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Zorluk: OrtaPreventive Care and Screening

A primary care physician is reviewing the electronic health records of four established patients who are scheduled for annual health maintenance visits this morning. Match each patient's specific clinical presentation to the single most appropriate, guideline-concordant screening intervention that should be ordered or performed today.

  • A 42-year-old female with average disease risk. Her most recent cervical cytology with HPV co-testing was performed at age 40 and was negative. She has never undergone breast imaging.Initiate biennial screening mammography
  • A 67-year-old male with a 35-pack-year smoking history who successfully quit smoking 10 years ago. He underwent a normal screening colonoscopy at age 62 and has no other major medical conditions.Order an annual low-dose chest computed tomography and a one-time abdominal aortic ultrasound
  • A 23-year-old female who is asymptomatic and reports being sexually active with a new partner. Her last cervical cytology was performed at age 21 and was normal.Perform nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae
  • A 66-year-old female with documented adequate prior negative cervical cancer screenings. She had a normal screening mammogram at age 65 and a normal colonoscopy at age 60. She has never undergone bone density testing.Order a dual-energy x-ray absorptiometry (DEXA) scan

Cevap

The 42-year-old female matches with initiating biennial screening mammography. The 67-year-old male former smoker matches with ordering annual low-dose chest CT and a one-time abdominal aortic ultrasound. The 23-year-old sexually active female matches with chlamydia and gonorrhea screening. The 66-year-old female matches with ordering a DEXA scan.
Each patient represents a classic demographic for specific USPSTF Grade A or B recommendations. The 42-year-old needs breast cancer screening (starts at age 40). The 67-year-old male smoker needs lung and AAA screening (based on age and smoking history). The 23-year-old needs STI screening (indicated for sexually active women <25). The 66-year-old female needs osteoporosis screening (starts at age 65 for women).

Adım Adım Çözüm

1
Evaluate the 42-year-old female for age-appropriate screenings.
She is due for breast cancer screening.
Current USPSTF guidelines recommend starting biennial screening mammography at age 40 for average-risk women. Her cervical screening is up to date.
2
Evaluate the 67-year-old male former smoker for age and exposure-appropriate screenings.
He is due for both lung cancer and abdominal aortic aneurysm (AAA) screening.
He has a >20 pack-year history and quit <15 years ago, meeting LDCT criteria. He is a male aged 65-75 with a smoking history, meeting AAA ultrasound criteria.
3
Evaluate the 23-year-old sexually active female.
She is due for STI screening.
All sexually active women younger than 25 years require annual screening for chlamydia and gonorrhea. She is not yet due for her next Pap smear.
4
Evaluate the 66-year-old female with up-to-date cancer screenings.
She is due for osteoporosis screening.
Routine screening for osteoporosis with a DEXA scan is recommended for all women aged 65 years and older.

Anahtar Kavram

Age, biological sex, and risk factor-based application of USPSTF preventive screening guidelines.
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Preventive Care and Screening

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