16.2 Cardiovascular & Metabolic Screening and Primary Prevention

ABIM Internal Medicine Exam

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1 Chapter 0: The ABIM Exam, Blueprint & Study Strategy

0.1 Exam Format, Question Types & the 2026 Blueprint 0.2 Eligibility, Registration, Fees & Exam-Day Logistics 0.3 Scoring, the Passing Standard & Score Reports 0.4 Building a Blueprint-Weighted Study Plan

2 Chapter 1: Cardiovascular Disease (14% of Exam)

1.1 Ischemic Heart Disease & Acute Coronary Syndromes 1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI 1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention 1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias 1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy 1.6 Device Therapy, HFpEF & the Cardiomyopathies 1.7 Valvular Heart Disease & Endocarditis Prophylaxis 1.8 Pericardial Disease & Acute Aortic Syndromes 1.9 Hypertension: Classification, Diagnosis & Secondary Causes 1.10 Hypertensive Crises & Dyslipidemia 1.11 Adult Congenital Heart Disease & Coarctation of the Aorta 1.12 Syncope: Reflex, Orthostatic & Cardiac Causes 1.13 Cardiac Physical Examination, Murmurs & Antithrombotic Selection

3 Chapter 2: Endocrinology, Diabetes & Metabolism (9% of Exam)

2.1 Diabetes Mellitus: Diagnosis, Glycemic Targets & Pharmacotherapy 2.2 Insulin Therapy, Hyperglycemic Emergencies & Chronic Complications 2.3 Thyroid Function Testing & Hypothyroidism 2.4 Thyrotoxicosis, Thyroid Storm & Thyroid Nodules 2.5 Adrenal & Pituitary Disorders 2.6 Hypercalcemia, Hypocalcemia & Disorders of Mineral Metabolism 2.7 Osteoporosis & Paget Disease of Bone 2.8 Ovarian, Testicular & Reproductive Endocrine Disorders 2.9 Hypoglycemia, Endocrine Tumors, Polyglandular Syndromes & Severe Hypertriglyceridemia

4 Chapter 3: Gastroenterology & Hepatology (9% of Exam)

3.1 Esophageal Disease 3.2 Stomach & Duodenal Disease and Gastrointestinal Hemorrhage 3.3 Inflammatory Bowel Disease 3.4 Celiac Disease & Irritable Bowel Syndrome 3.5 Diverticular Disease & Colorectal Cancer Screening 3.6 Viral Hepatitis, Steatotic & Alcohol-Associated Liver Disease 3.7 Cirrhosis & the Complications of Portal Hypertension 3.8 Acute Pancreatitis 3.9 Chronic Pancreatitis & Biliary Tract Disease 3.10 Inherited, Autoimmune & Drug-Induced Liver Disease 3.11 Small Intestinal Disease, Ischemia & Gastrointestinal Complications of HIV

5 Chapter 4: Infectious Disease (9% of Exam)

4.1 Lower Respiratory Tract Infections & Sepsis Syndromes 4.2 Viral Respiratory Pathogens & Tuberculosis 4.3 Central Nervous System Infections 4.4 Skin, Soft Tissue, Bone & Joint Infections 4.5 Infective Endocarditis & Cardiovascular Infection 4.6 Clostridioides difficile & Catheter-Related Bloodstream Infection 4.7 HIV Diagnosis, Antiretroviral Therapy & Prevention 4.8 Opportunistic Infections & Sexually Transmitted Infections 4.9 Fever of Unknown Origin, Neutropenic Fever & Toxic Shock 4.10 Travel-Related Illness, Vector-Borne Disease & Outbreaks 4.11 Infection Prevention, Nosocomial Infection & Postexposure Prophylaxis 4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

