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Zorluk: OrtaPreventive Care and Screening

A 67-year-old man comes to the clinic for a routine wellness examination. His past medical history includes essential hypertension, hyperlipidemia, and osteoarthritis. He underwent a normal screening colonoscopy at age 65 and had a negative hepatitis C antibody test last year. He reports smoking a pack of cigarettes per day from age 18 to 22 but has not smoked since. He drinks alcohol occasionally. Current medications are lisinopril, atorvastatin, and as-needed ibuprofen. Blood pressure is 128/78 mm Hg, and pulse is 72/min. Cardiopulmonary examination is unremarkable, and abdominal examination reveals no pulsatile masses. Which of the following is the most appropriate next step in preventive care for this patient?

  1. One-time abdominal ultrasonographyCevap
  2. B
    Annual low-dose chest computed tomography
  3. C
    Carotid duplex ultrasonography
  4. D
    Screening ankle-brachial index
  5. E
    Resting electrocardiography

Cevap

One-time abdominal ultrasonography
The recommendation for abdominal ultrasonography is correct because the patient fits the exact criteria established by the United States Preventive Services Task Force (USPSTF) for abdominal aortic aneurysm screening. Men between the ages of 65 and 75 who have smoked at least 100 cigarettes in their lifetime should receive a one-time screening ultrasound to evaluate for the presence of an abdominal aortic aneurysm. This patient's 4 pack-year history easily meets the 'ever smoked' threshold.

Adım Adım Çözüm

1
Identify the patient's demographic and risk factor profile.
The patient is a 67-year-old male with a history of smoking (4 pack-years).
Age, sex, and smoking history dictate eligibility for specific USPSTF preventive screening guidelines.
2
Determine if the patient meets the 'ever smoked' threshold.
The patient smoked 1 pack a day for 4 years (approximately 29,200 cigarettes), which far exceeds the 100 lifetime cigarettes threshold.
The definition of 'ever smoked' in the context of abdominal aortic aneurysm screening is at least 100 cigarettes in a lifetime.
3
Apply the appropriate screening guideline for this demographic.
The patient is a man aged 65 to 75 who has 'ever smoked', making him eligible for a one-time screening for an abdominal aortic aneurysm.
The USPSTF assigns a Grade B recommendation for one-time ultrasound screening for AAA in men aged 65 to 75 years who have ever smoked.

Anahtar Kavram

Abdominal Aortic Aneurysm (AAA) Screening Guidelines
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Konular

Preventive Care and Screening

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