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Question

Difficulty: MediumPreventive Care and Screening

For each of the following ambulatory patients presenting for routine care, select the most appropriate, guideline-concordant preventive intervention or screening strategy indicated by their unique risk factors.

  • A 45-year-old woman with a BMI of 28 kg/m² and no other medical conditions presenting for an initial wellness visitScreening for abnormal blood glucose and type 2 diabetes mellitus
  • A 28-year-old woman at 13 weeks of gestation with a history of systemic lupus erythematosusInitiation of daily low-dose aspirin prophylaxis
  • A 35-year-old man born in sub-Saharan Africa who recently immigrated to the United States and has no symptomsScreening for hepatitis B virus infection
  • A 55-year-old man with a 25 pack-year smoking history who quit 8 years agoAnnual screening with low-dose computed tomography

Answer

The correct matches align each patient with their specific USPSTF-indicated preventive intervention: the 45-year-old with overweight requires diabetes screening, the pregnant patient with SLE requires aspirin prophylaxis, the immigrant from an endemic region requires HBV screening, and the former smoker requires lung cancer screening.
Each clinical profile possesses a distinct set of risk factors that unambiguously triggers one specific USPSTF Grade A or B recommendation among the available choices. The matching relies on precise cutoffs for age, BMI, geographic prevalence, and smoking history.

Step-by-Step Solution

1
Analyze the 45-year-old woman's profile.
Identify her BMI of 28 kg/m² as overweight, which along with her age (35-70 years range), meets the USPSTF criteria for type 2 diabetes screening.
Age and BMI are the primary independent triggers for routine glycemic screening in asymptomatic adults.
2
Evaluate the 28-year-old pregnant patient's risk profile.
Recognize systemic lupus erythematosus as a major high-risk condition for preeclampsia, indicating the need for low-dose aspirin starting after 12 weeks of gestation.
Preventing preeclampsia is critical in high-risk pregnancies, and aspirin is the standard guideline-concordant prophylactic intervention.
3
Assess the 35-year-old immigrant's background.
Determine that birth in sub-Saharan Africa (an endemic region with prevalence ≥ 2%) places him at high risk for hepatitis B, requiring one-time screening.
Targeted screening based on geographic origin identifies chronic asymptomatic carriers who require monitoring or treatment.
4
Review the 55-year-old man's smoking history.
Calculate that his 25 pack-year history and 8-year quit duration fall within the USPSTF parameters (50-80 years old, ≥20 pack-years, quit within 15 years) for low-dose computed tomography.
Annual LDCT is the only proven modality to reduce lung cancer mortality in appropriately selected high-risk individuals.

Key Concept

Application of United States Preventive Services Task Force (USPSTF) guidelines based on specific patient demographics, comorbidities, and social histories.
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Topics

Preventive Care and Screening

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