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Zorluk: OrtaPreventive Care and Screening

A 69-year-old man comes to the clinic for a routine health maintenance examination. He has no acute complaints. His medical history includes primary hypertension and gastroesophageal reflux disease, which are well controlled with amlodipine and pantoprazole. He smoked 1 pack of cigarettes daily from age 18 to 50 (32 pack-years) but quit 19 years ago. He drinks alcohol occasionally and does not use illicit drugs. His last colonoscopy was performed at age 63 and showed no polyps or other abnormalities. A hepatitis C virus antibody test was negative three years ago. He received the 2-dose recombinant zoster vaccine series at age 65 and a 20-valent pneumococcal conjugate vaccine (PCV20) at age 66. He received a Tdap booster 4 years ago. Vital signs today are blood pressure 126/78 mm Hg, pulse 70/min, and respirations 14/min. Physical examination is unremarkable. Which of the following is the most appropriate next step in preventive care for this patient?

  1. A
    Annual low-dose computed tomography of the chest
  2. B
    Dual-energy x-ray absorptiometry
  3. C
    Fecal immunochemical testing
  4. D
    Thyroid-stimulating hormone testing
  5. Ultrasonography of the abdomenCevap

Cevap

Ultrasonography of the abdomen
This patient meets the criteria for abdominal aortic aneurysm (AAA) screening. The United States Preventive Services Task Force (USPSTF) recommends a one-time screening for AAA with ultrasonography of the abdomen in men aged 65 to 75 years who have ever smoked. 'Ever smoked' is defined as having smoked at least 100 cigarettes in a lifetime. This patient is 69 years old and has a 32 pack-year smoking history, making this the most appropriate next step in preventive care.

Adım Adım Çözüm

1
Evaluate the patient's demographics and social history.
The patient is a 69-year-old man with a significant smoking history (32 pack-years).
Age, biological sex, and smoking history dictate specific preventive screening guidelines.
2
Assess the need for lung cancer screening.
Lung cancer screening is not indicated because the patient quit smoking 19 years ago.
Guidelines recommend stopping annual screening once a person has not smoked for 15 years.
3
Determine eligibility for abdominal aortic aneurysm (AAA) screening.
The patient meets criteria for AAA screening.
Men aged 65 to 75 years who have ever smoked should receive a one-time screening ultrasound for AAA.

Anahtar Kavram

The USPSTF recommends a one-time screening for an abdominal aortic aneurysm with ultrasonography in men aged 65 to 75 years who have a history of smoking (at least 100 cigarettes in a lifetime).
Tahmini Süre:1m 15s
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Preventive Care and Screening

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