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Difficulty: MediumPreventive Care and Screening

Match each of the following ambulatory patient profiles with the single most appropriate guideline-concordant preventive care intervention.

  • A 60-year-old man with chronic obstructive pulmonary disease and a 40 pack-year smoking history who currently smokes. He is up to date on colonoscopy and diabetes screening. He received a Tdap booster 2 years ago and the recombinant zoster vaccine series last year.Initiate annual low-dose computed tomography (LDCT) of the chest and administer a pneumococcal conjugate vaccine (e.g., PCV20).
  • A 67-year-old woman with a history of three consecutive negative cervical co-tests (most recent at age 62) and a normal screening colonoscopy at age 58. Her body mass index is 22 kg/m² and her hemoglobin A1c is normal.Discontinue cervical cancer screening and perform osteoporosis screening with dual-energy x-ray absorptiometry.
  • A 68-year-old man who reports having smoked exactly six packs of cigarettes during his freshman year of college but has not smoked since. He has no chronic medical conditions and is up to date on his colonoscopies and immunizations.Perform one-time screening for an abdominal aortic aneurysm with duplex ultrasonography.
  • A 45-year-old man with a body mass index of 32 kg/m² who feels well and takes no medications. He has not seen a physician in six years and has never undergone any cancer screening.Screen for type 2 diabetes mellitus with a hemoglobin A1c level and initiate colorectal cancer screening.

Answer

The 60-year-old smoker with COPD requires LDCT and a pneumococcal vaccine. The 67-year-old woman requires osteoporosis screening and discontinuation of cervical screening. The 68-year-old male former light smoker requires an abdominal aortic aneurysm ultrasound. The 45-year-old obese man requires diabetes and colorectal cancer screening.
Each patient profile contains specific demographic and clinical triggers (age, BMI, specific medical history, exact smoking quantification) that definitively isolate one guideline-concordant next step, while intentionally excluding the other interventions.

Step-by-Step Solution

1
Evaluate the 60-year-old man's risk profile (COPD, active heavy smoker).
Identified the need for lung cancer screening and pneumococcal vaccination.
His age and pack-year history meet the strict LDCT criteria; his COPD is an indication for pneumococcal vaccination under age 65.
2
Analyze the 67-year-old woman's preventive timeline.
Determined cervical screening is no longer indicated, colonoscopy is not yet due, but DEXA is indicated.
Age >65 with adequate negative testing history allows cervical screening cessation; women ≥65 universally require DEXA; the standard normal colonoscopy interval is 10 years.
3
Assess the 68-year-old man's brief smoking history.
Determined he meets the threshold of 'ever smoked'.
Six packs of cigarettes equals 120 cigarettes, which exceeds the USPSTF threshold of ≥100 lifetime cigarettes required to trigger the one-time abdominal aortic aneurysm ultrasound recommendation for men aged 65-75.
4
Evaluate the 45-year-old man's demographics and BMI.
Identified the need for diabetes and colorectal cancer screening.
He meets the age (35-70) and BMI (≥25) threshold for diabetes screening and the age threshold (≥45) for colorectal cancer screening.

Key Concept

Application of age, comorbidity, and exposure-specific USPSTF and ACIP preventive guidelines.
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Topics

Preventive Care and Screening

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