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Difficulty: MediumPreventive Care and Screening

Match each of the following ambulatory patients with the single most appropriate screening recommendation according to current United States Preventive Services Task Force (USPSTF) guidelines.

  • A 70-year-old biological male presenting to the ambulatory clinic. He smoked 3 cigarettes daily from age 18 to 24 but has not smoked since. His last colonoscopy was 5 years ago, and he had a normal lipid panel last month.One-time ultrasonography of the abdomen
  • A 42-year-old biological female presenting for a wellness visit. She has never smoked, has a BMI of 31 kg/m^2, and had a normal Pap smear 2 years ago. She has no known medical conditions.Measurement of hemoglobin A1c or fasting plasma glucose
  • A 58-year-old biological female in the clinic for follow-up. She smoked 1.5 packs of cigarettes daily for 20 years and quit 12 years ago. She had a normal mammogram and normal colonoscopy 2 years ago.Annual low-dose computed tomography of the chest
  • A 23-year-old biological female presenting for contraceptive counseling. She is a lifelong nonsmoker, sexually active with a new male partner, and had a normal physical exam today. She has never been tested for sexually transmitted infections.Nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae

Answer

The correct pairings match the 70-year-old male with an abdominal ultrasound, the 42-year-old female with diabetes screening, the 58-year-old female with low-dose CT, and the 23-year-old female with chlamydia/gonorrhea testing.
Each patient profile directly aligns with specific USPSTF grade A or B recommendations based on their age, sex, BMI, and exposure history. The 70-year-old male needs an abdominal ultrasound for AAA screening due to his age and lifetime smoking history of >100 cigarettes. The 42-year-old female requires diabetes screening due to her age and elevated BMI. The 58-year-old female requires a low-dose CT scan because she meets the 20 pack-year threshold and quit within the last 15 years. The 23-year-old female needs STI screening because she is sexually active and under the age of 25.

Step-by-Step Solution

1
Evaluate the 70-year-old male's risk factors based on age and exposure.
Identify that a male aged 65-75 with a history of smoking >100 cigarettes needs one-time AAA screening.
USPSTF guidelines mandate a one-time abdominal ultrasound for this exact demographic to prevent catastrophic aneurysm rupture.
2
Evaluate the 42-year-old female's risk factors based on age and biometrics.
Identify that her age (35-70) and BMI (>25 kg/m^2) meet criteria for diabetes screening.
USPSTF recommends HbA1c or fasting glucose for overweight adults in this age range to catch prediabetes early.
3
Evaluate the 58-year-old female's smoking history.
Calculate her smoking history as 30 pack-years (1.5 packs x 20 years) and note she quit 12 years ago.
She meets criteria for annual low-dose CT lung cancer screening because she is 50-80 years old, has a >20 pack-year history, and quit <15 years ago.
4
Evaluate the 23-year-old female's demographics.
Note she is under 25 and sexually active.
USPSTF recommends annual chlamydia and gonorrhea screening for all sexually active women 24 years or younger.

Key Concept

Current USPSTF guidelines for age- and risk-appropriate preventive screening.
Estimated Time:2m 0s
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Topics

Preventive Care and Screening

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