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Difficulty: MediumPreventive Care and Screening

A 66-year-old male presents to his primary care physician for an annual wellness visit. He has a history of essential hypertension that is well-controlled with amlodipine. He reports feeling well and has no acute complaints. His social history is notable for smoking 1 pack of cigarettes per day from age 18 to 30, after which he completely quit. He drinks alcohol occasionally and exercises three times a week.

Review of his preventive care records reveals the following:
- Screening colonoscopy at age 60 was normal.
- Fasting lipid panel and plasma glucose levels obtained last year were within normal limits.
- He received the 20-valent pneumococcal conjugate vaccine (PCV20) at age 65.
- He completed the two-dose recombinant zoster vaccine series at age 50.
- He received a Tdap booster 3 years ago and his annual influenza vaccine 2 weeks ago.

The patient has never had any abdominal imaging. Vital signs today show a blood pressure of 122/78 mm Hg122/78 \text{ mm Hg}, heart rate of 72/min72/\text{min}, and a body mass index of 24 kg/m224 \text{ kg/m}^2. Physical examination is unremarkable.

Which of the following is the most appropriate next step in this patient's preventive care?

  1. Order an abdominal duplex ultrasoundAnswer
  2. B
    Order a low-dose chest computed tomography
  3. C
    Order a dual-energy x-ray absorptiometry (DEXA) scan
  4. D
    Schedule a screening colonoscopy
  5. E
    Administer the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

Answer

Order an abdominal duplex ultrasound
The correct action is to order an abdominal duplex ultrasound. The patient is a 66-year-old male with a history of smoking (12 pack-years, which easily exceeds the threshold of 100 lifetime cigarettes). The USPSTF gives a Grade B recommendation for a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked. Since he has never had abdominal imaging, this screening is strongly indicated during his wellness visit.

Step-by-Step Solution

1
Analyze the patient's demographic profile and medical history.
The patient is a 66-year-old male with a 12 pack-year smoking history who quit at age 30.
Age, biological sex, and smoking history are critical determinants for USPSTF screening recommendations.
2
Evaluate the need for abdominal aortic aneurysm (AAA) screening.
The patient meets the criteria for a one-time AAA screening.
The USPSTF recommends a one-time screening with ultrasonography for men aged 65 to 75 years who have ever smoked (defined as at least 100 cigarettes in a lifetime).
3
Review the patient's prior preventive care to rule out other interventions.
His colonoscopy is not due for another 4 years, his pneumococcal vaccination is complete with PCV20, and he does not meet the pack-year or timeframe criteria for low-dose CT lung screening.
Confirming that no other screening or immunization is currently due ensures that the AAA ultrasound is the uniquely correct next step.

Key Concept

The USPSTF recommends a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have a history of smoking.
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Topics

Preventive Care and Screening

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