A 72-year-old man comes to the office for a health maintenance examination. The patient feels well and does not report any symptoms, aside from occasional pain in his knees. Medical history is significant for hypertension and osteoarthritis, for which he takes hydrochlorothiazide, lisinopril, and as-needed acetaminophen. The patient has a 30-pack-year smoking history but quit 15 years ago. He does not use alcohol. He is a retired plumber and lives with his wife in a retirement community. During the visit, the patient reveals that a friend recently had an abdominal aortic aneurysm repair and inquires whether he should be screened for the same disorder. Which of the following is the most appropriate next step in management of this patient?

Question

A 72-year-old man comes to the office for a health maintenance examination.  The patient feels well and does not report any symptoms, aside from occasional pain in his knees.  Medical history is significant for hypertension and osteoarthritis, for which he takes hydrochlorothiazide, lisinopril, and as-needed acetaminophen.  The patient has a 30-pack-year smoking history but quit 15 years ago.  He does not use alcohol.  He is a retired plumber and lives with his wife in a retirement community.  During the visit, the patient reveals that a friend recently had an abdominal aortic aneurysm repair and inquires whether he should be screened for the same disorder.  Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d2d7_39d1_bc81_617c7d97997d_MD0003_00 Abdominal aortic aneurysm (AAA) is a common disorder with a long asymptomatic phase. The mortality rate for patients with ruptured AAA is very high (75%-90%), but the risk is mitigated if the aneurysm is repaired prior to rupture, making it an appropriate subject for screening in patients at risk. The primary risk factors for AAA include male gender, smoking history, and age >65. The US Preventive Services Task Force recommends screening for AAA with a one-time abdominal ultrasound in men age 65-75 who have ever smoked (ie, any lifetime exposure >100 cigarettes). 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 because of its high sensitivity (>95%), low cost, noninvasive nature, and lack of ionizing radiation. Screening for AAA may also be beneficial for men age 65-75 who have not smoked but have other significant risk factors (eg, first-degree family history of AAA rupture). Screening in younger men and in women appears to have little, if any, benefit and is not recommended. (Choices B and E) CT and MRI both have high sensitivity for AAA, and AAA is often detected incidentally on abdominal imaging performed for other purposes. However, these tests are more expensive and less validated than ultrasound for screening. In addition, CT exposes patients to ionizing radiation. (Choice D) Transesophageal and, to a lesser degree, transthoracic echocardiogram can detect dilation of the proximal ascending aorta, but they do not play a role in screening for AAA. Educational objective: The primary risk factors for abdominal aortic aneurysm include male gender, smoking history, and age >65. The US Preventive Services Task Force recommends screening for this condition with a one-time abdominal ultrasound in men age 65-75 who ever smoked. 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) Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement (http://www.ncbi.nlm.nih.gov/pubmed/24957320)

A 72-Year-Old Man Comes to the Office for a Health