Adult Medicine
What the exam tests
Adult medicine questions cluster around chronic disease screening, risk stratification, and antibiotic or anticoagulant decisions. Anchor these numbers: colorectal cancer screening ages 45–75; lung cancer screening with low-dose CT for adults 50–80 with ≥20 pack-years who currently smoke or quit within 15 years; one-time hepatitis C screening ages 18–79; abdominal aortic ultrasound for men 65–75 who have ever smoked; and diabetes screening for adults 35–70 with overweight or obesity. Statin therapy is triggered by a 10-year ASCVD risk ≥10% (moderate intensity) or 7.5–9.9% with risk enhancers. Hypertension treatment generally starts at ≥140/90 in low-risk patients and ≥130/80 for those with diabetes, CKD, or established cardiovascular disease.
Traps
- Treating asymptomatic bacteriuria (screen and treat only in pregnancy and before urologic procedures).
- Chasing a mildly elevated TSH with a normal free T4 - repeat in 6–8 weeks rather than reflexively starting levothyroxine.
- Prescribing antibiotics for acute bronchitis, or for sinus symptoms present only a few days; watchful waiting is appropriate for many uncomplicated cases.
- Forgetting that anticoagulation in atrial fibrillation is driven by a validated score (CHA₂DS₂-VASc), and that aspirin is no longer routine primary prevention in older adults.
- Ignoring medication adherence and cost before intensifying therapy.
Rule of thumb
When a question asks for the next best step, first confirm the patient meets the age and risk criteria for the test. If they do not, the answer is usually no test.
Worked example: a 68-year-old who smoked 40 pack-years and quit 3 years ago meets criteria for annual low-dose CT. A 45-year-old never-smoker with a cough does not; image only if red flags are present.