6 Chapter 5: Pulmonary Disease (9% of Exam)

5.1 COPD: Diagnosis, GOLD Classification & Initial Pharmacotherapy 5.2 Interventions That Reduce COPD Mortality & Exacerbation Management 5.3 Asthma: Diagnosis, Stepwise Therapy & Status Asthmaticus 5.4 Interstitial Lung Disease & Idiopathic Pulmonary Fibrosis 5.5 Sarcoidosis, Hypersensitivity Pneumonitis & Occupational Lung Disease 5.6 Pulmonary Embolism: Diagnosis, Risk Stratification & Anticoagulation 5.7 Pulmonary Hypertension & Sleep-Disordered Breathing 5.8 Acute Respiratory Distress Syndrome & Mechanical Ventilation 5.9 Pleural Disease, Empyema & Pneumothorax 5.10 Bronchiectasis, Cystic Fibrosis & Restrictive Lung Disease 5.11 Evaluation of Cough, Dyspnea, Hemoptysis & the Solitary Pulmonary Nodule

7 Chapter 6: Rheumatology & Orthopedics (9% of Exam)

6.1 Rheumatoid Arthritis: Diagnosis & Systemic Manifestations 6.2 Antirheumatic Pharmacotherapy & the Spondyloarthropathies 6.3 Gout: Pathophysiology & Acute Management 6.4 Urate-Lowering Therapy & Calcium Pyrophosphate Deposition Disease 6.5 Osteoarthritis 6.6 Systemic Lupus Erythematosus 6.7 Systemic Sclerosis, Sjogren Syndrome & Inflammatory Myopathies 6.8 The Vasculitides 6.9 Regional Musculoskeletal Syndromes, Back Pain & Sports Injuries 6.10 Other Primary Rheumatic Disorders & Mixed Connective Tissue Disease 6.11 Osteonecrosis & Metabolic Bone Disease

8 Chapter 7: Hematology (6% of Exam)

7.1 Approach to Anemia & the Microcytic Anemias 7.2 Macrocytic, Normocytic & Hemolytic Anemias 7.3 Hemoglobinopathies, Thalassemias & Paroxysmal Nocturnal Hemoglobinuria 7.4 Platelet Disorders, Thrombocytopenia & the Bleeding Patient 7.5 Coagulation Factor Disorders, Thrombophilia & Anticoagulant Reversal 7.6 Acute Leukemias, Chronic Leukemias & Myeloproliferative Neoplasms 7.7 Lymphomas & Plasma Cell Disorders 7.8 Myelodysplastic Syndrome, Myeloproliferative Neoplasms & Porphyria 7.9 Transfusion Medicine & Late Complications of Transplantation

9 Chapter 8: Medical Oncology (6% of Exam)

8.1 Breast, Lung, Colorectal & Prostate Cancer 8.2 Oncologic Emergencies 8.3 Genitourinary & Gynecologic Malignancies 8.4 Head and Neck, Bone & Soft Tissue Cancer and Cancer of Unknown Primary 8.5 Complications of Cancer & Its Treatment 8.6 Cancer Prevention, Survivorship & Psychosocial Care

10 Chapter 9: Nephrology & Urology (6% of Exam)

9.1 Acute Kidney Injury: Staging, Etiology & Urine Microscopy 9.2 Glomerular Disorders & Nephrotic Syndrome 9.3 Nephritic Syndromes, RPGN & Indications for Renal Replacement Therapy 9.4 Chronic Kidney Disease: Staging & Progression Retardation 9.5 Complications of Chronic Kidney Disease: Anemia, CKD-MBD & Acidosis 9.6 Hyponatremia, Hypernatremia & Water Balance 9.7 Potassium Disorders & Systematic Acid-Base Analysis 9.8 Renal Tubular Acidosis & Nephrolithiasis 9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions 9.10 Cystic Kidney Disease, Obstructive Uropathy, Tubulointerstitial Disease & Hematuria

11 Chapter 10: Neurology (4% of Exam)

10.1 Acute Ischemic Stroke: Syndromes & Reperfusion 10.2 Transient Ischemic Attack, Secondary Prevention & Hemorrhagic Stroke 10.3 Headache & Facial Pain 10.4 Seizures, Epilepsy & Movement Disorders 10.5 Multiple Sclerosis & Neuromuscular Junction Disorders 10.6 Motor Neuron Disease & Acute Peripheral Neuropathy 10.7 Cranial Neuropathies & Neuro-Ophthalmology 10.8 Peripheral Neuropathies, CNS Tumors & Other Neurologic Disorders

