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Difficulty: MediumPreventive Care and Screening

A 45-year-old male presents to the clinic to establish care. He reports feeling generally well but wants a comprehensive health evaluation as he has not seen a physician in 12 years. His medical history is notable for prior intravenous heroin use, though he has been abstinent for 5 years and is currently maintained on buprenorphine. He has smoked one pack of cigarettes daily for the past 25 years. Vital signs are within normal limits, and his physical examination is unremarkable. Based on current guidelines, which of the following preventive interventions are indicated for this patient at today's visit? (Select all that apply)

  1. Hepatitis C virus antibody testingAnswer
  2. Screening colonoscopyAnswer
  3. C
    Low-dose computed tomography of the chest
  4. D
    Abdominal aortic aneurysm screening with ultrasonography
  5. E
    Prostate-specific antigen testing

Answer

Hepatitis C virus antibody testing and Screening colonoscopy
The patient is 45 years old, which is the current guideline-recommended age to initiate colorectal cancer screening in average-risk individuals. Furthermore, he is within the 18 to 79 age cohort for universal Hepatitis C virus antibody testing, an indication made even stronger by his past intravenous drug use.

Step-by-Step Solution

1
Analyze patient demographics and risk factors.
The patient is a 45-year-old male with a 25 pack-year smoking history and a history of intravenous drug use.
Preventive screening guidelines are dictated by age, biological sex, and specific behavioral risk factors.
2
Evaluate indications for infectious disease screening.
Hepatitis C screening is indicated.
The USPSTF recommends a one-time Hepatitis C screening for all adults aged 18 to 79. His history of IV drug use provides an additional, high-risk indication.
3
Evaluate indications for cancer screening.
Colorectal cancer screening is indicated, but lung and prostate cancer screenings are not.
Colorectal screening begins at age 45. Low-dose CT for lung cancer requires a 20 pack-year history BUT does not begin until age 50. PSA screening (via shared decision-making) typically begins at age 55.
4
Evaluate indications for vascular screening.
Abdominal aortic aneurysm (AAA) screening is not indicated.
While the patient has a smoking history, AAA screening with ultrasonography is exclusively recommended for men aged 65 to 75.

Key Concept

Age-appropriate integration of USPSTF preventive screening guidelines, particularly the updated starting age for colorectal cancer screening (age 45) and the specific age parameters for lung cancer and AAA screening.
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Topics

Preventive Care and Screening

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