANSWERS/VERIFIED/CORRECT {Graded A+}
1. You are counseling a B
45-year-old male with
elevated LDL-choles- In 2013, the American Heart Association (AHA) is-
terol. When discussing sued lifestyle management guidelines designed to
dietary changes to pro- reduce cardiovascular risk. For adult patients with
mote healthy lipid lev- elevated LDL-cholesterol levels the AHA advises
els, which one of the following diet plans such as the Dietary Approaches
following would be ac- to Stop Hypertension (DASH) diet, the AHA diet,
curate advice? or the USDA Food Pattern. The AHA specifically
recommends reducing the percentage of calories
He should minimize his from saturated fat, aiming for a goal of 6%-7% of
consumption of nuts calories from this source. The AHA also recom-
The Dietary Approach- mends a diet that emphasizes the consumption of
es to Stop Hyper- fruits, vegetables, and whole grains, and which in-
tension (DASH) diet cludes fish, poultry, low-fat dairy products, legumes,
recommended for re- nontropical vegetable oils, and nuts. Consumption
ducing hypertension of red meat, sweets, and sugar-sweetened bever-
will help lower his ages should be discouraged.Although dietary fiber
LDL-cholesterol level has been shown to have several beneficial health
Saturated fats should effects, the average daily intake for most Americans
comprise 15% or less is 15 g daily, which is much lower than the rec-
of his caloric intake ommended amount. The recommended daily fiber
He should aim for a intake for males age 14-50 is 38 g daily. For other
fiber intake of 25 g daily populations the recommended amount is lower, and
He should record what varies according to age and sex. Several random-
he has eaten in a food ized, controlled trials have shown a reduction of
diary at the end of each LDL-cholesterol with higher fiber consumption. A
day food diary is an important aspect of dietary behavior
change but it is most accurate if entries are made
immediately after food is consumed.
2. A 24-year-old female D
sees you for a precon-
ception visit and re- There are many reproductive problems related to
moval of her IUD. This smoking, including conception delay and both pri-
will be her first preg- mary and secondary infertility; an increased risk
nancy and she tells you of ectopic pregnancy and spontaneous abortion;
that she has smoked an increased risk of abruption, preterm rupture of
¼-½ pack of cigarettes membranes, placenta previa, and premature deliv-
, ABFM HEALTH COUNSELING AND PREVENTIVE CARE
a day for the past ery; and increased perinatal morbidity and mortality,
5 years.Which one of including stillbirth, low birth weight, and SIDS-relat-
the following would be ed deaths. The 2001 Surgeon General's Report on
appropriate advice re- women and smoking makes it clear that stopping
garding the risks from smoking during pregnancy reduces and sometimes
smoking? eliminates many of these consequences.Small for
gestational age (SGA) infants are a dose-depen-
Smoking during dent outcome of maternal smoking, with an odds
pregnancy increas- ratio (OR) of 2.11 when women smoke throughout
es the risk pregnancy. Risks for prematurity (OR 1.15) and fetal
of attention-deficit/hy- death (OR 1.15) are also increased. The risk of hav-
peractivity disorder ing an SGA infant is avoided if smoking is reduced,
Smoking during preg- but the risks for prematurity and increased fetal
nancy increases the death are not.In 2014 the U.S. Surgeon General
risk of clubfoot issued a new report on the health consequences
Smoking during preg- of smoking that noted that the evidence was strong
nancy increases the enough to infer a causal link between maternal
risk of congenital atrial smoking and orofacial clefts. This was still true when
septal defects the Surgeon General issued a report on smoking
Stopping smoking now cessation in 2020. No link could be inferred, how-
will reduce the in- ever, between smoking and other congenital de-
creased risk of orofa- fects, including clubfoot, gastroschisis, and atrial
cial defects in her in- septal defects. There is no evidence that maternal
fant smoking leads to increased rates of childhood at-
Reducing smoking tention-deficit/hyperactivity disorder.
now will reduce the risk
of preterm delivery
3. A 55-year-old male ex- D
presses concern about
his inability to main- Erectile dysfunction (ED) is common, affecting an
tain an erection that estimated 30 million men in the United States,
allows for satisfacto- and becomes more common with advancing age.