12 Chapter 11: Psychiatry & Behavioral Health (4% of Exam)

11.1 Major Depressive Disorder & Medical Mimics 11.2 Antidepressant Pharmacotherapy & Treatment-Resistant Depression 11.3 Bipolar Disorder, Mood Stabilizers & Lithium Toxicity 11.4 Anxiety, Stress-Related & Obsessive-Compulsive Disorders 11.5 Alcohol Use Disorder & Withdrawal 11.6 Pharmacotherapy for Alcohol & Opioid Use Disorder 11.7 Toxidromes, Psychiatric Emergencies & Suicide Risk Assessment 11.8 Psychotic, Somatic Symptom, Factitious & Personality Disorders 11.9 Eating Disorders, Sleep Disorders & Sexual Health

13 Chapter 12: Dermatology (3% of Exam)

12.1 Dermatitis, Papulosquamous & Inflammatory Dermatoses 12.2 Acne, Rosacea & Cutaneous Infections 12.3 Herpes Zoster & Autoimmune Blistering Diseases 12.4 Nodules, Tumors & Cutaneous Oncology 12.5 Dermatologic Emergencies & Severe Cutaneous Adverse Reactions 12.6 Pigment Disorders, Alopecia, Nail Disease & Photosensitivity 12.7 Vascular Dermatoses, Environmental Injury & Cutaneous Signs of Systemic Disease

14 Chapter 13: Obstetrics & Gynecology / Women's Health (3% of Exam)

13.1 Contraception, Preconception Care & Teratogenicity 13.2 Hypertensive Disorders of Pregnancy & Gestational Diabetes 13.3 Thyroid Disease & Venous Thromboembolism in Pregnancy 13.4 Menopause & Menopausal Hormone Therapy 13.5 Abnormal Uterine Bleeding, Endometrial Disease & Gynecologic Cancer Screening 13.6 Breast Disorders & Diseases of the Vulva and Vagina 13.7 Menstrual Disorders, Fibroids, Endometriosis & Early Pregnancy Complications

15 Chapter 14: Geriatric Syndromes (3% of Exam)

14.1 Comprehensive Geriatric Assessment & Frailty 14.2 Falls, Gait Assessment & Polypharmacy 14.3 Urinary Incontinence & Pressure Injuries in Older Adults 14.4 Mild Cognitive Impairment, Dementia & Its Subtypes 14.5 Delirium & the Pharmacotherapy of Cognitive Disorders 14.6 Palliative Care, Hospice & Advance Care Planning 14.7 Chronic Wounds, Nutrition, Swallowing, Constipation & Hip Fracture 14.8 Sensory Impairment, Dizziness, Elder Mistreatment & Care Settings

16 Chapter 15: Allergy & Immunology (2% of Exam)

15.1 Anaphylaxis: Recognition & Emergency Management 15.2 Urticaria & Angioedema 15.3 Drug Allergy, Desensitization & Adult Immunodeficiency 15.4 Food Allergy, Insect Venom Hypersensitivity, Serum Sickness & Contrast Reactions 15.5 Rhinitis, Conjunctivitis, Eosinophilic & Mast Cell Disorders

17 Chapter 16: Preventive Medicine, Immunization & Clinical Epidemiology

16.1 The USPSTF Framework & Evidence-Based Cancer Screening 16.2 Cardiovascular & Metabolic Screening and Primary Prevention 16.3 Adult Immunization & Vaccines in Special Populations 16.4 Clinical Epidemiology, Biostatistics & Study Design

18 Chapter 17: Miscellaneous - Ethics, Patient Safety & Quality Improvement (2% of Exam)

17.1 Principles of Bioethics & Decisional Capacity 17.2 Informed Consent, Treatment Refusal & Special Scenarios 17.3 Surrogate Decision-Making, Advance Directives & Confidentiality 17.4 Patient Safety Science, Medical Error & Diagnostic Reasoning 17.5 Quality Improvement Methods, Health Disparities & Health Equity

19 Chapter 18: Perioperative Medicine & Medical Consultation

18.1 Preoperative Cardiovascular Risk Assessment 18.2 Preoperative Pulmonary Risk & Perioperative Medication Management 18.3 Perioperative Anticoagulation, Bridging & Postoperative Complications

20 Chapter 19: Ophthalmology (1% of Exam)

19.1 The Acute Red Eye & Ophthalmic Emergencies 19.2 Painless Vision Loss & Chronic Ophthalmic Disease 19.3 Uveitis, Scleritis & Orbital Disease

