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Difficulty: HardClinical Preventive Services and Screening

Review the following patient profiles presenting for routine health maintenance. Which targeted preventive service or screening intervention is most appropriate for each patient? Match each patient profile with their corresponding guideline-concordant USPSTF Grade A or B recommendation.

  • Female patient, 33 years of age, with a maternal history of breast cancer diagnosed at age 45. She is asymptomatic and has never had genetic testing.Administration of a brief familial risk assessment tool and potential referral for genetic counseling
  • Male patient, 45 years of age, asymptomatic. He reports a history of unprotected sex with multiple male partners over the preceding 12 months.Screening for HIV and syphilis, and provision of preexposure prophylaxis (PrEP)
  • Female patient, 28 years of age, who immigrated from a region with high tuberculosis endemicity 3 years ago and currently works in a long-term care facility. She has no cough or weight loss.Screening for latent tuberculosis infection with a tuberculin skin test or interferon-gamma release assay
  • Male patient, 52 years of age, with essential hypertension and a calculated 10-year ASCVD risk of 12%12\%. His fasting lipid panel is within normal limits.Initiation of a low- to moderate-dose statin for primary prevention of cardiovascular events

Answer

The correct matches require applying specific USPSTF guidelines for targeted risk groups: the 33-year-old female needs BRCA risk assessment, the 45-year-old male needs PrEP and STI screening, the 28-year-old immigrant needs latent TB screening, and the 52-year-old male with hypertension needs statin therapy.
Each patient represents a specific high-risk demographic that triggers a targeted USPSTF recommendation. The 33-year-old female requires familial risk assessment for potential BRCA mutations. The 45-year-old male requires comprehensive STI screening and PrEP due to high-risk sexual behavior. The 28-year-old female requires latent TB screening due to her immigration history and occupational exposure. The 52-year-old male requires a statin for primary cardiovascular prevention based on his ASCVD risk exceeding 10%10\% and the presence of hypertension.

Step-by-Step Solution

1
Analyze the 33-year-old female with a strong family history of early-onset breast cancer.
Indicates a need for BRCA risk assessment.
The USPSTF recommends using a brief familial risk assessment tool for women with a family history suggestive of BRCA1/2 mutations before referring for genetic counseling.
2
Analyze the 45-year-old male with high-risk sexual behavior.
Indicates a need for PrEP, HIV, and syphilis screening.
Men who have sex with men and engage in unprotected intercourse are at high risk for HIV and syphilis, warranting routine screening and the provision of preexposure prophylaxis.
3
Analyze the 28-year-old immigrant working in a healthcare setting.
Indicates a need for latent tuberculosis screening.
Populations at increased risk for TB, such as immigrants from highly endemic areas and healthcare workers, should be screened with an IGRA or TST.
4
Analyze the 52-year-old male with hypertension and an ASCVD risk of 12%12\%.
Indicates a need for primary prevention with a statin.
Adults aged 40-75 with ≥1\geq 1 CVD risk factor and a 10-year ASCVD risk ≥10%\geq 10\% should be initiated on a low- to moderate-dose statin.

Key Concept

Targeted USPSTF Grade A and B preventive services based on specific patient risk factors.
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Topics

Clinical Preventive Services and Screening

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