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Difficulty: MediumClinical Preventive Services and Screening

A 68-year-old man comes to the clinic to establish care after recently moving to the area. His past medical history is significant for essential hypertension and osteoarthritis. He reports that he smoked one pack of cigarettes daily from age 18 until he quit at age 45. He drinks alcohol occasionally. His family history is notable for a younger brother who was diagnosed with colon cancer at age 62. The patient brings his medical records, which demonstrate a normal screening colonoscopy performed at age 63. His current medications include lisinopril and acetaminophen as needed. Vital signs today are within normal limits, and physical examination shows no significant abnormalities. Which of the following is the most appropriate preventive screening intervention for this patient at this time?

  1. One-time ultrasonography of the abdomenAnswer
  2. B
    Annual low-dose computed tomography of the chest
  3. C
    Prostate-specific antigen testing
  4. D
    Administration of the live-attenuated zoster vaccine
  5. E
    Fecal immunochemical testing

Answer

The most appropriate preventive screening intervention is a one-time ultrasonography of the abdomen.
The correct answer is one-time ultrasonography of the abdomen because the USPSTF recommends this for all men aged 65 to 75 who have ever smoked (defined as at least 100 cigarettes in a lifetime). This patient is a 68-year-old man with a significant smoking history, placing him at increased risk for an abdominal aortic aneurysm. Early detection through ultrasound significantly reduces AAA-related mortality.

Step-by-Step Solution

1
Analyze the patient's demographic and social history.
The patient is a 68-year-old male with a history of smoking (27 pack-years).
Age and smoking history are key determinants for deciding eligibility for abdominal aortic aneurysm (AAA) and lung cancer screening.
2
Evaluate criteria for AAA screening.
He is a man between 65 and 75 years old who has smoked more than 100 cigarettes in his lifetime.
This strictly meets the USPSTF Grade B criteria for a one-time screening ultrasound for AAA.
3
Evaluate criteria for other common screenings (lung, colorectal).
He quit smoking 23 years ago (disqualifying him from lung cancer screening) and had a normal colonoscopy 5 years ago (disqualifying him from current colorectal screening).
To rule out other potential preventive interventions and confirm the single most appropriate next step.

Key Concept

The United States Preventive Services Task Force (USPSTF) recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
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Topics

Clinical Preventive Services and Screening

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