Health Promotion and Disease Prevention
What the exam tests
Health promotion questions ask you to match a patient's age, sex, risk factors, and preferences to a screening or counseling service, then decide whether it is indicated, optional, or discouraged. Know the USPSTF framework: grade A/B services are recommended; C requires shared decision-making; D is discouraged; I means evidence is insufficient. Screening applies only to asymptomatic people. A test ordered to evaluate symptoms is diagnostic, not screening.
High-yield specifics
Adults 45–75 need colorectal cancer screening (colonoscopy every 10 years, annual FIT, or another validated strategy). Cervical screening begins at 21 and may stop at 65 after adequate prior negative screening. Mammography is biennial from 40–74. Men 65–75 who have ever smoked need a one-time abdominal aortic ultrasound. Adults 50–80 with at least 20 pack-years who currently smoke or quit within 15 years qualify for annual low-dose CT. Offer one-time hepatitis C screening for adults 18–79 and HIV screening for ages 15–65. Screen for diabetes at 35–70 if overweight or obese, and for osteoporosis in women 65 and older. Ask about tobacco, alcohol, and depression; vaccinate per the adult schedule (influenza annually, Td/Tdap every 10 years, zoster at 50, pneumococcal by age and risk).
Traps
Do not screen patients with limited life expectancy for cancers whose benefit takes years to accrue. Do not repeat a normal colonoscopy annually. Do not order PSA screening without shared decision-making for men 55–69. Do not treat a positive screen as a diagnosis-confirm it.
Rule of thumb
Before ordering any screening test, ask: Is the patient asymptomatic? Is the patient in the eligible risk group? Would a positive result change management? If any answer is no, reconsider.