Health Promotion, Disease Prevention, and Professional Practice
Health Promotion, Disease Prevention, and Screening
Grade before you recommend
USPSTF letter grades drive most prevention questions. Grade A and B services are recommended (and generally covered without cost sharing); C requires individualized decision-making; D is recommended against. Know the exceptions as well as the indications: prostate cancer screening is C for men 55–69 and D at 70 and older; PSA and testicular exams are not routine in average-risk younger men.
Screening anchors to memorize
- Colorectal cancer: ages 45–75, any validated method (colonoscopy every 10 years or stool-based annually/biennially).
- Cervical cancer: start at 21; cytology every 3 years, or high-risk HPV alone every 5 years from 30, to age 65 with adequate prior negative screening.
- Breast cancer: biennial mammography ages 40–74.
- Lung cancer: annual low-dose CT, ages 50–80, ≥20 pack-years, currently smoking or quit within 15 years.
- Hepatitis C: one-time antibody testing ages 18–79; HIV: ages 15–65 at least once.
- Abdominal aortic aneurysm: one-time ultrasound in men 65–75 who ever smoked.
- Osteoporosis: DXA in women 65 and older; earlier with risk factors.
Immunization thresholds change often - verify the current ACIP schedule rather than memorizing a snapshot (influenza annually, Tdap once then Td every 10 years, recombinant zoster at 50, pneumococcal and RSV by current age/risk criteria).
Traps
- Screening the already-screened: Pap testing after total hysterectomy for benign disease, or repeating a normal colonoscopy too early.
- Confusing screening with diagnostic testing; a positive screen leads to a diagnostic workup.
- Forgetting counseling and chemoprevention (smoking cessation, statins, pre-exposure prophylaxis).
Worked rule of thumb
Pack-years = packs per day × years smoked. A patient smoking one pack daily for 25 years has 25 pack-years and qualifies for lung cancer screening if age and quit-date criteria are met.
Professional Practice: Scope, Ethics, Legal, and Systems
Scope is jurisdictional
NP scope of practice is set by state law, not by the exam. Know whether your state is full, reduced, or restricted practice and whether a collaborative agreement, supervision, or mandated formulary applies. Prescriptive authority for controlled substances requires DEA registration and, in most states, PDMP query before prescribing opioids or benzodiazepines. Federal and state rules differ on schedule II refills and quantity limits.
Consent, confidentiality, and reporting
Valid informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness. HIPAA permits disclosure of the minimum necessary information for treatment, payment, and operations, plus specific public-health and safety exceptions. Mandatory reporting typically covers child and elder abuse, certain communicable diseases, and serious threats to identifiable others (duty to warn/protect). Minors' consent for confidential services (STI, contraception, mental health) varies by state - know your statute, and remember that explanation-of-benefits mailings can breach adolescent confidentiality.
Ethics and quality
Apply autonomy, beneficence, nonmaleficence, and justice. Malpractice requires four elements: duty, breach of the standard of care, causation, and damages. Quality improvement uses PDSA cycles and root-cause analysis; evidence appraisal ranks systematic reviews and RCTs above cohort and case series. Document with SOAP structure and medical decision-making that justifies the level of service.
Traps
- Assuming your scope equals a physician's, or that hospital privileging follows licensure automatically.
- Breaching confidentiality reflexively instead of asking whether a reporting duty or serious threat applies.
- Overlooking implicit bias and language access - use a qualified interpreter, not a family member.
Worked rule of thumb
When an ethical question feels like a conflict between two principles, identify which principle is being overridden and whether the least restrictive alternative protects the patient and the public. When in doubt about reporting, consult and document the reasoning.