APEA Health Promotion and Disease Prevention 2 — Questions and Answers
Question 1: According to USPSTF recommendations, which adults should be screened for prediabetes and type 2 diabetes?
- Only adults with symptoms of hyperglycemia
- Overweight or obese adults aged 35 to 70 — screening every 3 years if normal, or more frequently with risk factors (Correct answer)
- All adults over age 18 annually
- Only adults with a first-degree relative with type 2 diabetes
Correct answer: Overweight or obese adults aged 35 to 70 — screening every 3 years if normal, or more frequently with risk factors
USPSTF recommends screening for prediabetes and type 2 diabetes in overweight or obese adults aged 35-70. Screening every 3 years is appropriate for normal results.
The 2021 USPSTF recommendation lowered the age for diabetes screening from 40 to 35 for overweight or obese adults. Acceptable screening tests include fasting plasma glucose, 2-hour OGTT, A1C, or random glucose with symptoms. Prediabetes is defined as FPG 100-125, OGTT 140-199, or A1C 5.7-6.4%. Early detection enables lifestyle intervention to delay or prevent progression.
Question 2: A 30-year-old male patient asks about testicular cancer screening. According to USPSTF guidelines, the recommended approach is:
- Annual testicular ultrasound for all men ages 15 to 35
- Monthly self-examination and annual clinical exam for all men
- USPSTF recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males (Correct answer)
- PSA testing as a surrogate marker for testicular cancer
Correct answer: USPSTF recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males
The USPSTF recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males (Grade D), as harms outweigh benefits given the high cure rate even for detected tumors.
Testicular cancer has an excellent prognosis even when diagnosed at later stages, with greater than 95% 5-year survival rate. The USPSTF Grade D recommendation against screening is based on the absence of evidence that screening reduces mortality combined with potential harms including anxiety, false positives, and overtreatment.
Question 3: In primary prevention counseling, which lifestyle modification has the strongest evidence for reducing all-cause cardiovascular mortality in adults?
- Eliminating all dietary fat
- Regular aerobic exercise of at least 150 minutes of moderate-intensity activity per week (Correct answer)
- Vitamin E supplementation
- Daily red wine consumption for polyphenols
Correct answer: Regular aerobic exercise of at least 150 minutes of moderate-intensity activity per week
Regular aerobic exercise meeting AHA guidelines of at least 150 minutes per week of moderate intensity has the strongest evidence base for reducing cardiovascular mortality through multiple mechanisms.
AHA physical activity guidelines recommend at least 150 minutes per week of moderate-intensity or at least 75 minutes per week of vigorous-intensity aerobic activity for adults. Benefits include reduced systolic BP, improved HDL and LDL levels, improved insulin sensitivity, weight management, and reduced inflammatory markers. Vitamin E supplementation has been shown to be ineffective for CVD prevention.
Question 4: USPSTF recommends screening for unhealthy alcohol use in adults. Which validated screening tool is most commonly used in primary care?
- CAGE questionnaire alone for all presentations
- AUDIT-C (3-item Alcohol Use Disorders Identification Test Consumption) with full AUDIT-10 for positive screens (Correct answer)
- Blood alcohol level testing at routine visits
- Liver function tests as the primary alcohol screen
Correct answer: AUDIT-C (3-item Alcohol Use Disorders Identification Test Consumption) with full AUDIT-10 for positive screens
The AUDIT-C is the recommended brief alcohol screening tool for primary care, consisting of 3 questions. A positive screen triggers the full 10-item AUDIT for comprehensive assessment.
USPSTF Grade B recommendation supports screening all adults for unhealthy alcohol use. AUDIT-C covers 3 questions on frequency, typical drinks per occasion, and frequency of heavy drinking. Scoring positive thresholds: men 4 or above, women 3 or above. Full AUDIT-10 assesses consumption patterns, dependence symptoms, and alcohol-related problems.
Question 5: A nurse practitioner is counseling a 28-year-old woman of childbearing age about folic acid supplementation. The USPSTF recommends:
- Folic acid only after a positive pregnancy test
- 400 to 800 mcg of folic acid daily for all women planning or capable of becoming pregnant to prevent neural tube defects (Correct answer)
- 1 mg folic acid weekly for all adult women
- Folic acid supplementation only for women with previous NTD-affected pregnancies
Correct answer: 400 to 800 mcg of folic acid daily for all women planning or capable of becoming pregnant to prevent neural tube defects
USPSTF recommends 400-800 mcg of folic acid daily for all women who are planning or capable of pregnancy (Grade A). Supplementation should begin before conception since the neural tube closes by day 28.
Neural tube defects occur during the first 28 days of embryonic development, typically before a woman knows she is pregnant. USPSTF Grade A recommendation: 400-800 mcg per day for women who are planning pregnancy or could become pregnant. Women with a prior NTD-affected pregnancy should take 4 mg per day beginning 1-3 months before conception.
Question 6: Which primary prevention intervention has the strongest evidence for reducing mortality from colorectal cancer in average-risk patients?
- Annual digital rectal exams beginning at age 40
- Adherence to recommended colorectal cancer screening protocols beginning at age 45 (Correct answer)
- Daily aspirin for all adults over age 50
- High-fiber diet alone without formal screening
Correct answer: Adherence to recommended colorectal cancer screening protocols beginning at age 45
Adherence to evidence-based colorectal cancer screening protocols starting at age 45 is the strongest intervention for reducing CRC mortality through early detection and removal of precancerous polyps.
Colorectal cancer is the second leading cause of cancer death in the US. USPSTF Grade A (ages 45-75) supports screening through colonoscopy, FIT, guaiac FOBT, FIT-DNA, or CT colonography. Daily aspirin is no longer recommended for primary CRC prevention given bleeding risk. While a high-fiber diet is associated with reduced CRC risk, it does not substitute for formal screening.
APEA Health Promotion and Disease Prevention 2
According to USPSTF recommendations, which adults should be screened for prediabetes and type 2 diabetes?