Examkin

Soru

Zorluk: OrtaClinical Preventive Services and Screening

A 48-year-old woman comes to the office for a routine health maintenance examination. She has a history of rheumatoid arthritis, for which she takes methotrexate and infliximab. She feels well and has no current joint pain, swelling, or systemic symptoms. Her last preventive care visit was 2 years ago, during which she underwent a screening colonoscopy that was normal. At that same visit, she had a normal Papanicolaou (Pap) test with negative high-risk human papillomavirus (HPV) testing. A fasting lipid panel and hemoglobin A1c obtained 1 month ago by her rheumatologist were within normal limits. She reached menarche at age 12 and has regular, monthly menstrual cycles with no abnormal bleeding. Her mother was diagnosed with endometrial cancer at age 65 and breast cancer at age 62. Vital signs are within normal limits, and her BMI is 24 kg/m224 \text{ kg/m}^2. Physical examination, including a clinical breast examination, reveals no masses or skin changes. Which of the following is the most appropriate next step in preventive care for this patient?

  1. A
    Endometrial biopsy
  2. B
    Routine measurement of serum thyrotropin (TSH) level
  3. Biennial screening mammographyCevap
  4. D
    Administration of live-attenuated influenza vaccine
  5. E
    Annual screening breast magnetic resonance imaging (MRI)

Cevap

Biennial screening mammography
The United States Preventive Services Task Force (USPSTF) recommends biennial screening mammography for all women aged 40 to 74 years (Grade B recommendation). This patient is 48 years old and has not had a recent mammogram mentioned in her otherwise up-to-date preventive care checklist, making it the most appropriate next step. While she has a family history of breast cancer in her mother at age 62, this places her at an average or slightly increased risk, which is appropriately managed with standard screening mammography rather than advanced imaging.

Adım Adım Çözüm

1
Evaluate the patient's age and current preventive screening status.
The patient is a 48-year-old woman whose colonoscopy, Pap testing, and metabolic screenings (lipid panel, A1c) are up to date. She has no record of a recent mammogram.
Identifying missing preventive services based on age and sex is the first step in primary care health maintenance.
2
Apply current USPSTF breast cancer screening guidelines.
The USPSTF recommends biennial screening mammography for all women starting at age 40. Therefore, this patient is due for screening mammography.
Her age (48) falls within the universal screening window, making this a Grade B recommendation.
3
Assess the patient's family history and medication list to rule out advanced testing or inappropriate interventions.
Her family history of breast cancer constitutes average to slightly increased risk, which does not warrant an MRI. Her use of immunosuppressants (infliximab, methotrexate) constitutes an absolute contraindication to live vaccines.
This confirms standard mammography as the best step and rules out distractors like breast MRI or live-attenuated influenza vaccination.

Anahtar Kavram

The USPSTF recommends biennial screening mammography for all women aged 40 to 74 years. Routine endometrial cancer screening is not recommended, and live-attenuated vaccines are absolutely contraindicated in patients on immunosuppressive therapy.
Bu soruyu puanla

Konular

Clinical Preventive Services and Screening

Bu konudan daha fazla soru