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Difficulty: MediumPreventive Care and Screening

A 67-year-old man comes to the clinic to establish care after moving to a new city. He reports feeling well and has no current symptoms. His past medical history includes essential hypertension, which is well-controlled with lisinopril. He had an appendectomy at age 20. Social history is notable for smoking 1 pack of cigarettes daily from age 18 to age 25, after which he completely quit. He drinks 1 to 2 glasses of wine on the weekends.

His last colonoscopy was 3 years ago and was completely normal. A fasting lipid panel and hemoglobin A1c were checked 2 months ago and were within normal limits. A one-time hepatitis C virus antibody test was negative 5 years ago. At age 65, he received the 20-valent pneumococcal conjugate vaccine (PCV20) and completed the recombinant zoster vaccine series. He received a Tetanus, Diphtheria, Pertussis (Tdap) booster 4 years ago and the seasonal influenza vaccine last week.

Vital signs and physical examination are unremarkable.

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

  1. One-time abdominal ultrasonographyAnswer
  2. B
    Annual low-dose chest computed tomography
  3. C
    Screening for pancreatic cancer with abdominal magnetic resonance imaging
  4. D
    Dual-energy x-ray absorptiometry
  5. E
    Administration of the 23-valent pneumococcal polysaccharide vaccine

Answer

One-time abdominal ultrasonography
The correct answer is one-time abdominal ultrasonography. The United States Preventive Services Task Force (USPSTF) recommends a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked. 'Ever smoked' is strictly defined as having smoked at least 100 cigarettes in a lifetime. This patient smoked 1 pack of cigarettes daily for 7 years, significantly exceeding the 100-cigarette threshold, and falls within the target age range. Therefore, he definitively requires AAA screening.

Step-by-Step Solution

1
Evaluate the patient's age and demographic risk factors.
The patient is a 67-year-old man.
Age and biological sex dictate specific USPSTF screening pathways, particularly for vascular and oncologic diseases.
2
Analyze the patient's social history for substance exposures.
The patient has a smoking history of 1 pack per day for 7 years and quit 42 years ago. This totals more than 100 cigarettes in his lifetime.
Smoking history is a critical criterion for determining the necessity of abdominal aortic aneurysm and lung cancer screenings.
3
Synthesize demographics and exposures with current preventive guidelines.
As a man aged 65 to 75 who has 'ever smoked', he meets the precise criteria for a one-time abdominal aortic aneurysm screening.
The USPSTF Grade B recommendation mandates a one-time ultrasound for AAA in this specific demographic.

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 ever smoked, which is strictly defined as having smoked 100 or more cigarettes in their lifetime.
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Topics

Preventive Care and Screening

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