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Difficulty: MediumClinical Preventive Services and Screening

Match each patient presentation to the most appropriate, guideline-based clinical preventive screening test indicated at their current visit based on United States Preventive Services Task Force (USPSTF) recommendations.

  • A 58-year-old man with a BMI of 23 kg/m² who currently smokes 1.5 packs of cigarettes daily for the past 20 years.Annual low-dose computed tomography of the chest
  • A 68-year-old man with a BMI of 24 kg/m² who quit smoking 30 years ago (15 pack-year history) and has never had abdominal imaging.One-time ultrasonography of the abdomen
  • A 67-year-old woman with a BMI of 22 kg/m² who has never smoked and has never undergone bone density testing.Dual-energy x-ray absorptiometry of the hip and spine
  • A 42-year-old man with a BMI of 31 kg/m², normal blood pressure, and no history of smoking.Fasting plasma glucose or hemoglobin A1c testing

Answer

The 58-year-old smoker matches with annual low-dose CT. The 68-year-old former smoker matches with one-time abdominal ultrasound. The 67-year-old woman matches with DEXA scan. The 42-year-old obese man matches with fasting plasma glucose or HbA1c testing.
Each patient precisely meets the demographic and risk-factor requirements for a specific USPSTF Grade A or B recommendation: lung cancer screening for the current heavy smoker (age 50-80, 20+ pack-years), AAA screening for the older male former smoker (men 65-75 with any smoking history), osteoporosis screening for the woman over 65, and diabetes screening for the middle-aged obese patient (adults 35-70 with BMI ≥ 25).

Step-by-Step Solution

1
Evaluate the 58-year-old man with a 30 pack-year smoking history.
Matches criteria for lung cancer screening.
He is between 50 and 80 years old, has at least a 20 pack-year history of smoking, and is a current smoker.
2
Evaluate the 68-year-old man who quit smoking 30 years ago.
Matches criteria for abdominal aortic aneurysm (AAA) screening.
He is a male between 65 and 75 years old who has a lifetime history of smoking (at least 100 cigarettes in his lifetime).
3
Evaluate the 67-year-old woman with no smoking history.
Matches criteria for osteoporosis screening.
She is a female aged 65 years or older, which is the demographic requiring baseline DEXA screening regardless of other risk factors.
4
Evaluate the 42-year-old man with a BMI of 31 kg/m².
Matches criteria for diabetes screening.
He is between 35 and 70 years old and has a BMI categorizing him as obese (>30 kg/m²), indicating the need for diabetes screening.

Key Concept

USPSTF guidelines mandate age, sex, and risk-factor specific clinical preventive screenings, emphasizing selective testing to maximize mortality benefit while minimizing unnecessary and potentially harmful procedures.
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Topics

Clinical Preventive Services and Screening

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