A 67-year-old man comes to the office for a preventive examination. He feels well and has no concerns aside from occasional pain in his knees. Medical history is significant for hypertension and osteoarthritis, for which he takes chlorthalidone, lisinopril, and, occasionally, acetaminophen. The patient has a 20-pack-year smoking history but quit 25 years ago. His last colonoscopy 4 years ago was unremarkable. He does not drink alcohol. He is a retired plumber and lives with his wife in a retirement community.
Vital signs and physical examination show no abnormalities.
Which of the following is the most appropriate next step in management of this patient?

Question

A 67-year-old man comes to the office for a preventive examination.  He feels well and has no concerns aside from occasional pain in his knees.  Medical history is significant for hypertension and osteoarthritis, for which he takes chlorthalidone, lisinopril, and, occasionally, acetaminophen.  The patient has a 20-pack-year smoking history but quit 25 years ago.  His last colonoscopy 4 years ago was unremarkable.  He does not drink alcohol.  He is a retired plumber and lives with his wife in a retirement community.
Vital signs and physical examination show no abnormalities.
Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

11ec193a_976c_094b_853d_c5871446afd2_MD0002_00 Abdominal aortic aneurysm (AAA), a common disorder with a long asymptomatic phase, is often noted incidentally on imaging studies done for other purposes. The mortality rate for patients with ruptured AAA is very high, making it an ideal subject for screening in patients at risk. The primary risk factors for AAA include male gender, smoking history, and age >65. ideal subject for screening The US Preventive Services Task Force (USPSTF) has identified men age 65-75 who have smoked cigarettes as having the greatest benefit from screening and recommends a one-time abdominal ultrasound in such patients. Screening and surgical repair of large AAAs (≥5.5 cm) have been found to decrease AAA-specific mortality in this population. Ultrasonography is the recommended screening modality due to its low cost, noninvasive nature, and lack of ionizing radiation. There are no recommendations for or against screening in men age 65-75 who have never smoked. (Choice B) Screening for osteoporosis with bone densitometry is recommended for women age ≥65 and for women age <65 at increased risk. Bone densitometry may be considered for men at increased risk (eg, prolonged glucocorticoid exposure), but evidence to support screening the general male population is lacking. (Choice C) The USPSTF recommends HIV screening for patients age 15-65 and for those at increased risk. Screening may also be considered in patients who request testing regardless of age, known risk factors, or prior screening. (Choice D) Lung cancer screening with yearly low-dose CT scan of the chest is recommended for patients age 50-80 with a 20-pack-year smoking history. It may be discontinued once the patient has not smoked for 15 years, has other conditions that would limit life expectancy, or would be unable or unwilling to undergo curative surgery. (Choice E) Transesophageal and, to a lesser degree, transthoracic echocardiography can detect dilation of the proximal ascending aorta, but they are not used for general screening purposes outside specific populations (eg, those with Marfan syndrome). Educational objective: The US Preventive Services Task Force recommends screening men age 65-75 who have smoked cigarettes with a one-time abdominal ultrasound to evaluate for abdominal aortic aneurysm. __________ References: Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. (http://www.ncbi.nlm.nih.gov/pubmed/24473919)

A 67-Year-Old Man Comes to the Office for a Preventive