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Tobacco use disorder — USMLE Step 3 MCQ

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EasyAmbulatory Medicine / Primary CareTobacco use disorderUSMLE Step 3

A 60-year-old man with a 45-pack-year smoking history wants to quit. He smokes 20 cigarettes daily and failed nicotine gum because of cravings. He has no seizure disorder, eating disorder, or current opioid use. PHQ-2 score is 0. Which of the following is the most appropriate next step in management?

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Correct answer: E — Offer varenicline with behavioral support

Counseling plus pharmacotherapy improves tobacco cessation; varenicline is an effective first-line option when no contraindication exists.

Reference: USPSTF tobacco cessation recommendation; US Public Health Service tobacco guidance