Preventive Care and Health Promotion
Core concepts
Preventive care questions test immunization schedules, cancer screening intervals, and counseling. Know adult vaccination: influenza annually, Tdap every 10 years (and each pregnancy), shingles at 50, pneumococcal by risk/age, and COVID per current guidance. Know cancer screening: colorectal (45–75), breast (shared decision, typically 40–74), cervical (21–65 with interval by method), and lung (annual low-dose CT for high-risk smokers). Understand USPSTF grades (A and B are recommended) and counseling topics: tobacco cessation, alcohol, obesity, STI prevention, and falls. Health behavior change models (transtheoretical stages) inform counseling.
Traps
- Screening outside recommended age ranges or intervals.
- Forgetting that shared decision-making applies to breast and prostate screening.
- Missing that Tdap is given in every pregnancy (27–36 weeks).
- Confusing primary prevention (statin for risk reduction) with secondary prevention (statin after MI).
Worked example / rule of thumb
A 52-year-old smoker with a 25 pack-year history: recommend annual low-dose CT lung screening (age 50–80, ≥20 pack-years, current or former smoker within 15 years). Rule of thumb: match screening to age, risk, and interval-not to patient request alone.
Counseling
Brief, repeated, nonjudgmental counseling outperforms one-time advice; combine with pharmacotherapy for tobacco cessation (varenicline, NRT, bupropion).