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Difficulty: EasyPreventive Care and Screening

An asymptomatic 6969-year-old male visits his primary care physician for a scheduled health maintenance examination. His medical history includes only mild osteoarthritis of the knees. The patient states that he smoked one pack of cigarettes daily starting at age 1818 but successfully quit on his 4545 th birthday. His blood pressure is 122/78122/78 mm Hg, heart rate is 7272/min, and body mass index is 2424 kg/m 2^2. Cardiopulmonary and abdominal examinations reveal no abnormalities. Based on current guidelines, which of the following is the most appropriate screening intervention for this patient?

  1. Ultrasonography of the abdomenAnswer
  2. B
    Low-dose computed tomography of the chest
  3. C
    Computed tomography of the abdomen
  4. D
    Carotid artery duplex ultrasonography
  5. E
    Resting 12-lead electrocardiography

Answer

Ultrasonography of the abdomen
The correct answer is ultrasonography of the abdomen. The United States Preventive Services Task Force recommends a one-time screening for an abdominal aortic aneurysm with ultrasonography in men aged 6565 to 7575 years who have ever smoked (defined as 100100 or more cigarettes in a lifetime). This patient is a 6969-year-old male with a significant smoking history, making this the most appropriate next step in his preventive care.

Step-by-Step Solution

1
Evaluate patient demographics and risk factors.
The patient is a 6969-year-old male with a 2727 pack-year smoking history who quit 2424 years ago.
Age, sex, and smoking history determine eligibility for specific age- and risk-based screening programs.
2
Assess the indication for abdominal aortic aneurysm (AAA) screening.
The patient meets the criteria for a one-time AAA screening.
Guidelines recommend a one-time screening for men aged 6565 to 7575 years who have ever smoked.
3
Select the appropriate imaging modality for AAA screening.
Ultrasonography of the abdomen is the standard screening modality.
It is highly sensitive, non-invasive, and does not expose the asymptomatic patient to radiation.
4
Rule out lung cancer screening.
The patient does not qualify for annual low-dose computed tomography.
Although he has a >20>20 pack-year smoking history, he quit more than 1515 years ago.

Key Concept

Abdominal aortic aneurysm screening guidelines
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Topics

Preventive Care and Screening

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