Ease Into Prep with a USMLE^® Step 2 CK Question of the Day

The correct answer is C. The American Diabetes Association (ADA) recommends screening for diabetes or prediabetes in all adults who have a BMI >25. According to the ADA, all adults older than age 45 years should be screened for diabetes. The U.S. Preventive Services Task Force (USPSTF) concluded that there is insufficient evidence to perform routine screening in healthy adults; however, screening for diabetes in patients with hypertension is recommended to assess cardiovascular risk. This patient does have hypertension and thus warrants screening for diabetes, even by conservative standards.

Measurement of C-reactive protein (choice A) in patients who have heart disease has shown a relationship with elevated protein levels. These are considered to be "putative" risk factors. Currently, measurement of C-reactive protein is not used as a routine screening test.

Elevated erythrocyte sedimentation rate (choice B) is an indication of inflammation. There is no history or physical examination findings to suggest an inflammatory process.

Homocysteine (choice D) has gained recent attention for its relationship with carotid disease. It has not yet been accepted, however, as a routine measure for assessing coronary disease risk.

Similarly, lipoprotein (a) (choice E) may be elevated in patients who have heart disease. This is not considered a traditional risk factor, however, and thus is not routinely screened.