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Difficulty: HardClinical Preventive Services and Screening

Match each patient's demographic and clinical profile with the most appropriate, guideline-concordant preventive service or screening recommendation for their current visit.

  • A 43-year-old asymptomatic man presenting for a physical exam. His mother was diagnosed with colon cancer at age 51. His last healthcare visit was 10 years ago.Screening colonoscopy currently, with a recommended interval of every 5 years
  • A 68-year-old man with well-controlled hypertension. In his twenties, he smoked half a pack of cigarettes daily for exactly one year, but has strictly abstained since.One-time screening ultrasonography of the abdominal aorta
  • A 55-year-old woman with a normal lipid panel who currently smokes and has a cumulative 25 pack-year smoking history. She had a normal screening colonoscopy 3 years ago.Annual screening with low-dose computed tomography of the chest
  • A 23-year-old asymptomatic sexually active woman using oral contraceptives. She has one monogamous partner. Her last Pap smear was normal at age 21.Routine nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae
  • A 12-month-old boy with a confirmed diagnosis of severe combined immunodeficiency (SCID) presenting for a routine well-child visit.Administration of inactivated immunizations only, withholding live-attenuated vaccines

Answer

The correct matches align specific demographic thresholds with USPSTF/ACIP guidelines: the 43-year-old with early family history needs 5-yearly colonoscopies; the 68-year-old brief-smoker qualifies as an 'ever smoker' for AAA ultrasound; the 55-year-old smoker needs LDCT; the 23-year-old requires NAAT for STIs but no Pap; and the SCID infant requires withholding of live vaccines.
Each correct match rigorously applies current national screening guidelines to nuanced clinical scenarios, identifying critical thresholds such as the >100>100 cigarette definition of an 'ever smoker' or the specific 5-year interval for high-risk colorectal screening.

Step-by-Step Solution

1
Evaluate the 43-year-old man's colorectal cancer risk profile.
He has a first-degree relative diagnosed at age 51.
This triggers high-risk screening protocols: starting at age 40 with a 5-year surveillance interval, matching with the 5-year colonoscopy option.
2
Calculate the lifetime cigarette exposure for the 68-year-old man.
Half a pack (10 cigarettes) per day for 365 days yields 3,650 cigarettes.
Since 3650>1003650 > 100, he meets the USPSTF definition of an 'ever smoker'. As a male aged 65-75, he requires a one-time AAA screening ultrasound.
3
Assess the 55-year-old woman's eligibility for lung cancer screening.
She is between 50 and 80 years old, has ≥20\ge 20 pack-years, and currently smokes.
She meets all three USPSTF criteria for annual LDCT screening.
4
Determine the necessary gynecologic preventive care for the 23-year-old.
She requires Chlamydia/Gonorrhea screening (indicated for sexually active females <25<25) but does not need a Pap smear (next due at age 24).
Overscreening with Pap smears is a common error; applying age-based STI screening is the correct preventive action.
5
Review the 12-month immunization schedule for an infant with SCID.
Standard 12-month live vaccines (MMR, Varicella) are absolutely contraindicated.
Only inactivated vaccines should be administered to prevent life-threatening vaccine-strain infections.

Key Concept

Application of strict demographic, temporal, and risk-factor thresholds to USPSTF and ACIP clinical preventive guidelines.

Alternative Method

When evaluating preventive care questions, sequentially verify Age, Sex, Risk Factors, and Timing of Last Screening to rapidly eliminate incorrect modalities.
Estimated Time:2m 0s
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Topics

Clinical Preventive Services and Screening

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