ABFM HEALTH COUNSELING AND PREVENTIVE CARE EXAM
QUESTIONS AND CORRECT ANSWERS.
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 - 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 - 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 - 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?
QUESTIONS AND CORRECT ANSWERS.
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 - 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 - 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 - 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?
