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Difficulty: EasyPreventive Care and Screening

A 66-year-old female presents to the outpatient clinic for a routine wellness examination. She has no acute symptoms and feels well. Her past medical history is significant for primary hypertension, for which she takes amlodipine. She has never smoked, does not consume alcohol, and exercises by walking 30 minutes daily. Her last screening mammogram was performed 6 months ago and was unremarkable. A screening colonoscopy performed at age 61 was normal. Her medical records indicate she had negative cervical human papillomavirus (HPV) co-testing at ages 55, 60, and 64. She has never undergone bone mineral density testing. Vital signs today are within normal limits, and physical examination shows no abnormalities. Which of the following is the most appropriate next step in preventive screening for this patient?

  1. Dual-energy x-ray absorptiometryAnswer
  2. B
    Cervical cytology with human papillomavirus co-testing
  3. C
    Low-dose chest computed tomography
  4. D
    Fecal immunochemical testing
  5. E
    Resting 12-lead electrocardiography

Answer

Dual-energy x-ray absorptiometry is the correct screening step for this patient because all women aged 65 years and older should be screened for osteoporosis.
The most appropriate next step in preventive screening for this 66-year-old woman is dual-energy x-ray absorptiometry (DEXA). The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing in all women aged 65 years and older. Because she has never had a bone density test, she should undergo DEXA screening at this visit.

Step-by-Step Solution

1
Analyze the patient's demographics and medical history to identify indicated preventive screenings.
The patient is a 66-year-old female with a history of hypertension, no smoking history, and up-to-date breast, colon, and cervical cancer screenings.
Preventive screening guidelines are highly dependent on age, biological sex, and specific risk factors.
2
Evaluate the indication for osteoporosis screening.
The patient is over the age of 65 and has never had bone density testing, making her eligible for screening.
The USPSTF recommends routine osteoporosis screening for all women aged 65 years and older.
3
Review the distractors to ensure no other screening is currently indicated.
Cervical, colorectal, and lung cancer screenings are not indicated due to adequate prior testing or lack of risk factors. Routine ECG is not indicated.
Selecting the 'most appropriate next step' requires confirming that alternative interventions are either contraindicated or not yet due.

Key Concept

The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
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Topics

Preventive Care and Screening

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