APEA Health Promotion and Disease Prevention 1 — Questions and Answers
Question 1: According to USPSTF recommendations, which adults should receive aspirin therapy for primary prevention of cardiovascular disease?
- All adults over age 40 regardless of cardiovascular risk
- Adults aged 40 to 59 with 10% or greater 10-year CVD risk where benefit-harm balance is individualized; aspirin is NOT recommended for primary prevention in adults 60 and older (Correct answer)
- All adults with hypertension regardless of age
- Adults under age 30 at high CVD risk
Correct answer: Adults aged 40 to 59 with 10% or greater 10-year CVD risk where benefit-harm balance is individualized; aspirin is NOT recommended for primary prevention in adults 60 and older
The USPSTF 2022 guidelines recommend individualized aspirin use for primary prevention only in adults 40-59 with 10% or greater 10-year CVD risk. For adults 60 and older, primary prevention aspirin is not recommended due to increased bleeding risk outweighing benefit.
This represents a significant 2022 guideline update. USPSTF: Adults 40-59 with 10% or greater 10-year CVD risk — individualized decision (Grade C). Adults 60 and older — recommend against primary prevention (Grade D, harms exceed benefits due to GI bleeding risk). Aspirin for secondary prevention in established CVD is unchanged. This is high-yield FNP board content.
Question 2: A 45-year-old patient with a 30 pack-year smoking history and no symptoms asks about lung cancer screening. Per USPSTF recommendations, what is the appropriate recommendation?
- No screening recommended until symptoms develop
- Annual low-dose CT scan if aged 50 to 80 with 20 or more pack-year history who currently smokes or quit within the past 15 years (Correct answer)
- Annual chest X-ray for all smokers
- Bronchoscopy every 3 years for heavy smokers
Correct answer: Annual low-dose CT scan if aged 50 to 80 with 20 or more pack-year history who currently smokes or quit within the past 15 years
USPSTF recommends annual LDCT for lung cancer screening in adults aged 50-80 with 20 or more pack-year history who currently smoke or quit within the past 15 years (Grade B). This patient is 45 and not yet eligible by age criteria.
The 2021 USPSTF lung cancer screening update lowered the age from 55 to 50 and reduced the pack-year threshold from 30 to 20. This patient (age 45, 30 pack-years) does not meet the age criterion. When this patient turns 50 — if still meeting criteria — annual LDCT should be recommended. Shared decision-making regarding benefits, harms, and the importance of smoking cessation should be discussed.
Question 3: A 55-year-old woman with no family history asks about colorectal cancer screening options. Which of the following represents a current USPSTF-approved screening strategy?
- Digital rectal exam annually in primary care
- Colonoscopy every 10 years, annual high-sensitivity FOBT, or FIT-DNA test every 1 to 3 years — multiple modalities are acceptable (Correct answer)
- CT colonography every 20 years
- Sigmoidoscopy only for women over 65
Correct answer: Colonoscopy every 10 years, annual high-sensitivity FOBT, or FIT-DNA test every 1 to 3 years — multiple modalities are acceptable
USPSTF recommends colorectal cancer screening for all average-risk adults 45-75 using multiple acceptable modalities: colonoscopy every 10 years, annual high-sensitivity FOBT or FIT, sigmoidoscopy every 5 years, or FIT-DNA every 1-3 years.
The 2021 USPSTF update lowered the colorectal cancer screening start age from 50 to 45 (Grade B, ages 45-75; Grade C individualized 76-85; no recommendation above 85). Primary care NPs must counsel patients on available options, risks, and benefits to support informed decision-making.
Question 4: A 62-year-old male with a 40 pack-year smoking history asks about abdominal aortic aneurysm screening. USPSTF recommends AAA screening for which group?
- All adults over age 50 regardless of smoking history
- Men aged 65 to 75 who have ever smoked (100 or more cigarettes lifetime) — one-time abdominal ultrasound (Correct answer)
- Women aged 65 to 75 who currently smoke
- Annual CT angiography for all adults with family history of AAA
Correct answer: Men aged 65 to 75 who have ever smoked (100 or more cigarettes lifetime) — one-time abdominal ultrasound
USPSTF recommends one-time abdominal aortic ultrasound screening for men aged 65-75 who have ever smoked (100 or more cigarettes lifetime). Screening is not recommended for women or never-smokers in this age group.
AAA is significantly more common in men and in those with a smoking history. USPSTF Grade B recommendation: one-time screening abdominal ultrasound for men 65-75 who have ever smoked. This patient is only 62, so screening should be initiated at age 65 if he still meets criteria.
Question 5: Which vaccine is recommended by the ACIP for all adults 65 and older to prevent pneumococcal disease, per updated 2021 recommendations?
- PCV13 (Prevnar 13) alone
- PCV15 followed by PPSV23, or PCV20 alone — replacing the previous PCV13 strategy (Correct answer)
- Annual influenza vaccine only
- No pneumococcal vaccination is needed after age 65
Correct answer: PCV15 followed by PPSV23, or PCV20 alone — replacing the previous PCV13 strategy
Since 2021, ACIP recommends that adults 65 and older who have not previously received a pneumococcal conjugate vaccine receive PCV15 followed by PPSV23 one year later, or PCV20 alone — replacing the previous PCV13/PPSV23 strategy.
The 2021 ACIP update replaced PCV13 with higher-valent PCV15 and PCV20 for pneumococcal vaccination in adults 65 and older. Options include PCV20 alone or PCV15 followed by PPSV23 at least 1 year later. Adults who previously received PCV13 but not PPSV23 should receive PPSV23. This is a high-yield immunization update on FNP boards.
Question 6: A 38-year-old woman asks about osteoporosis screening. Per USPSTF recommendations, when should osteoporosis screening with DEXA scan begin for women?
- Age 30 for all women regardless of risk
- Age 65 for all women, or earlier for postmenopausal women under 65 with increased osteoporosis risk based on FRAX or a similar tool (Correct answer)
- Age 50 for all women
- Only after the first fragility fracture
Correct answer: Age 65 for all women, or earlier for postmenopausal women under 65 with increased osteoporosis risk based on FRAX or a similar tool
USPSTF recommends DEXA screening for all women 65 and older and for postmenopausal women under 65 whose fracture risk is equal to or greater than that of a 65-year-old white woman with no additional risk factors, based on risk assessment tools like FRAX.
USPSTF Grade B recommendation for osteoporosis screening: all women 65 and older. For postmenopausal women under 65, use FRAX to determine if 10-year fracture probability equals or exceeds the reference threshold. This patient is 38 and premenopausal — no screening indicated. Risk factors that may accelerate eligibility include early menopause, corticosteroid use, and malabsorption syndromes.
APEA Health Promotion and Disease Prevention 1
According to USPSTF recommendations, which adults should receive aspirin therapy for primary prevention of cardiovascular disease?