Examkin

Question

Difficulty: HardPreventive Care and Screening

A 72-year-old woman arrives at the outpatient physician office for a routine wellness evaluation. She feels well and has no acute symptoms. Her medical history is significant for hypertension, hyperlipidemia, and a total abdominal hysterectomy with bilateral salpingo-oophorectomy performed at age 45 for high-grade cervical intraepithelial neoplasia (CIN 3). She does not take hormone replacement therapy. Social history is notable for smoking 1.5 packs of cigarettes daily from age 18 until age 60 (63 pack-years); she has not smoked since. Her preventive health history includes a normal screening mammogram 10 months ago, a normal screening colonoscopy at age 66, and a dual-energy x-ray absorptiometry scan at age 65 that showed normal bone mineral density. Vital signs are within normal limits. Physical examination shows a well-appearing woman with no abnormalities.

Which of the following is the most appropriate indicated preventive screening test for this patient today?

  1. Yearly low-dose chest computed tomographyAnswer
  2. B
    Vaginal cuff cytology
  3. C
    Repeat colonoscopy
  4. D
    Multi-target stool DNA and occult blood test
  5. E
    Transvaginal ultrasonography

Answer

The correct indicated screening for this patient is yearly low-dose chest computed tomography.
The correct action is to order yearly low-dose chest computed tomography. The USPSTF recommends annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50 to 80 years who have at least a 20 pack-year smoking history and either currently smoke or have quit within the past 15 years. This patient is 72 years old, has a 63 pack-year smoking history, and quit 12 years ago. Because she is under 80 and her quit date is within the 15-year window, she is an appropriate candidate for this screening.

Step-by-Step Solution

1
Evaluate the patient's eligibility for lung cancer screening.
The patient is 72 years old, has a 63 pack-year smoking history, and quit smoking 12 years ago.
The USPSTF recommends annual low-dose chest CT for adults aged 50 to 80 with a 20+ pack-year history who currently smoke or quit within the last 15 years. She meets all criteria.
2
Determine if cervical/vaginal cancer screening is still required.
Vaginal cuff cytology is no longer indicated for this patient.
While women with a history of CIN 3 require screening after a hysterectomy, this surveillance is only required for 20 years. Her surgery was 27 years ago (age 45).
3
Assess whether colorectal or breast cancer screenings are due.
Neither screening is currently due.
Her last colonoscopy was normal 6 years ago (due in 10 years), and her last mammogram was normal 10 months ago (due every 2 years).

Key Concept

Application of time-dependent guidelines for lung cancer (time since quitting smoking) and post-hysterectomy cervical cancer screening (time since CIN 3 treatment).
Rate this question

Topics

Preventive Care and Screening

More questions from this topic