A 36-year-old woman comes to the office for a routine annual visit. The patient feels well and has no health concerns. She has regular monthly menses with mild breast tenderness a day before bleeding starts. The patient had a copper-containing intrauterine device (IUD) placed 2 years ago and uses condoms consistently. She is in a monogamous relationship with a male partner, and they are getting married next year. Pap testing was normal 2 years ago. The patient has smoked a pack of cigarettes daily for the past 20 years, but she does not use alcohol or illicit drugs. Blood pressure is 120/78 mm Hg. BMI is 24 kg/m². Clinical breast examination shows no palpable masses or skin changes. The abdomen is nontender with no palpable masses or hernias. Pelvic examination shows 2-cm IUD strings visible at the cervix and scant physiologic vaginal discharge. The remainder of the physical examination is unremarkable. Which of the following is recommended for this patient at this visit?

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11ec25c8_d266_7703_bc81_afe32ffda261_MD0003_00 Intimate partner violence (IPV) is any type of physical, psychological, or sexual harm committed by a partner or spouse. It affects all genders, ages, races, and sexual orientations and is highly prevalent, with a lifetime risk of approximately 1 in 3 for women and 1 in 4 for men. IPV results in significant morbidity (eg, physical injury, mental health disorders) and mortality, accounting for nearly 15% of all homicides. IPV particularly affects women of childbearing age; however, it is underreported because patients are often reluctant to disclose IPV for multiple reasons, including denial, shame, self-blame, and fear of retribution. The United States Preventive Services Task Force (USPSTF) recommends that screening be performed in all women of childbearing age and appropriate patients be given referral for support services. Screening commonly includes questions, both open ended (eg, "How safe do you feel in your relationship?") and specific (eg, "Have you ever been hit, slapped, or kicked by your partner?"), to improve disclosure rates. Patients who screen positive should be further assessed for immediate safety and given additional resources (eg, local shelter referral) for long-term planning. (Choice A) Abdominal ultrasound is used to screen for abdominal aortic aneurysm (AAA) in men age 65-75 with a smoking history. Because screening does not reduce AAA-related mortality in women, this test is not indicated for this patient. (Choice B) ECG is indicated in high-risk patients (eg, hypertension, family history of premature cardiac death at age <50), but routine screening is not recommended due to high false-positive rates and overtreatment. (Choice D) Low-dose helical chest CT is used to screen for lung cancer in certain population groups; however, it is not indicated in this patient based on her age and smoking history. screen for lung cancer (Choice E) Breast cancer screening with mammography should begin at age 40-50 for women of average risk. Earlier screening should be considered for certain high-risk patients (eg, BRCA1 mutation, history of radiation therapy in the chest) but is not routinely advised. (Choice F) In patients age ≥30, the preferred cervical cancer screening is a Pap test with human papillomavirus cotesting, and it should be performed every 5 years. Alternately, a Pap test alone should be performed every 3 years. This patient's Pap test was normal 2 years ago. Educational objective: Intimate partner violence has a high prevalence and significant morbidity and mortality and is underreported. Therefore, screening is required in all women of childbearing age at routine medical visits. References: Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/30357305) Intimate partner violence discussions in the healthcare setting: a cross-sectional study. (http://www.ncbi.nlm.nih.gov/pubmed/29159016)

A 36-Year-Old Woman Comes to the Office for a Routine