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Difficulty: MediumClinical Preventive Services and Screening

A 65-year-old woman comes to the physician for a routine health maintenance examination. She feels well and has no acute complaints. She went through menopause at age 51 and denies any postmenopausal vaginal bleeding. Her medical history is significant for well-controlled essential hypertension, for which she takes lisinopril. She smoked one pack of cigarettes daily for 25 years but quit 20 years ago. Her mother died of a myocardial infarction at age 75.

Review of her medical records shows:
- A normal screening colonoscopy at age 57.
- A normal screening mammogram 6 months ago.
- Negative cervical cytology and human papillomavirus cotesting at ages 55, 60, and 64.
- No history of fractures, and she has never had a bone density scan.

Vital signs are within normal limits. Physical examination shows no abnormalities.

Which of the following is the most appropriate next step in the health maintenance of this patient?

  1. A
    Cervical cytology and human papillomavirus cotesting
  2. B
    Measurement of serum free thyroxine levels
  3. Dual-energy x-ray absorptiometryAnswer
  4. D
    Endometrial biopsy
  5. E
    Live-attenuated influenza vaccination

Answer

Dual-energy x-ray absorptiometry
The USPSTF recommends osteoporosis screening with dual-energy x-ray absorptiometry (DEXA) for all women aged 65 years and older. This patient has reached the age threshold and has no prior bone density scans, making DEXA the most appropriate indicated preventive service during this visit. She is already up to date on her colorectal and breast cancer screenings, and she no longer requires cervical or lung cancer screening.

Step-by-Step Solution

1
Review the patient's cancer screening history and current age.
She is 65 years old. Breast cancer screening is up to date (mammogram 6 months ago). Colorectal cancer screening is up to date (colonoscopy at age 57, due at 67). Cervical cancer screening criteria for discontinuation have been met (adequate negative tests, now age 65).
To rule out any immediate need for cancer screening based on USPSTF guidelines.
2
Assess the patient's eligibility for lung cancer screening.
She has a 25 pack-year history but quit 20 years ago. She does not meet the criteria for low-dose chest CT.
Screening is only indicated for patients aged 50-80 with a 20+ pack-year history who currently smoke or have quit within the past 15 years.
3
Determine the age-specific preventive requirements for a 65-year-old female.
The USPSTF Grade A recommendation states all women aged 65 and older should undergo osteoporosis screening.
She has never had a DEXA scan and has just reached the starting age for routine osteoporosis screening.

Key Concept

USPSTF guidelines recommend routine osteoporosis screening with dual-energy x-ray absorptiometry (DEXA) for all women starting at age 65.
Estimated Time:1m 30s
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Topics

Clinical Preventive Services and Screening

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