21 Chapter 20: Otolaryngology & Dental Medicine (1% of Exam)

20.1 Dizziness, Vertigo & Epistaxis 20.2 Ear Disorders, Hearing Loss & Upper Respiratory Infections 20.3 Oral Cavity, Salivary Gland, Laryngeal & Taste and Smell Disorders

16.2 Cardiovascular & Metabolic Screening and Primary Prevention

Key Takeaways Explain This Topic AI

One-time abdominal aortic aneurysm ultrasonography is recommended for men aged 65 to 75 who have ever smoked.

Statin therapy for primary prevention is guided by calculated atherosclerotic cardiovascular disease risk together with LDL cholesterol level and risk enhancers.

Aspirin is no longer recommended for routine primary prevention because bleeding harm offsets cardiovascular benefit in most adults.

Hepatitis C screening is recommended once for all adults, and HIV screening at least once for adolescents and adults.

Coronary artery calcium scoring can refine treatment decisions for patients at intermediate calculated risk.

Last updated: August 2026

• 1. Cardiovascular & Metabolic Screening and Primary Prevention
• A. Hypertension Screening

USPSTF Recommendation (Grade A):

Adults aged >=40 years and those at increased risk (Black race, high-normal BP 130–139/85–89 mmHg, overweight/obese): Screen annually .

Adults aged 18 to 39 years with normal BP (<130/85 mmHg) and no risk factors: Screen every 3 to 5 years .

Mandatory Confirmation: Elevated in-office blood pressure readings must be confirmed with out-of-office BP measurement before establishing a formal diagnosis of hypertension and initiating lifetime pharmacotherapy:

24-Hour Ambulatory Blood Pressure Monitoring (ABPM): Gold standard (mean daytime BP >=130/80 mmHg or 24-hour mean >=125/75 mmHg confirms HTN).

Home Blood Pressure Monitoring (HBPM): Documented average BP >=130/80 mmHg across multiple morning and evening readings over 7 days.

Purpose: Rules out White-Coat Hypertension (elevated clinic BP, normal out-of-office BP) and detects Masked Hypertension (normal clinic BP, elevated out-of-office BP).

B. Lipid Screening & Statin Primary Prevention

USPSTF 2022 Statin Primary Prevention Recommendations:

Grade B (Prescribe Statin): Adults aged 40 to 75 years with NO history of CVD who have >=1 CVD risk factor (dyslipidemia [LDL >130 mg/dL or HDL <40 mg/dL], diabetes mellitus, hypertension, or current smoking) AND a calculated 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk of >=10% .

Grade C (Individualize Statin): Adults aged 40 to 75 years with >=1 CVD risk factor and a calculated 10-year ASCVD risk of 7.5% to <10% .

Grade I (Insufficient Evidence): Adults aged >=76 years with no prior history of CVD.

Severe Hypercholesterolemia Rule: Any patient aged 20–75 with baseline LDL-C >=190 mg/dL has an absolute indication for High-Intensity Statin (Atorvastatin 40–80 mg or Rosuvastatin 20–40 mg) without needing ASCVD risk calculation (Class I ACC/AHA recommendation).

Diabetes Mellitus Rule: Any patient aged 40–75 with Diabetes Mellitus warrants at least Moderate-Intensity Statin therapy regardless of calculated 10-year ASCVD score.

C. Abdominal Aortic Aneurysm (AAA) Screening

USPSTF 2019 Recommendation:

Men aged 65 to 75 years who have EVER smoked (>=100 lifetime cigarettes): One-time screening with abdominal ultrasonography ( Grade B ).

Men aged 65 to 75 years who have NEVER smoked: Selective screening based on family history of AAA, personal cardiovascular disease history, and preferences ( Grade C ).

Women who have NEVER smoked: Recommend against routine screening ( Grade D ).

Women who have smoked: Grade I (insufficient evidence; consider if first-degree relative had AAA).

Management Based on AAA Diameter:

< 3.0 cm: Normal aortic caliber; no surveillance required.

3.0 to 3.9 cm: Abdominal ultrasound surveillance every 2 to 3 years .

