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
You are counseling a 45-year- from saturated fat, aiming for a goal of 6%-7% of calories
old male with elevated LDL- from this source. The AHA also recommends a diet that
cholesterol. When discussing emphasizes the consumption of fruits, vegetables, and whole
dietary changes to promote grains, and which includes fish, poultry, low-fat dairy
healthy lipid levels, which products, legumes, nontropical vegetable oils, and nuts.
one of the following would be Consumption of red meat, sweets, and sugar-sweetened
accurate advice? beverages should be discouraged.Although dietary fiber has
been shown to have several beneficial health effects, the
He should minimize his average daily intake for most Americans is 15 g daily, which
consumption of nuts is much lower than the recommended amount. The
The Dietary Approaches to recommended daily fiber intake for males age 14-50 is 38 g
Stop Hypertension (DASH) daily. For other populations the recommended amount is
diet recommended for lower, and varies according to age and sex. Several
reducing hypertension will randomized, controlled trials have shown a reduction of
help lower his LDL- LDL-cholesterol with higher fiber consumption. A food diary
cholesterol level is an important aspect of dietary behavior change but it is
Saturated fats should most accurate if entries are made immediately after food is
comprise 15% or less of his consumed.
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
, 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
A 24-year-old female sees you pregnancy reduces and sometimes eliminates many of these
for a preconception visit and consequences.Small for gestational age (SGA) infants are a
removal of her IUD. This will dose-dependent outcome of maternal smoking, with an odds
be her first pregnancy and she ratio (OR) of 2.11 when women smoke throughout
tells you that she has smoked pregnancy. Risks for prematurity (OR 1.15) and fetal death
¼-½ pack of cigarettes a day (OR 1.15) are also increased. The risk of having an SGA
for the past 5 years.Which one infant is avoided if smoking is reduced, but the risks for
of the following would be prematurity and increased fetal death are not.In 2014 the U.S.
appropriate advice regarding Surgeon General issued a new report on the health
the risks from smoking? consequences of smoking that noted that the evidence was
strong enough to infer a causal link between maternal
Smoking during pregnancy smoking and orofacial clefts. This was still true when the
increases the risk of attention- Surgeon General issued a report on smoking cessation in
deficit/hyperactivity disorder 2020. No link could be inferred, however, between smoking
Smoking during pregnancy and other congenital defects, including clubfoot,
increases the risk of clubfoot gastroschisis, and atrial septal defects. There is no evidence
Smoking during pregnancy that maternal smoking leads to increased rates of childhood
increases the risk of attention-deficit/hyperactivity disorder.
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
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,
A 55-year-old male expresses which can be divided into hormonal, vasculogenic, and
concern about his inability to neurogenic causes. Vasculogenic etiologies are the most
maintain an erection that common, with arterial or "inflow" disorders accounting for
allows for satisfactory sexual more problems than venous disorders. The patient should be
intercourse with his wife. He
advised that their ED is a risk factor for underlying
takes over-the-counter
cardiovascular disease and that further evaluation may be
diphenhydramine (Benadryl)
appropriate. It is important to remember, however, that even
at night for sleep and takes a though the primary etiology of ED is most often organic,
daily multivitamin. He says psychological factors frequently coexist and play a role in the
he drinks one 12-ounce beer dysfunction.Many medications can cause or contribute to
2-3 times per week. A ED. It is estimated that as many as 25% of ED cases are due
physical examination is
to medication side effects. This highlights the crucial role of
normal, including his blood
the primary care physician in reviewing medication lists and
pressure.Which one of the modifying treatment regimens as part of addressing ED.
following would you tell him? Common offenders include antihistamines, antihypertensives
and diuretics such as hydrochlorothiazide and spironolactone,
Most cases of erectile psychoactive medications including SSRIs, and anti-epilepsy
dysfunction (ED) have a medications. It is not clear whether low amounts of alcohol
psychogenic etiology
cause erectile dysfunction.
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
, 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
A 42-year-old female sees you estrogen use may increase the risk.The U.S. Preventive
for a routine health Services Task Force does not currently recommend screening
maintenance visit. Her for ovarian cancer, as it is likely to have a relatively low yield
neighbor was just diagnosed (D recommendation). Almost all women with a positive
with ovarian cancer and has screening test for CA-125 will not have ovarian cancer. In
encouraged her to have her women at average risk, the positive predictive value of an
CA-125 level checked. The abnormal CA-125 is approximately 2%, so 98% of women
patient asks about ovarian with positive test results will not have ovarian cancer. There
cancer risk factors, are no current recommendations for ovarian cancer screening
prevention, and screening. by either transvaginal ultrasonography or pelvic examination.
