Kaplan USMLE Step 2: Screening test for 68-year-old lifelong smoker

If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.

A 68-year-old man comes to the physician for a routine maintenance examination. He denies chest pain, dyspnea, cough or shortness of breath. He has a five-year history of hypercholesterolemia controlled with atorvastatin. He recently retired from his job as a mail carrier. He has smoked one pack of cigarettes daily for 45 years. He drinks three to five beers on the weekends. His mother had a myocardial infarction at age 52 years, and his brother had a myocardial infarction at age 48 years. Complete blood count, metabolic panel and lipid panel were within normal limits eight months ago. He had a colonoscopy three years ago that showed no abnormalities. Which of the following is the most appropriate screening test for this patient? 

A. 12-lead electrocardiography

B. Abdominal ultrasound

C. Chest radiograph

D. Lipid panel

E. Prostate-specific antigen

The correct answer is B.

All male patients aged 65 to 75 years of age who have ever smoked should undergo one-time AAA screening via abdominal ultrasonography.

Choice A. A 12-lead electrocardiography (ECG), although a very sensitive test for myocardial injury or ischemia, is not recommended to screen for coronary heart disease. The USPSTF did not identify convincing evidence to recommend ECG as a screening test for asymptomatic patients.