4.0 to 5.4 cm: Abdominal ultrasound or CT angiography every 6 to 12 months .

>= 5.5 cm in Men (or >= 5.0 cm in Women), OR rapid expansion (>0.5 cm in 6 months or >1.0 cm in 1 year), OR symptomatic: Indication for Elective Repair (Endovascular Aneurysm Repair [EVAR] or Open Surgical Repair).

D. Diabetes Mellitus & Prediabetes Screening

USPSTF 2021 Recommendation (Grade B): Screen for prediabetes and type 2 diabetes in non-pregnant adults aged 35 to 70 years who are overweight or obese (BMI >=25 kg/m2, or BMI >=23 kg/m2 in Asian American individuals ).

Diagnostic Testing:

• Fasting Plasma Glucose (FPG: normal <100 mg/dL; prediabetes 100–125 mg/dL; diabetes >=126 mg/dL),
• Hemoglobin A1c (normal <5.7%; prediabetes 5.7–6.4%; diabetes >=6.5%), OR

2-Hour 75g Oral Glucose Tolerance Test (OGTT: normal <140 mg/dL; prediabetes 140–199 mg/dL; diabetes >=200 mg/dL).

Rescreening Interval: If initial testing is normal, repeat screening every 3 years .

E. Osteoporosis Screening

USPSTF 2018 Recommendation (Grade B): Screen for osteoporosis with Dual-Energy X-ray Absorptiometry (DEXA) of the hip and lumbar spine in:

All women aged >=65 years , AND

Postmenopausal women aged <65 years who have an increased fracture risk equivalent to or greater than that of a 65-year-old white woman (calculated 10-year major osteoporotic fracture risk >=8.4% or 10-year hip fracture risk >=3.0% using the FRAX tool ; risk factors include low BMI <21 kg/m2, history of fragility fracture, parental hip fracture, current smoking, alcohol >=3 drinks/day, or chronic systemic glucocorticoid use >=5 mg prednisone daily for >=3 months).

Men: Grade I (insufficient evidence for routine screening in asymptomatic men without secondary causes of bone loss).

Diagnostic T-Score Thresholds:

• Normal: T-score >= -1.0
• Osteopenia: T-score between -1.0 and -2.5
• Osteoporosis: T-score <= -2.5 (or presence of a fragility fracture regardless of T-score)

Loading diagram... Evidence-Based Adult Cancer and Cardiovascular Screening Algorithm (USPSTF Standards)

2. Comprehensive Screening Summary Table

• Screening Target Target Population Recommended Modality Interval USPSTF Grade
• Breast Cancer Women aged 40–74 Mammography Every 2 years Grade B

Colorectal Cancer Adults aged 45–49; Adults aged 50–75 Colonoscopy; FIT / hsFOBT; Stool DNA-FIT Every 10 years; Annually; Every 3 years Grade B (45–49); Grade A (50–75)

Cervical Cancer Women aged 21–29; Women aged 30–65 Cervical Cytology; hrHPV alone OR Co-testing; Cytology alone Every 3 years; Every 5 years; Every 3 years Grade A ; Grade A ; Grade A

Lung Cancer Adults aged 50–80 with >=20 pack-year smoking (current or quit <15y) Low-Dose CT (LDCT) Annually Grade B

Prostate Cancer Men aged 55–69; Men aged >=70 PSA-based screening; PSA-based screening Individualized; Recommend against Grade C ; Grade D

Abdominal Aortic Aneurysm Men aged 65–75 who have ever smoked (>=100 cigs) Abdominal Ultrasound One-time Grade B

Hypertension Adults aged >=40 (or high risk); Adults aged 18–39 (normal BP) Office BP + ABPM confirmation; Office BP Annually; Every 3–5 years Grade A ; Grade A

Statin Primary Prevention Adults aged 40–75 with >=1 risk factor + 10-yr ASCVD >=10% Moderate-intensity statin Continuous Grade B

Type 2 Diabetes Adults aged 35–70 with BMI >=25 (>=23 in Asian Americans) Fasting glucose, HbA1c, or OGTT Every 3 years Grade B

Osteoporosis Women aged >=65; Postmenopausal <65 with high FRAX DEXA hip and spine Baseline / Periodic Grade B ; Grade B