Match each ambulatory patient profile with the most appropriate, guideline-concordant prev… — USMLE Step 3

Match each ambulatory patient profile with the most appropriate, guideline-concordant preventive care intervention or recommendation.

52-year-old male; $25$ pack-year smoking history, quit $8$ years ago; recent colonoscopy and lipid panel are normalAnnual screening with low-dose computed tomography (LDCT)
55-year-old male with type 2 diabetes mellitus; blood pressure $128/80 \text{ mmHg}$ ; recent LDL-C is $90 \text{ mg/dL}$ Initiation of moderate-intensity statin therapy
28-year-old female at $28$ weeks gestation; received a Tdap booster $2$ years ago for a laceration; standard prenatal screening negativeAdministration of Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine
66-year-old female; total hysterectomy for benign uterine fibroids at age $50$ ; history of normal Pap smears prior to surgeryDiscontinuation of cervical cancer screening

Answer

The 52-year-old former heavy smoker requires annual LDCT. The 55-year-old diabetic male requires moderate-intensity statin therapy. The 28-year-old pregnant female requires a Tdap vaccine. The 66-year-old female with a prior total hysterectomy for benign fibroids requires discontinuation of cervical cancer screening.

Each match strictly follows the primary prevention pathways outlined by the USPSTF and ACIP, correctly identifying the defining clinical variable (smoking pack-years, diabetes status, gestational age, surgical history) that triggers the respective intervention.

Step-by-Step Solution

Evaluate the 52-year-old male's risk factors.

He meets criteria for annual low-dose computed tomography (LDCT).

He falls within the

50

80

age range, has a smoking history of

>20

pack-years, and quit within the last

15

years.

Evaluate the 55-year-old male with type 2 diabetes.

He meets criteria for initiating moderate-intensity statin therapy.

Any patient aged

40

75

with diabetes mellitus qualifies for statin therapy for primary prevention, even if their LDL-C is relatively controlled (e.g.,

90 \text{ mg/dL}

Evaluate the 28-year-old pregnant female's vaccination status.

She must receive the Tdap vaccine now.

Tdap is strictly indicated in the third trimester (

27

36

weeks) of every pregnancy to maximize passive infant immunity, superseding the usual

10

-year booster interval.

Evaluate the 66-year-old female's cancer screening requirements.

She qualifies for discontinuation of cervical cancer screening.

She has no cervix (post-total hysterectomy) and the surgery was for a benign indication (fibroids), removing the anatomic substrate for typical cervical cancer.

Key Concept

Application of age- and risk-specific preventive care guidelines (USPSTF and ACIP)

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

Topics

More questions from this topic