NBME Family Medicine

Question 1

At what age does the USPSTF recommend that average-risk adults begin routine colorectal cancer screening?

Accepted Answer

45 years

Answer

The USPSTF recommends screening for average-risk adults from age 45 to 75, using colonoscopy, FIT, stool DNA testing or other accepted modalities.

Question 2

A healthy 35-year-old woman with no prior abnormal results asks about cervical cancer screening. Which is the most appropriate recommendation?

Accepted Answer

Cytology every 3 years, or primary HPV testing every 5 years

Answer

For average-risk women aged 30 to 65, acceptable options are cytology alone every 3 years, primary HPV testing every 5 years, or co-testing every 5 years. Annual screening is unnecessary.

Question 3

A 52-year-old man is newly diagnosed with type 2 diabetes. His eGFR is normal and he has no contraindications. Which is the best initial pharmacologic therapy alongside lifestyle modification?

Accepted Answer

Metformin

Answer

Metformin is first-line for most patients with type 2 diabetes. It is effective, inexpensive, weight-neutral and carries a low risk of hypoglycemia.

Question 4

Which patient should receive a one-time screening abdominal ultrasound for abdominal aortic aneurysm?

Accepted Answer

A 70-year-old man who smoked previously

Answer

The USPSTF recommends one-time ultrasound screening for AAA in men aged 65 to 75 who have ever smoked.

Question 5

Which patient meets criteria for annual low-dose CT lung cancer screening?

Accepted Answer

A 62-year-old with a 30 pack-year history who currently smokes

Answer

Criteria are age 50 to 80, a smoking history of at least 20 pack-years, and either current smoking or having quit within the past 15 years. The 62-year-old is the only patient who meets all of them.

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NBME Family Medicine