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Difficulty: MediumPreventive Care and Screening

A 72-year-old man comes to the clinic to establish care. He recently moved to the area to live closer to his daughter and has not seen a physician in over 10 years. His past medical history includes hypertension, which is well controlled on amlodipine. He smoked one pack of cigarettes daily from age 20 to 55 but has not smoked since. He drinks alcohol occasionally. His blood pressure is 128/82 mmHg, pulse is 72/min, and BMI is 24 kg/m². Physical examination is unremarkable. He has not undergone any cancer screening or preventive testing in the past decade. Based on current guidelines, which of the following preventive interventions are indicated for this patient today? (Select all that apply)

  1. Abdominal ultrasonographyAnswer
  2. B
    Low-dose computed tomography of the chest
  3. C
    Prostate-specific antigen testing
  4. Screening for colorectal cancerAnswer
  5. E
    Screening for type 2 diabetes mellitus

Answer

The indicated preventive interventions for this patient are abdominal ultrasonography and screening for colorectal cancer.
Based on USPSTF guidelines, this 72-year-old man requires a one-time screening for an abdominal aortic aneurysm (AAA) via abdominal ultrasonography because he is a male aged 65 to 75 who has smoked at least 100 cigarettes in his lifetime. He also requires screening for colorectal cancer because he is between the ages of 45 and 75 and is overdue (having not seen a physician in over 10 years).

Step-by-Step Solution

1
Evaluate the patient's demographics and vital signs against screening guidelines.
The patient is a 72-year-old male with a normal BMI of 24 kg/m².
Age and BMI dictate eligibility for several screenings (e.g., colorectal cancer, diabetes, prostate cancer).
2
Evaluate the patient's smoking history.
He has a 35 pack-year smoking history but quit 17 years ago.
Smoking history is required to determine the need for lung cancer and abdominal aortic aneurysm (AAA) screening.
3
Apply the USPSTF criteria for each potential intervention to identify indicated tests.
He requires AAA screening (men 65-75, ever smoker) and colorectal cancer screening (all adults 45-75). He does not require lung cancer screening (quit >15 years ago), PSA testing (age >70), or diabetes screening (age >70, normal BMI).
Evidence-based guidelines ensure that the benefits of screening outweigh the potential harms.

Key Concept

Application of age- and risk-based USPSTF preventive screening guidelines for older adults, particularly emphasizing the 'stop screening' criteria for lung cancer and prostate cancer.
Estimated Time:1m 30s
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Topics

Preventive Care and Screening

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