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Zorluk: OrtaPreventive Care and Screening

An established 66-year-old female patient is evaluated in the ambulatory clinic for her annual health maintenance visit. She has no acute complaints and reports feeling well. Her medical history is notable for mild primary hypertension, which is well-controlled on amlodipine. She has never smoked cigarettes and consumes a glass of wine occasionally in social settings. She underwent a normal screening colonoscopy eight years ago and a normal screening mammogram three months ago. A fasting lipid panel performed last year was within normal limits. Her gynecologic history reveals negative cervical cytology and high-risk human papillomavirus (HPV) co-testing at ages 58 and 63, with no history of cervical dysplasia or immunocompromise. Her blood pressure is 124/78 mm Hg, and her body mass index is 23 kg/m². Physical examination is unremarkable. Which of the following is the most appropriate next step in preventive care for this patient?

  1. A
    Perform cervical cytology with high-risk human papillomavirus co-testing
  2. B
    Schedule a screening colonoscopy
  3. C
    Order a low-dose computed tomography scan of the chest
  4. Order a dual-energy x-ray absorptiometry scanCevap
  5. E
    Obtain a screening ultrasound of the abdominal aorta

Cevap

Order a dual-energy x-ray absorptiometry scan
The correct answer identifies that dual-energy x-ray absorptiometry (DEXA) scanning is indicated for this patient. The United States Preventive Services Task Force (USPSTF) Grade B recommendation states that all women 65 years and older should undergo bone measurement testing to screen for osteoporosis. As this patient is 66 years old and has not yet had a DEXA scan, ordering one is the most appropriate next step in her preventive care.

Adım Adım Çözüm

1
Evaluate the patient's age and sex to identify age-specific screening requirements.
The patient is a 66-year-old female.
Preventive guidelines from the USPSTF are heavily stratified by age and biological sex.
2
Review the patient's prior screening history to determine if established testing should be continued or discontinued.
She meets the criteria to discontinue cervical cancer screening, and her next colorectal cancer screening is not due for two more years.
Avoiding over-screening is critical. She has adequate prior negative Pap/HPV co-tests within the appropriate timeframes and a normal colonoscopy 8 years ago.
3
Assess the indication for newly applicable age-based screenings.
Women aged 65 and older require routine osteoporosis screening with a bone measurement test.
Routine screening prevents osteoporotic fractures, and she has crossed the age threshold of 65 without a prior DEXA scan.

Anahtar Kavram

In average-risk women, routine osteoporosis screening with dual-energy x-ray absorptiometry (DEXA) should commence at age 65, while routine cervical cancer screening can be discontinued at age 65 if adequate prior negative screening is documented.
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Preventive Care and Screening

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