ABFM HEALTH COUNSELING AND PREVENTIVE CARE EXAM QUESTIONS AND ANSWERS 2023 (UPDATED) ASSURED A+.
You are counseling a 45-year-old male with elevated LDL... [Show More] -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 - B
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 LDLcholesterol 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
ABFM HEALTH COUNSELING AND PREVENTIVE
CARE EXAM QUESTIONS AND ANSWERS 2023
(UPDATED) ASSURED A+.
Reducing smoking now will reduce the risk of preterm delivery - D
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 dosedependent 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 - D
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
Bimanual examinations are recommended to screen for ovarian cancer
Transvaginal ultrasonography is recommended to screen for ovarian cancer - C
Ovarian cancer is the fifth leading cause of cancer death among women in the United States.
Risk factors associated with ovarian cancer include a positive family history and having the
BRCA1 or BRCA2 gene mutation. A first or second degree relative with ovarian cancer increases
the risk by about threefold. 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 risk.The U.S. Preventive Services Task Force does not currently
recommend screening for ovarian cancer, as it is likely to have a relatively low yield (D
recommendation). Almost all women with a positive screening test for CA-125 will not have
ovarian cancer. 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 cancer.
There are no current recommendations for ovarian cancer screening by either transvaginal
ultrasonography or pelvic examination.
A male who was born in 1970 comes to your office for a preoperative examination for an
orthopedic procedure on his knee. He is otherwise healthy and does not take any medications,
but he has not seen a physician for 6 years. 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 female. You use
this opportunity to counsel him on preventive health screenings, including hepatitis C.Which
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 U.S. 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 (PCR) testing
Screening all adults up to age 80 regardless of risk profile is recommended - E
In 2019 the U.S. 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 test. 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 antiviral response to
therapy. Quantitative PCR is used to determine viral load. The CDC previously recommended
screening for people born between 1945 and 1965, but that has been expanded.HCV is the
most common chronic bloodborne pathogen in the United States and a leading cause of
complications from chronic liver disease. Before the COVID pandemic, HCV infection was
associated with more deaths than the top 60 other reportable infectious diseases combined,
including HIV. The most important risk factor for HCV infection is past or current injection drug
use. In the United States an estimated 4.1 million people have past or current HCV infection,
based on a positive test for the anti-HCV antibody. Approximately 2.4 million persons with a
positive antibody test have a current infection based on results of molecular assays for HCV
RNA and would be potential candidates for treatment. Treatment results in very high levels of
virus remission.Cases of acute HCV infection increased approximately 3.5-fold between 2010
and 2017. The increased incidence has mostly affected young white people who inject drugs,
especially those living in rural areas. There has also been an increase in the number of women
age 15-44 years with HCV infection. There is no recommended testing frequency for high-risk
individuals at this time.
You see a 45-year-old male who has smoked cigarettes for 25 years. He is very interested in
quitting but has not been able to do so despite many attempts. He is interested in using
medications to help.Which one of the following would likely be most effective?
Calling the QUIT LINE and using over-the-counter nicotine patches
Bupropion (Wellbutrin SR, Zyban)
Nortriptyline (Pamelor)
Varenicline (Chantix)
Varenicline plus nicotine replacement therapy - E . [Show Less]
