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Difficulty: HardPreventive Care and Screening

An asymptomatic 6666-year-old man is evaluated in the primary care clinic for an annual wellness assessment. His past medical history is significant for well-controlled type 2 diabetes mellitus and mild osteoarthritis of the right knee. Current medications include metformin and acetaminophen as needed. The patient reports a former tobacco habit, having smoked one and a half packs of cigarettes daily from age 2020 until he successfully quit at age 5050. His vital signs today are within normal limits. A review of his electronic medical record shows a normal screening colonoscopy performed four years ago and up-to-date immunizations, including the 2020-valent pneumococcal conjugate vaccine administered last year. He has not undergone any recent imaging studies. Which of the following is the most appropriate next step in this patient's preventive care?

  1. One-time screening for an abdominal aortic aneurysm with ultrasonographyAnswer
  2. B
    Annual screening for lung cancer with low-dose computed tomography
  3. C
    Routine screening for peripheral arterial disease with an ankle-brachial index
  4. D
    Screening for colorectal cancer with an annual fecal immunochemical test
  5. E
    Screening for osteoporosis with dual-energy x-ray absorptiometry

Answer

One-time screening for an abdominal aortic aneurysm with ultrasonography is the correct next step because the patient is a male between 65 and 75 years old with a history of smoking.
The most appropriate next step in preventive care for this patient is a one-time screening for an abdominal aortic aneurysm (AAA) using ultrasonography. According to the United States Preventive Services Task Force (USPSTF), a one-time screening for AAA with ultrasonography is recommended for men aged 65 to 75 years who have ever smoked (defined as having smoked at least 100 cigarettes in a lifetime). Since this patient is a 66-year-old man with a significant smoking history who has never undergone this specific screening, the imaging study is strongly indicated to reduce AAA-related mortality.

Step-by-Step Solution

1
Evaluate the patient's demographics and smoking history.
The patient is a 66-year-old male with a 45 pack-year smoking history who quit 16 years ago.
Preventive screening guidelines are heavily dependent on age, biological sex, and specific risk factors such as smoking history.
2
Assess eligibility for lung cancer screening.
Ineligible. Although he meets the age (50-80) and pack-year (>=20) criteria, he exceeds the 15-year smoking cessation limit.
The USPSTF recommends discontinuing lung cancer screening once a person has not smoked for 15 years.
3
Assess eligibility for abdominal aortic aneurysm (AAA) screening.
Eligible. He is a male aged 65-75 who has 'ever smoked' (at least 100 cigarettes in a lifetime).
The USPSTF recommends a one-time AAA screening with ultrasonography for this specific demographic.
4
Review other routine screening statuses.
Colorectal cancer screening is up-to-date (normal colonoscopy 4 years ago). PAD and osteoporosis screening are not routinely indicated for his demographic.
Prevents redundant or unindicated testing that could lead to unnecessary interventions or healthcare costs.

Key Concept

Application of time-sensitive smoking cessation criteria in preventive screening guidelines.
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Topics

Preventive Care and Screening

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