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Zorluk: OrtaPreventive Care and Screening

A 63-year-old female presents to the clinic for a routine annual wellness examination. She feels well and has no acute complaints. Her medical history is significant for type 2 diabetes mellitus and primary hypertension. Her current medications include metformin and lisinopril. Vital signs are within normal limits, and her body mass index is 27 kg/m². She has never smoked and drinks one glass of wine on weekends.

Review of her preventive care history reveals the following:
- Screening mammography: Performed 11 months ago, BI-RADS 1 (negative).
- Cervical cancer screening: Pap smear with HPV co-testing performed at age 60, negative for intraepithelial lesions and high-risk HPV.
- Colorectal cancer screening: Colonoscopy performed at age 53, revealing no polyps or abnormalities.
- Vaccinations: Received 2 doses of the recombinant zoster vaccine at age 50. Received the 20-valent pneumococcal conjugate vaccine (PCV20) at age 61. Received a Tdap booster 6 years ago. Received an annual influenza vaccine last month.

The patient asks if she is due for any other screening tests or preventive medications today. Which of the following is the most appropriate next step in this patient's preventive care?

  1. Screening colonoscopyCevap
  2. B
    Screening mammography
  3. C
    Dual-energy x-ray absorptiometry scan
  4. D
    Cervical cytology with human papillomavirus co-testing
  5. E
    Initiation of daily low-dose aspirin therapy

Cevap

The most appropriate next step is to perform a screening colonoscopy, as it has been 10 years since her last normal examination.
The most appropriate next step in preventive care for this patient is a screening colonoscopy. According to the United States Preventive Services Task Force (USPSTF), average-risk adults should undergo colorectal cancer screening between ages 45 and 75. For individuals utilizing colonoscopy as their screening modality, the recommended interval is every 10 years following a normal exam. Because this patient's last colonoscopy was performed 10 years ago at age 53, she is currently due for repeat screening.

Adım Adım Çözüm

1
Evaluate the patient's colorectal cancer screening status.
The patient is 63 years old and her last colonoscopy was 10 years ago at age 53.
The United States Preventive Services Task Force (USPSTF) recommends colorectal cancer screening for average-risk adults aged 45 to 75. A normal colonoscopy establishes a 10-year interval for the next screening.
2
Assess the interval for breast and cervical cancer screening.
The patient had a mammogram 11 months ago (due in 13 months) and Pap/HPV co-testing 3 years ago (due in 2 years).
USPSTF guidelines recommend biennial (every 2 years) mammography for women aged 40-74, and cervical cancer co-testing every 5 years for women aged 30-65.
3
Determine the indication for an osteoporosis screening (DEXA) scan.
The patient is 63, lacks major osteoporotic risk factors, and has a normal BMI.
Routine DEXA screening begins at age 65 for average-risk women. Women under 65 are only screened if their 10-year fracture risk meets or exceeds that of a 65-year-old white woman.
4
Review the guidelines for primary prevention of cardiovascular disease with aspirin.
The patient is over 60 without a history of atherosclerotic cardiovascular disease.
Current guidelines recommend against starting low-dose aspirin for primary prevention in adults 60 and older due to the net harm from bleeding risks.

Anahtar Kavram

Ambulatory adult preventive care guidelines require tracking and applying distinct screening intervals for colorectal, breast, and cervical cancers, as well as age-specific contraindications for primary prevention medications.
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Preventive Care and Screening

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