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Difficulty: MediumPreventive Care and Screening

A 38-year-old man schedules an appointment for a general wellness visit. He has not interacted with the healthcare system for the past five years. The patient feels entirely well and reports no fatigue, changes in weight, polyuria, or polydipsia. His past medical history is unremarkable, and he takes no medications. He does not use tobacco, consumes one to two alcoholic beverages per week, and exercises sporadically. His family history is notable for a father diagnosed with primary hypertension at age 55 and a mother with hypothyroidism. Vital signs show a temperature of 37.0∘C37.0^\circ\text{C} (98.6∘F98.6^\circ\text{F}), blood pressure of 122/78 mmHg122/78 \text{ mmHg}, pulse of 74/min74/\text{min}, and respiratory rate of 14/min14/\text{min}. His body mass index is 28 kg/m228 \text{ kg/m}^2. Physical examination reveals no abnormalities. According to current guidelines, which of the following is the most appropriate next step in preventive screening for this patient?

  1. Measurement of hemoglobin A1cAnswer
  2. B
    Fecal immunochemical testing
  3. C
    Resting 12-lead electrocardiography
  4. D
    Ultrasound of the abdominal aorta
  5. E
    Serum prostate-specific antigen level

Answer

Measurement of hemoglobin A1c is the most appropriate preventive screening test for this patient.
The correct answer is the measurement of hemoglobin A1c. The United States Preventive Services Task Force (USPSTF) recommends screening for prediabetes and type 2 diabetes in asymptomatic adults aged 35 to 70 years who are overweight or obese (body mass index ≥25 kg/m2\geq 25 \text{ kg/m}^2, or ≥23 kg/m2\geq 23 \text{ kg/m}^2 in Asian American individuals). This 38-year-old patient has a body mass index of 28 kg/m228 \text{ kg/m}^2, making him a candidate for screening via fasting plasma glucose, oral glucose tolerance test, or hemoglobin A1c.

Step-by-Step Solution

1
Identify the patient's key demographic and clinical risk factors.
The patient is a 38-year-old male who is asymptomatic, does not smoke, and has a body mass index of 28 kg/m228 \text{ kg/m}^2 (overweight).
Preventive screening guidelines are primarily stratified by age, biological sex, smoking history, and body mass index.
2
Evaluate the indications for metabolic and cardiovascular screening.
The patient falls into the 35 to 70 years age range and has a body mass index ≥25 kg/m2\geq 25 \text{ kg/m}^2, meeting the criteria for prediabetes and type 2 diabetes screening.
The United States Preventive Services Task Force (USPSTF) guidelines dictate screening parameters for metabolic conditions to prevent long-term cardiovascular complications.
3
Rule out other screening modalities that do not align with the patient's profile.
Tests such as colorectal cancer screening, prostate cancer screening, and abdominal aortic aneurysm screening are excluded because the patient is too young and lacks the specific risk factors for these conditions.
Applying age-appropriate guidelines prevents over-testing and minimizes the risk of false positives and unnecessary procedures.

Key Concept

The USPSTF recommends screening for prediabetes and type 2 diabetes in asymptomatic adults aged 35 to 70 years who are overweight or obese.
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Topics

Preventive Care and Screening

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