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Difficulty: MediumPreventive Care and Screening

Evaluate the following patient profiles during routine ambulatory visits. Match each patient with the most appropriate, guideline-concordant next step in preventive care based on current United States Preventive Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) recommendations.

  • A 66-year-old woman who underwent a total hysterectomy for symptomatic uterine leiomyomas five years ago and had three consecutive negative routine Pap tests prior to the surgery.Discontinue routine cervical cytology and human papillomavirus screening indefinitely.
  • A 45-year-old man with no chronic medical conditions and a body mass index of 33 kg/m², presenting for his first primary care visit in five years.Order fasting plasma glucose or hemoglobin A1c testing.
  • A 28-year-old woman at 30 weeks gestation in her first pregnancy, who received a tetanus-diphtheria-acellular pertussis (Tdap) booster at age 24.Administer the tetanus-diphtheria-acellular pertussis (Tdap) vaccine during this visit.
  • A 38-year-old healthy woman whose mother and maternal aunt were both diagnosed with breast cancer in their early 40s.Perform a familial risk assessment tool (e.g., Ontario Family History Assessment Tool) for BRCA testing referral.

Answer

The post-hysterectomy patient requires cessation of cervical screening. The 45-year-old man with obesity requires diabetes screening. The pregnant patient requires Tdap vaccination. The woman with a strong family history of breast cancer requires a familial risk assessment for BRCA.
Each correct match strictly follows current evidence-based guidelines for primary care. Cervical screening is stopped after benign hysterectomy. Diabetes screening starts at age 35 for overweight/obese individuals. Tdap is required in every pregnancy between 27-36 weeks. A strong family history of early breast cancer prompts BRCA risk assessment.

Step-by-Step Solution

1
Analyze the 66-year-old woman's history.
She had a total hysterectomy for a benign indication and no prior high-grade cervical dysplasia.
This confirms she no longer has a cervix and is not at risk for cervical cancer, meaning screening should be discontinued.
2
Analyze the 45-year-old man's demographics and vitals.
He is between the ages of 35 and 70 and has a BMI in the obese range (>30 kg/m²).
Current USPSTF guidelines mandate diabetes screening for overweight or obese adults starting at age 35.
3
Analyze the 28-year-old pregnant woman's vaccination status.
She is at 30 weeks gestation and had a previous Tdap at age 24.
The Tdap vaccine must be given between 27-36 weeks in every pregnancy, making prior non-pregnancy vaccine dates irrelevant.
4
Analyze the 38-year-old woman's family history.
She has multiple first- and second-degree relatives diagnosed with breast cancer before age 50.
This is a red flag for a hereditary cancer syndrome (e.g., BRCA1/2), necessitating formal risk assessment.

Key Concept

Application of age-, sex-, and risk-specific USPSTF and ACIP guidelines for preventive screening and immunizations in adults.
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Topics

Preventive Care and Screening

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