A 56-year-old man comes to the office for a routine preventive visit. He works as a welder on an oil rig and currently feels well. The patient has a history of hypertension and hyperlipidemia, which are well controlled with oral medications. He has smoked a pack of cigarettes daily since age 14 and has been unable to quit despite repeated attempts. The patient drinks alcohol socially and does not use illicit drugs. His father died due to complications of Alzheimer disease, and his mother died from ovarian cancer. Screening colonoscopy at age 52 revealed a 0.5-cm hyperplastic polyp. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following screening tests is recommended for this patient?

Question

A 56-year-old man comes to the office for a routine preventive visit.  He works as a welder on an oil rig and currently feels well.  The patient has a history of hypertension and hyperlipidemia, which are well controlled with oral medications.  He has smoked a pack of cigarettes daily since age 14 and has been unable to quit despite repeated attempts.  The patient drinks alcohol socially and does not use illicit drugs.  His father died due to complications of Alzheimer disease, and his mother died from ovarian cancer.  Screening colonoscopy at age 52 revealed a 0.5-cm hyperplastic polyp.  Vital signs are within normal limits.  Physical examination shows no abnormalities.  Which of the following screening tests is recommended for this patient?

Quizplus · Accepted Answer

11ec25c8_d2ab_bcc8_bc81_b3204415bfe2_MD0003_00 Cigarette smoking is the single greatest risk factor for lung cancer. Because early diagnosis reduces lung cancer morbidity and mortality, annual screening with a low-dose CT scan of the chest is recommended for those who have smoked ≥20 pack-years. Screening should begin at age 50 and continue to age 80 or until ≥15 years of smoking cessation is achieved. Screening is therefore indicated for this patient (age 56, 42 pack-year history) (Choice E). (Choice A) One-time screening for abdominal aortic aneurysm with an abdominal ultrasound is recommended for men age 65-75 who have ever smoked. Mortality due to this condition in younger men is significantly lower, so screening is not recommended. (Choice B) Bone mineral density screening (eg, DXA scan) for osteoporosis is recommended for women age ≥65 and for younger women at increased risk for osteoporosis. Screening can be considered for men with signs of osteoporosis (eg, vertebral compression fracture) or elevated risk (eg, chronic glucocorticoid therapy) but is not otherwise recommended. (Choice C) A 10-year interval is generally recommended for screening colonoscopy. Although more frequent screening is recommended for those with adenomatous (precancerous) polyps, hyperplastic polyps do not increase the risk of colorectal cancer and do not warrant more frequent screening. Educational objective: An annual low-dose CT scan of the chest is recommended for patients with a ≥20-pack-year smoking history to reduce morbidity and mortality from lung cancer. Screening should generally begin at age 50 and continue to age 80 or until ≥15 years of smoking cessation. References: Screening for lung cancer: US Preventive Services Task Force recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/33687470)

A 56-Year-Old Man Comes to the Office for a Routine