Health Promotion and Disease Prevention
Core concepts
Know the USPSTF grade framework cold: A and B services are recommended (and generally covered without cost sharing under the ACA), C is selective/individualized, D is recommended against, and I is insufficient evidence. Questions love to test whether you can distinguish a screening recommendation from a counseling recommendation for the same condition.
Be fluent in the major adult screens and their intervals: colorectal cancer (start at 45, options include colonoscopy every 10 years, FIT annually, or stool-DNA), cervical cancer (start at 21 with cytology every 3 years, or 25 with primary HPV every 5 years, ending around 65 with adequate prior negative screening), breast cancer (biennial mammography 40–74), lung cancer (annual low-dose CT for ages 50–80 with ≥20 pack-years and current or quit within 15 years), and osteoporosis in women 65+. Vaccination schedules, HIV screening once for ages 15–65, and hepatitis C screening once for adults 18–79 are high-yield.
Traps
- Age cutoffs and stop rules - e.g., stopping cervical screening after hysterectomy with cervix removed for benign disease, or the 75-year upper bound for colorectal screening.
- Shared decision-making items (PSA, lung cancer in some edge cases, aspirin for primary prevention) - the answer is usually a discussion, not a blanket order.
- Risk-based vs. age-based initiation (e.g., earlier colorectal screening in family history or hereditary syndromes).
- Confusing screening with diagnostic testing.
Rule of thumb
If a stem describes an asymptomatic average-risk adult and asks "what is the next best step," first ask: Is there a grade A/B screen due for this age and risk? If yes, that usually beats a diagnostic workup or a lifestyle-counseling distractor.