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
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
You are counseling a 45-year- from saturated fat, aiming for a goal of 6%-7% of calories
old male with elevated LDL- from this source. The AHA also recommends a diet that
cholesterol. When discussing emphasizes the consumption of fruits, vegetables, and whole
dietary changes to promote grains, and which includes fish, poultry, low-fat dairy
healthy lipid levels, which products, legumes, nontropical vegetable oils, and nuts.
one of the following would be Consumption of red meat, sweets, and sugar-sweetened
accurate advice? beverages should be discouraged.Although dietary fiber has
been shown to have several beneficial health effects, the
He should minimize his average daily intake for most Americans is 15 g daily, which
consumption of nuts is much lower than the recommended amount. The
The Dietary Approaches to recommended daily fiber intake for males age 14-50 is 38 g
Stop Hypertension (DASH) daily. For other populations the recommended amount is
diet recommended for lower, and varies according to age and sex. Several
reducing hypertension will randomized, controlled trials have shown a reduction of
help lower his LDL- LDL-cholesterol with higher fiber consumption. A food diary
cholesterol level is an important aspect of dietary behavior change but it is
Saturated fats should most accurate if entries are made immediately after food is
comprise 15% or less of his consumed.
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
, 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
A 24-year-old female sees you pregnancy reduces and sometimes eliminates many of these
for a preconception visit and consequences.Small for gestational age (SGA) infants are a
removal of her IUD. This will dose-dependent outcome of maternal smoking, with an odds
be her first pregnancy and she ratio (OR) of 2.11 when women smoke throughout
tells you that she has smoked pregnancy. Risks for prematurity (OR 1.15) and fetal death
¼-½ pack of cigarettes a day (OR 1.15) are also increased. The risk of having an SGA
for the past 5 years.Which one infant is avoided if smoking is reduced, but the risks for
of the following would be prematurity and increased fetal death are not.In 2014 the U.S.
appropriate advice regarding Surgeon General issued a new report on the health
the risks from smoking? consequences of smoking that noted that the evidence was
strong enough to infer a causal link between maternal
Smoking during pregnancy smoking and orofacial clefts. This was still true when the
increases the risk of attention- Surgeon General issued a report on smoking cessation in
deficit/hyperactivity disorder 2020. No link could be inferred, however, between smoking
Smoking during pregnancy and other congenital defects, including clubfoot,
increases the risk of clubfoot gastroschisis, and atrial septal defects. There is no evidence
Smoking during pregnancy that maternal smoking leads to increased rates of childhood
increases the risk of attention-deficit/hyperactivity disorder.
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
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,
A 55-year-old male expresses which can be divided into hormonal, vasculogenic, and
concern about his inability to neurogenic causes. Vasculogenic etiologies are the most
maintain an erection that common, with arterial or "inflow" disorders accounting for
allows for satisfactory sexual more problems than venous disorders. The patient should be
intercourse with his wife. He
advised that their ED is a risk factor for underlying
takes over-the-counter
cardiovascular disease and that further evaluation may be
diphenhydramine (Benadryl)
appropriate. It is important to remember, however, that even
at night for sleep and takes a though the primary etiology of ED is most often organic,
daily multivitamin. He says psychological factors frequently coexist and play a role in the
he drinks one 12-ounce beer dysfunction.Many medications can cause or contribute to
2-3 times per week. A ED. It is estimated that as many as 25% of ED cases are due
physical examination is
to medication side effects. This highlights the crucial role of
normal, including his blood
the primary care physician in reviewing medication lists and
pressure.Which one of the modifying treatment regimens as part of addressing ED.
following would you tell him? Common offenders include antihistamines, antihypertensives
and diuretics such as hydrochlorothiazide and spironolactone,
Most cases of erectile psychoactive medications including SSRIs, and anti-epilepsy
dysfunction (ED) have a medications. It is not clear whether low amounts of alcohol
psychogenic etiology
cause erectile dysfunction.
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
, 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
A 42-year-old female sees you estrogen use may increase the risk.The U.S. Preventive
for a routine health Services Task Force does not currently recommend screening
maintenance visit. Her for ovarian cancer, as it is likely to have a relatively low yield
neighbor was just diagnosed (D recommendation). Almost all women with a positive
with ovarian cancer and has screening test for CA-125 will not have ovarian cancer. In
encouraged her to have her women at average risk, the positive predictive value of an
CA-125 level checked. The abnormal CA-125 is approximately 2%, so 98% of women
patient asks about ovarian with positive test results will not have ovarian cancer. There
cancer risk factors, are no current recommendations for ovarian cancer screening
prevention, and screening. by either transvaginal ultrasonography or pelvic examination.
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