ry sexual intercourse The Health Professionals Follow-up Study reported
with his wife. He moderate to severe ED in 12% of men younger than
takes over-the-counter 59, 22% of men ages 60-69, and 30% of men older
diphenhydramine (Be- than 69.It was previously thought that the majority
nadryl) at night for of cases of ED were caused by psychogenic fac-
sleep and takes a daily tors such as family or occupational stress. However,
, ABFM HEALTH COUNSELING AND PREVENTIVE CARE
multivitamin. He says evidence suggests that approximately 80% of ED
he drinks one 12-ounce is due to organic disease, which can be divided
beer 2-3 times per into hormonal, vasculogenic, and neurogenic caus-
week. A physical exam- es. Vasculogenic etiologies are the most common,
ination is normal, in- with arterial or "inflow" disorders accounting for
cluding his blood pres- more problems than venous disorders. The patient
sure.Which one of the should be advised that their ED is a risk factor for
following would you underlying cardiovascular disease and that further
tell him? evaluation may be appropriate. It is important to
remember, however, that even though the primary
Most cases of erectile etiology of ED is most often organic, psychological
dysfunction (ED) have factors frequently coexist and play a role in the dys-
a psychogenic etiology function.Many medications can cause or contribute
Diphenhydramine has to ED. It is estimated that as many as 25% of ED
little impact on his ED cases are due to medication side effects. This high-
Abstaining from alco- lights the crucial role of the primary care physician
hol use will improve his in reviewing medication lists and modifying treat-
symptoms ment regimens as part of addressing ED. Com-
Erectile dysfunction mon offenders include antihistamines, antihyperten-
may be an early indi- sives and diuretics such as hydrochlorothiazide and
cation of vascular dis- spironolactone, psychoactive medications including
ease SSRIs, and anti-epilepsy medications. It is not clear
About 5% of men his whether low amounts of alcohol cause erectile dys-
age experience ED function.
4. A 42-year-old female C
sees you for a rou-
tine health mainte- Ovarian cancer is the fifth leading cause of cancer
nance visit. Her neigh- death among women in the United States. Risk
bor was just diagnosed factors associated with ovarian cancer include a
with ovarian cancer positive family history and having the BRCA1 or
and has encouraged BRCA2 gene mutation. A first or second degree
her to have her CA-125 relative with ovarian cancer increases the risk by
level checked. The pa- about threefold. The use of oral contraceptives dur-
tient asks about ovar- ing the reproductive years, and pregnancy, espe-
ian cancer risk fac- cially after age 35, reduce the risk of ovarian cancer,
tors, prevention, and but postmenopausal estrogen use may increase the
screening. Which one risk.The U.S. Preventive Services Task Force does
of the following would not currently recommend screening for ovarian can-
, ABFM HEALTH COUNSELING AND PREVENTIVE CARE
be appropriate advice? cer, as it is likely to have a relatively low yield (D
recommendation). Almost all women with a positive
A past history of oral screening test for CA-125 will not have ovarian can-
contraceptive use in- cer. In women at average risk, the positive predictive
creases the risk for value of an abnormal CA-125 is approximately 2%,
ovarian cancer so 98% of women with positive test results will not
Hormone replace- have ovarian cancer. There are no current recom-
ment therapy after mendations for ovarian cancer screening by either
menopause decreases transvaginal ultrasonography or pelvic examination.
the risk for subsequent
ovarian cancer
CA-125 has a
false-positive rate of
98% when used to
screen for ovarian can-
cer
Bimanual examina-
tions are recommend-
ed to screen for ovarian
cancer
Transvaginal ultra-
sonography is recom-
mended to screen for
ovarian cancer
5. A male who was born E
in 1970 comes to your
office for a preoper- In 2019 the U.S. Preventive Services Task Force
ative examination for (USPSTF) recommended screening all patients
an orthopedic proce- 18-79 years of age at least once for hepatitis C
dure on his knee. He is with the anti-HCV antibody test. Detection of hepati-
otherwise healthy and tis C virus (HCV) RNA by polymerase chain reac-
does not take any med- tion (PCR) testing provides evidence of active HCV
ications, but he has not infection, confirms the diagnosis, and is used in
seen a physician for monitoring the antiviral response to therapy. Quan-
6 years. He used il- titative PCR is used to determine viral load. The
licit drugs for a brief CDC previously recommended screening for people
period at age 23 but born between 1945 and 1965, but that has been
has not done so since expanded.HCV is the most common chronic blood-
