ABFM HEALTH COUNSELING AND PREVENTIVE

ABFM HEALTH COUNSELING AND PREVENTIVE

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known medical problems. There are no significant findings on her personal history or family history.Important components of the preparticipation evaluation for this patient include all of the following EXCEPT

cardiac auscultation with the patient both standing and supine evaluation of femoral pulses vision and hearing screenings

a urinalysis - CORRECT ANSWER: D

Obtaining a urinalysis is not recommended in asymptomatic individuals unless clinical signs such as elevated blood pressure warrant further investigation. Cardiac auscultation to detect murmurs is important to assess for any change in a heart murmur with a Valsalva type maneuver, which could indicate hypertrophic cardiomyopathy.Evaluation of femoral pulses can detect coarctation of the aorta. It is appropriate to perform hearing and vision screenings during a preparticipation evaluation.

A 2-month-old male is brought to your office by his parents for a well child visit. They also have a 3-year-old son who is obese. The mother asks what to do to keep the infant's weight under control over the next few years.Which one of the following recommendations is supported by good evidence?

Excluding all juices from the diet until 4 years of age Limiting juice intake to no more than 8 oz per day from 1-6 years of age Restricting chocolate milk intake after 12 months of age 1 / 4

Restricting whole milk and using reduced-fat or fat-free milk beginning at 12 months of

age - CORRECT ANSWER: D

Pediatric obesity has become epidemic. Measures to prevent this condition should be shared with parents as early as possible. For infants, major recommendations to reduce the risk of obesity include breastfeeding (SOR A), avoiding television and computer screen time (SOR C), avoiding premature introduction of solid foods (SOR C), avoiding high-calorie beverages with low nutritional value (SOR C), and educating parents to be role models of healthy lifestyles (SOR C). Breastfeeding after the age of 12 months has been associated with a 47% reduction in obesity. Cow's milk and fruit juice can be introduced at 12 months of age. Providing 100% fruit juice can be an important component of fruit intake in children who may not be able to access fresh fruits and eliminating them may cause nutritional deficiencies. It is important to only use 100% juice and to not exceed 4-6 oz daily for children 1-6 years of age. When consumed within the Dietary Guidelines for Americans recommendations, 100% fruit juice is not associated with overweight/obesity or childhood dental caries and does not compromise fiber intake. While there have been concerns in the past about low-fat diets and their effect on brain development, low-fat or fat-free milk is appropriate at this age, especially if there are concerns about obesity or a family history of cardiovascular disease (SOR A). Evidence does not support restricting flavored milk products to reduce the prevalence of obesity.

A 20-year-old male is brought to your office by friends a few hours after they went dancing at a nightclub. His friends report that he has been combative and confused, and that he keeps clenching his jaw. Examination reveals a temperature of 38.2°C (100.8°F), a blood pressure of 160/94 mm Hg, and a heart rate of 108 beats/min. He has a mildly ataxic gait.Which one of the following club drugs is the most likely cause of these findings?

Flunitrazepam (Rohypnol) GHB (γ-hydroxybutyrate) Ketamine

MDMA (3,4-methylenedioxymethamphetamine) - CORRECT ANSWER: D

MDMA, flunitrazepam, GHB, and ketamine are among the drugs used by teens and young adults at nightclubs, bars, raves, or trance parties. Raves and trance parties are generally nightlong dances, often held in warehouses. Many who attend these dances 2 / 4

use club drugs in an effort to enhance the experience.MDMA is a synthetic psychoactive drug that is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. Street names for MDMA include ecstasy, XTC, and hug drug. It is taken as a pill. Results from the 2018 National Survey on Drug Use and Health showed that 7% of people over the age of 12 had used MDMA at some time during their life and 1% had used it in the past year.MDMA users might feel very alert or energetic at first. At raves they can dance for hours at a time. They may also experience distortions in time and other changes in perception. Some, however, can become anxious and agitated.Sweating or chills may occur, and MDMA users may feel faint or dizzy. MDMA can interfere with the body's temperature regulation, which can cause dangerous hyperthermia. Other effects on the body include muscle tension, clenching of teeth, nausea, blurred vision, fainting, and chills or sweating. MDMA increases heart rate and blood pressure and can cause confusion, depression, sleep problems, intense fear, and anxiety. In regular abusers some of these side effects can last for days or weeks after taking MDMA.GHB, flunitrazepam, and ketamine have been referred to as date rape drugs, since they have been used to facilitate sexual assault. These drugs can be easily added to flavored drinks without the victim's knowledge. Symptoms of GHB intoxication include relaxation, drowsiness, vision problems, nausea/vomiting, headache, loss of consciousness, loss of reflexes, seizures, coma, and death. Flunitrazepam ("roof

A 24-year-old female in the second trimester of her first pregnancy is concerned that she may contract influenza and endanger her baby's health. Her due date is in December and she plans to breastfeed. She has not received influenza vaccine in the past because she develops hives if she eats eggs.Which one of the following would be an appropriate recommendation?

She can safely receive trivalent inactivated influenza (TIV) vaccine prior to the upcoming influenza season She can safely receive live attenuated influenza vaccine (LAIV) prior to the upcoming influenza season She should not receive the vaccine this year due to her history of an allergic reaction to eggs She should not take oseltamivir (Tamiflu) for prophylaxis if she is exposed to influenza

prior to delivery - CORRECT ANSWER: A

The American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the CDC recommend influenza vaccine for all women who will be pregnant during influenza season. It has been shown to reduce the risk of influenza- 3 / 4

associated acute respiratory infection in pregnant women by about one-half and reduces a pregnant woman's risk of being hospitalized with influenza by an average of 40%. The CDC recommends use of injectable influenza vaccines, including inactivated influenza vaccines and recombinant influenza vaccines. The nasal spray vaccine, which is a live attenuated influenza vaccine, is not recommended during pregnancy. Influenza vaccine is also recommended for women who are breastfeeding (SOR A). Current CDC guidelines recommend oseltamivir as the preferred treatment for pregnant women with suspected influenza.People with egg allergies such as hives, but no previous reaction to influenza vaccine in the past, no longer need to be observed for an allergic reaction for 30 minutes after receiving influenza vaccine. Monitoring for 30 minutes may be done if this is the first time the patient has received influenza vaccine but is not mandatory according to the CDC. Any licensed and recommended influenza vaccine that is otherwise appropriate for the recipient's age and health status may be used.Patients who report reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis, or who required epinephrine or another emergency medical intervention, may also receive any licensed and recommended influenza vaccine that is otherwise appropriate for the recipient's age and health status. If an egg-based vaccine is used, it should be administered in an inpatient or outpatient medical setting, including, but not necessarily limit

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 - CORRECT ANSWER:

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

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