ABFM HEALTH COUNSELING AND PREVENTIVE CARE
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 - ANSW - 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 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 - ANSW - 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 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 - ANSW - 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 - ANSW -
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 (PC -
ANSW - 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 - ANSW - E
Not only are tobacco cessation treatments effective clinically, they are also cost-
effective in comparison to treatments for other medical disorders (SOR A). Several
analyses have found that the cost of treatment per patient who quits ranges from
several hundred to a few thousand dollars. Insurance coverage of medications and
counseling to stop smoking increases success rates (SOR A). Bupropion, varenicline,
and five forms of nicotine replacement (gum, inhaler, lozenge, nasal spray, and patch)
have all been shown to be effective in helping adults quit smoking (SOR A).For every 10
smokers who quit while taking a placebo nearly 30 could be expected to quit when
taking varenicline as a single agent. Varenicline as a single agent has also been shown
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 - ANSW - 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 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 - ANSW - 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 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 - ANSW - 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 - ANSW -
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 (PC -
ANSW - 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 - ANSW - E
Not only are tobacco cessation treatments effective clinically, they are also cost-
effective in comparison to treatments for other medical disorders (SOR A). Several
analyses have found that the cost of treatment per patient who quits ranges from
several hundred to a few thousand dollars. Insurance coverage of medications and
counseling to stop smoking increases success rates (SOR A). Bupropion, varenicline,
and five forms of nicotine replacement (gum, inhaler, lozenge, nasal spray, and patch)
have all been shown to be effective in helping adults quit smoking (SOR A).For every 10
smokers who quit while taking a placebo nearly 30 could be expected to quit when
taking varenicline as a single agent. Varenicline as a single agent has also been shown
