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Difficulty: EasyClinical Preventive Services and Screening

A 66-year-old woman comes to the clinic to establish primary care. She recently moved to the area and has not seen a physician in over 5 years. She feels well and has no acute complaints. She takes no daily medications and has no chronic medical conditions. She went through menopause at age 51 and explicitly denies any postmenopausal bleeding. She has never smoked and consumes alcohol socially. She reports having a normal screening colonoscopy 4 years ago and a normal screening mammogram 6 months ago. Her blood pressure is 118/76 mm Hg, and body mass index is 23 kg/m². Physical examination is unremarkable. According to current preventive care guidelines, which of the following is the most appropriate next step in the care of this patient?

  1. A
    One-time abdominal ultrasonography
  2. B
    Routine endometrial biopsy
  3. Dual-energy x-ray absorptiometryAnswer
  4. D
    Low-dose chest computed tomography
  5. E
    Administration of live-attenuated influenza vaccine

Answer

Dual-energy x-ray absorptiometry
The correct answer is dual-energy x-ray absorptiometry (DEXA). The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing in all women aged 65 years and older, regardless of clinical risk factors. Because this patient is 66 years old and has not received medical care in 5 years, she is due for this one-time baseline screening to assess her fracture risk.

Step-by-Step Solution

1
Identify the patient's demographic and clinical history.
The patient is a 66-year-old asymptomatic woman who has never smoked and is up to date on her colon and breast cancer screenings.
Patient characteristics (age, sex, smoking history) determine which preventive screening recommendations apply.
2
Evaluate applicable USPSTF screening guidelines for a woman over 65.
Women aged 65 and older should undergo osteoporosis screening.
Age is the primary criterion for initiating baseline dual-energy x-ray absorptiometry (DEXA) in women.
3
Evaluate the other choices for lack of indication or contraindications.
The patient does not meet criteria for abdominal aortic aneurysm screening or lung cancer screening. Furthermore, the live-attenuated influenza vaccine is contraindicated.
To systematically rule out distractors and confirm the single best answer.

Key Concept

The USPSTF recommends osteoporosis screening with dual-energy x-ray absorptiometry (DEXA) for all women aged 65 years and older.
Estimated Time:1m 0s
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Topics

Clinical Preventive Services and Screening

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