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Zorluk: KolayPreventive Care and Screening

An asymptomatic 68-year-old male presents to the primary care office for an annual wellness visit. He has no acute complaints and feels well. His medical history is significant for mild osteoarthritis, which is well controlled with occasional acetaminophen. He is a former smoker who smoked half a pack of cigarettes daily for 20 years, quitting 5 years ago. He drinks alcohol occasionally and exercises three times a week. Review of his records shows a normal screening colonoscopy at age 65 and a normal lipid panel 6 months ago. His blood pressure today is 122/78 mmHg, and his heart rate is 72/min. Physical examination is unremarkable. Which of the following is the most appropriate next step in preventive screening for this patient?

  1. Abdominal ultrasonographyCevap
  2. B
    Low-dose computed tomography of the chest
  3. C
    Dual-energy x-ray absorptiometry
  4. D
    Prostate-specific antigen testing
  5. E
    Resting electrocardiography

Cevap

Abdominal ultrasonography is the most appropriate next step.
The correct intervention is abdominal ultrasonography. The United States Preventive Services Task Force (USPSTF) provides a Grade B recommendation for a one-time screening for an abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked. 'Ever smoked' is clinically defined as having smoked 100 or more cigarettes in a lifetime. This asymptomatic 68-year-old man clearly meets this criterion with his 10 pack-year history, and he has not yet had this screening.

Adım Adım Çözüm

1
Analyze the patient's demographics and behavioral history.
The patient is a 68-year-old male with a 10 pack-year smoking history (half a pack daily for 20 years).
Age, sex, and smoking history dictate specific preventive screening guidelines.
2
Evaluate the patient's past screening history.
The patient is up to date on colorectal cancer screening (colonoscopy at 65) and lipid screening.
Prevents redundant testing and focuses on missing indicated screenings.
3
Apply USPSTF preventive guidelines to the patient's profile.
The patient qualifies for a one-time screening for abdominal aortic aneurysm (AAA) because he is a male aged 65-75 who has 'ever smoked' (at least 100 cigarettes in a lifetime).
Guideline concordant care requires matching patient risk factors to Grade A and B recommendations.

Anahtar Kavram

The USPSTF recommends a one-time screening for abdominal aortic aneurysm with ultrasonography in men aged 65 to 75 years who have ever smoked.
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Preventive Care and Screening

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