A 34-year-old man comes to the office for a routine preventive visit. He has had low back pain intermittently for the past 2 months and believes he injured his back while exercising at the gym. The patient has taken naproxen as needed and says that the pain is slowly improving. He has no fevers, focal weakness, or bowel or bladder difficulties. The patient has a 20-pack-year smoking history. His father was diagnosed with prostate cancer at age 66, and his mother had a myocardial infarction at age 59.
Vital signs, weight, and physical examination are unremarkable. The patient is interested in improving his health and asks if he should be screened for any other diseases.
Which of the following is the most appropriate screening test for this patient?

Question

A 34-year-old man comes to the office for a routine preventive visit.  He has had low back pain intermittently for the past 2 months and believes he injured his back while exercising at the gym.  The patient has taken naproxen as needed and says that the pain is slowly improving.  He has no fevers, focal weakness, or bowel or bladder difficulties.  The patient has a 20-pack-year smoking history.  His father was diagnosed with prostate cancer at age 66, and his mother had a myocardial infarction at age 59.
Vital signs, weight, and physical examination are unremarkable.  The patient is interested in improving his health and asks if he should be screened for any other diseases.
Which of the following is the most appropriate screening test for this patient?

Quizplus · Accepted Answer

This patient is being seen to discuss preventive services. His initial evaluation, including blood pressure and physical examination, is unremarkable, but his smoking history and family history of premature coronary heart disease (CHD) (eg, first-degree male relative diagnosed at age <50, female relative at age <60) significantly increases his risk for CHD. Screening for lipid disorders is recommended for men age ≥35 and women age ≥45 but is not generally recommended for younger adults because the prevalence of lipid disorders is low, and the benefit of specific interventions (eg, statin therapy) is small. However, screening should be considered on an individual basis for younger patients who have additional CHD risk factors, such as this patient (Choice D). Serum total cholesterol and HDL generally have the greatest prognostic utility, but LDL and triglyceride levels are also useful and are typically included in the lipid panel. (Choice A) There is insufficient evidence regarding the benefit of screening for diabetes in young, otherwise healthy individuals. Most professional organizations recommend screening select patients who fall within higher prevalence groups (eg, overweight or obese, age ≥45, hypertension, dyslipidemia) or who are more likely to benefit from early treatment. (Choice C) Screening for lung cancer with a low-dose noncontrast CT scan is recommended for individuals age 50-80 who have a ≥20-pack-year smoking history and currently smoke or quit smoking within the past 15 years. Screening in younger patients has not been shown to be effective and is not recommended. (Choice E) Screening for prostate cancer with a serum prostate-specific antigen level is not universally recommended due to low disease-specific mortality and significant risk of overtreatment. It can be considered in men age 55-69 who are at increased risk (eg, family history of prostate cancer, high-risk racial groups) but is not recommended for younger men. Educational objective: Screening for lipid disorders is recommended for men age ≥35 and women age ≥45, and for younger patients who have additional risk factors (eg, smoking, hypertension, diabetes mellitus, family history of premature coronary heart disease) for coronary heart disease. __________ References: The adult well male examination. (http://www.ncbi.nlm.nih.gov/pubmed/22612046) Statin use for the primary prevention of cardiovascular disease in adults: us preventive services task force recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/27838723)

A 34-Year-Old Man Comes to the Office for a Routine