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Zorluk: ZorClinical Preventive Services and Screening

A 5656-year-old woman presents to the clinic for a routine health maintenance examination. She feels well and reports no new symptoms, specifically denying any vaginal bleeding, weight loss, or changes in bowel habits. Her medical history is significant for well-controlled hypertension and a bilateral tubal ligation at age 3535. She smoked 1.51.5 packs of cigarettes daily for 2020 years but successfully quit 1212 years ago. Her family history is notable for her father dying of a ruptured abdominal aortic aneurysm at age 7272, and her mother being diagnosed with colon cancer at age 7070. Her most recent preventive screenings include a normal colonoscopy at age 5151, a normal Pap smear with negative human papillomavirus co-testing at age 5353, and a normal mammogram 66 months ago. Her body mass index is 26 kg/m226 \text{ kg/m}^2. Which of the following is the most appropriate next step in this patient's preventive care today?

  1. A
    Dual-energy x-ray absorptiometry
  2. Low-dose chest computed tomographyCevap
  3. C
    Live-attenuated influenza vaccine
  4. D
    Human papillomavirus co-testing
  5. E
    Endometrial biopsy

Cevap

The correct answer is low-dose chest computed tomography, as the patient meets all age and smoking history criteria for annual lung cancer screening.
The correct answer is low-dose chest computed tomography. The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low-dose computed tomography in adults aged 5050 to 8080 years who have a 2020 pack-year smoking history and currently smoke or have quit within the past 1515 years. This patient is 5656 years old, has a 3030 pack-year history (1.51.5 packs/day ×\times 2020 years), and quit 1212 years ago, perfectly meeting all criteria for screening.

Adım Adım Çözüm

1
Calculate the patient's smoking pack-year history and time since quitting.
The patient smoked 1.51.5 packs per day for 2020 years, which equals 3030 pack-years. She successfully quit 1212 years ago.
Accurate smoking history metrics are required to determine eligibility for lung cancer screening.
2
Evaluate the patient's eligibility for lung cancer screening using current guidelines.
The patient is 5656 years old (fits the 5050 to 8080 age range), has a 3030 pack-year history (fits the ≥20\geq 20 pack-year requirement), and quit 1212 years ago (fits the ≤15\leq 15 years since quitting requirement).
To identify if low-dose chest computed tomography is indicated at today's visit.
3
Assess the need for other routine screenings based on the patient's age, surgical history, and family history.
She is not due for colorectal cancer screening (due at age 6161), cervical cancer screening (due at age 5858), or a mammogram (completed 66 months ago). She does not meet age criteria for osteoporosis screening or the live-attenuated influenza vaccine.
To eliminate incorrect options and definitively confirm the most appropriate next step in preventive care.

Anahtar Kavram

The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low-dose computed tomography for adults aged 50 to 80 years with at least a 20 pack-year smoking history who currently smoke or have quit within the past 15 years.
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