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Question

Difficulty: HardPreventive Care and Screening

Match each adult patient presenting for a health maintenance or prenatal visit with the most appropriate next step in preventive care based on current guidelines.

  • A 42-year-old asymptomatic man whose paternal uncle was diagnosed with colon cancer at age 55.Schedule to begin average-risk screening for colorectal cancer at age 45.
  • A 68-year-old man with a 25 pack-year smoking history who quit smoking at age 45.Order a one-time abdominal ultrasound to screen for an aortic aneurysm.
  • A 28-year-old pregnant woman at 28 weeks gestation who received a Tdap vaccine during her previous pregnancy 2 years ago.Administer the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at the current visit.
  • A 45-year-old woman who underwent mantle field radiation therapy for Hodgkin lymphoma at age 25.Recommend annual screening with both mammography and breast magnetic resonance imaging.

Answer

The 42-year-old man requires average-risk colon cancer screening at age 45; the 68-year-old former smoker requires an AAA ultrasound; the pregnant woman requires a Tdap vaccine now; the Hodgkin lymphoma survivor requires annual breast MRI and mammography.
Each patient presentation contains specific historical details—such as the degree of family relation, years since quitting smoking, current pregnancy status, and prior chest radiation—that trigger specific algorithms within established preventive care guidelines.

Step-by-Step Solution

1
Evaluate the 42-year-old man's family history for colon cancer risk.
He has a single second-degree relative affected at age 55, placing him at average risk.
High-risk screening requires a first-degree relative with colorectal cancer or advanced adenoma. Therefore, average-risk guidelines apply, meaning screening starts at age 45.
2
Assess the 68-year-old former smoker for lung and vascular screening eligibility.
He qualifies for an abdominal aortic aneurysm (AAA) ultrasound but not low-dose CT (LDCT) for lung cancer.
He is a man aged 65-75 who has smoked more than 100 cigarettes (qualifying for one-time AAA screening), but he quit 23 years ago, exceeding the 15-year limit for LDCT eligibility.
3
Determine the Tdap vaccine indication for the pregnant patient.
She should receive the Tdap vaccine at this 28-week visit.
Acellular pertussis vaccination is required during every pregnancy (optimally between 27 and 36 weeks) to maximize passive antibody transfer to the fetus, regardless of the patient's previous vaccination doses.
4
Identify appropriate breast cancer screening for a Hodgkin lymphoma survivor.
She requires both annual mammography and breast MRI.
Chest radiation between ages 10 and 30 significantly increases breast cancer risk, warranting aggressive screening with both modalities.

Key Concept

Nuances of USPSTF and ACIP guidelines regarding family history, smoking cessation timelines, pregnancy, and prior radiation exposure.
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Topics

Preventive Care and Screening

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