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Question

Difficulty: MediumPreventive Care and Screening

Match each clinical scenario evaluated in the primary care setting with the most appropriate, evidence-based preventive care intervention.

  • A 41-year-old female with no significant past medical history or family history of malignancy.Initiate screening mammography
  • A 54-year-old male with a 25 pack-year smoking history who successfully quit smoking 10 years ago.Order annual low-dose computed tomography (LDCT) of the chest
  • A 66-year-old male with essential hypertension who reports having smoked approximately 200 cigarettes total in his early twenties.Order a one-time abdominal aortic duplex ultrasound
  • A 31-year-old female at 29 weeks gestation who received a tetanus booster 3 years ago following a minor laceration.Administer the Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine

Answer

The 41-year-old female requires screening mammography. The 54-year-old former smoker requires annual LDCT of the chest. The 66-year-old male who previously smoked requires a one-time abdominal aortic ultrasound. The 31-year-old pregnant female requires Tdap vaccination.
Each patient meets specific age and risk factor thresholds established by current USPSTF and ACIP guidelines for preventive screening and vaccination. The 41-year-old female meets the updated age threshold of 40 for starting mammography. The 54-year-old male fits the 50-80 age range, >20 pack-year history, and <15 years since quitting criteria for LDCT. The 66-year-old male meets the 65-75 age range and >100 lifetime cigarette exposure criteria for AAA screening. The 31-year-old pregnant female is within the 27-36 week gestation window requiring Tdap vaccination.

Step-by-Step Solution

1
Evaluate the 41-year-old female for cancer screening eligibility.
She is eligible for breast cancer screening.
Current USPSTF guidelines recommend starting biennial screening mammography at age 40 for average-risk women, rather than waiting until age 50.
2
Assess the 54-year-old male's smoking history for lung cancer screening.
He meets criteria for low-dose computed tomography (LDCT).
He falls within the 50-80 age range, has greater than a 20 pack-year smoking history, and his quit date is within the last 15 years.
3
Determine vascular screening needs for the 66-year-old male.
He requires an abdominal aortic aneurysm (AAA) screening.
He is a male aged 65-75 with a history of smoking. A lifetime exposure of at least 100 cigarettes qualifies a patient as an 'ever smoker' for AAA screening purposes.
4
Review the immunization requirements for the 31-year-old pregnant female.
She requires the Tdap vaccine.
Tdap is indicated in every pregnancy between 27 and 36 weeks of gestation to provide passive immunity to the infant, regardless of when her last tetanus booster was administered.

Key Concept

Application of age- and risk-appropriate preventive screening and immunization guidelines
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Topics

Preventive Care and Screening

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