CPC Integrated Primary and Preventive Care 2 — Questions and Answers
Question 1: According to USPSTF guidelines, at what age should average-risk adults begin colorectal cancer screening?
- 40 years
- 45 years (Correct answer)
- 50 years
- 60 years
Correct answer: 45 years
The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults, down from the previous age of 50.
In May 2021, the USPSTF issued a Grade B recommendation to begin colorectal cancer screening at age 45 for average-risk individuals, extending coverage to the 45–49 age group. Accepted modalities include annual high-sensitivity fecal immunochemical test (FIT), fecal occult blood test (FOBT), or colonoscopy every 10 years. Community paramedics conducting home visits can identify patients who are overdue for screening and coordinate referrals to primary care or connect patients to mobile screening units, thereby reducing cancer mortality through early detection.
Question 2: A community paramedic measures a patient's blood pressure as 148/94 mmHg on two separate visits. According to the 2017 ACC/AHA guidelines, this reading is classified as:
- Elevated blood pressure
- Stage 1 hypertension
- Stage 2 hypertension (Correct answer)
- Hypertensive urgency
Correct answer: Stage 2 hypertension
Under the 2017 ACC/AHA guidelines, Stage 2 hypertension is defined as systolic ≥140 mmHg or diastolic ≥90 mmHg. A reading of 148/94 mmHg on two occasions meets these criteria.
The 2017 ACC/AHA Blood Pressure Guidelines reclassified hypertension into: Normal (<120/80), Elevated (120–129/<80), Stage 1 HTN (130–139/80–89), and Stage 2 HTN (≥140/≥90). A persistent reading of 148/94 mmHg meets Stage 2 criteria, warranting prompt pharmacological treatment alongside lifestyle modification. Community paramedics play a key role in hypertension management by providing home blood pressure monitoring, medication reconciliation, adherence support, and dietary counseling as part of a team-based care model.
Question 3: Which immunization is recommended annually for all adults aged 6 months and older regardless of health status?
- Pneumococcal vaccine (PPSV23)
- Influenza vaccine (Correct answer)
- Shingles vaccine (Shingrix)
- Tetanus-diphtheria-pertussis (Tdap)
Correct answer: Influenza vaccine
The CDC Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for all persons aged 6 months and older, making it the only vaccine with an annual universal recommendation.
Influenza strains mutate annually, requiring reformulation of the vaccine each season. ACIP recommends annual influenza vaccination universally from age 6 months onward, with special emphasis on high-risk groups (≥65, immunocompromised, chronic illness, pregnancy). Community paramedics can administer influenza vaccines under standing orders or collaborative practice agreements, increasing vaccination rates in homebound and hard-to-reach populations. Documentation in state immunization registries ensures continuity and prevents duplicate dosing.
Question 4: Which of the following BEST describes the role of a community paramedic in primary stroke prevention?
- Administer tPA at the first sign of stroke symptoms in the home
- Identify and manage modifiable stroke risk factors including hypertension, atrial fibrillation, and smoking (Correct answer)
- Transport all patients aged >65 years to stroke centers preventively
- Prescribe anticoagulation for patients with identified AF
Correct answer: Identify and manage modifiable stroke risk factors including hypertension, atrial fibrillation, and smoking
Primary stroke prevention focuses on identifying and controlling modifiable risk factors. Community paramedics assess BP, screen for AF (via pulse check or ECG), provide smoking cessation support, and coordinate with PCPs — not prescribe or administer stroke medications.
Modifiable risk factors for ischemic stroke include hypertension (the strongest), atrial fibrillation, diabetes, hyperlipidemia, smoking, obesity, and physical inactivity. Community paramedics conduct home-based risk-factor surveillance: measuring blood pressure, performing 12-lead ECG screening for AF, reviewing medication adherence (especially antihypertensives and anticoagulants), and delivering brief smoking cessation counseling. tPA is an emergency treatment, not a preventive measure, and requires hospital-level infrastructure. Anticoagulation prescribing is outside the CP scope of practice.
Question 5: When performing a home fall risk assessment, which tool is most commonly used to assess mobility and dynamic balance?
- MMSE (Mini-Mental State Examination)
- Timed Up and Go (TUG) test (Correct answer)
- Barthel Index
- Glasgow Coma Scale
Correct answer: Timed Up and Go (TUG) test
The Timed Up and Go (TUG) test measures the time a patient takes to rise from a chair, walk 3 meters, turn around, and return to seated — a validated predictor of fall risk in community-dwelling adults.
The TUG test is a widely validated, quick screening tool for fall risk. A completion time >12 seconds is associated with significantly increased fall risk; >20 seconds indicates high fall risk and dependence. Community paramedics administer TUG during home visits and pair findings with environmental hazard assessments. Results guide referrals to physical therapy, home modification programs (grab bars, removal of trip hazards), and medication review (polypharmacy is a key fall driver). The MMSE assesses cognition, the Barthel Index measures ADL independence, and GCS measures acute neurological status.
Question 6: A community paramedic is conducting a wellness visit for a 52-year-old male smoker with a 30 pack-year history. Per USPSTF guidelines, which screening is MOST indicated for this patient?
- Annual chest X-ray
- Annual low-dose CT (LDCT) of the chest (Correct answer)
- Sputum cytology every 6 months
- Bronchoscopy at first visit
Correct answer: Annual low-dose CT (LDCT) of the chest
USPSTF recommends annual low-dose CT (LDCT) lung cancer screening for adults aged 50–80 with a 20+ pack-year smoking history who currently smoke or quit within the past 15 years.
The USPSTF updated its lung cancer screening recommendation in 2021: annual LDCT for adults aged 50–80 years who have a 20 pack-year smoking history AND currently smoke or have quit within the past 15 years. This patient (52-year-old, 30 pack-years, active smoker) clearly meets criteria. Annual chest X-ray has not been shown to reduce lung cancer mortality. Community paramedics identify eligible patients during home visits, provide shared decision-making counseling about LDCT benefits and risks (false positives, radiation), and facilitate referrals.
CPC Integrated Primary and Preventive Care 2
According to USPSTF guidelines, at what age should average-risk adults begin colorectal cancer screening?