Preventative care and health management questions Flashcards
A 40-year-old patient presents for her first health maintenance examination. She denies any new complaints or symptoms. She has no history of any gynecologic problems. Family history is significant for a father with hypertension and a mother, deceased, with breast cancer diagnosed at age 56. A paternal aunt has ovarian cancer which was diagnosed at age 83. A physical exam is unremarkable. What screening test should be offered to this patient next?
mammogram
A 48-year-old G3P3 presents to the office for a health maintenance examination. Her past medical history, physical exam and labs are normal. Her body mass index (BMI) is normal. Her family history is significant for hypertension in her father and diabetes mellitus in her mother. Her grandfather passed away of colon cancer at the age of 82 and she is worried about getting colon cancer and desires to undergo screening. What is the most appropriate next step in the management of this patient?
A. Recommend a colonoscopy at age 50 and, if normal, repeat every 10 years
A 60-year-old postmenopausal woman has an appointment for a health maintenance examination. She wants to discuss bone density screening for osteoporosis. Her medical history is significant for hypertension for the last 10 years that is well controlled with antihypertensive medications. Which of the following is the most appropriate recommendation for this patient regarding initial bone mineral density screening?
Correct! Bone density screening is recommended for women beginning at age 65 unless they have pre-existing risk factors which warrant earlier screening. Risk factors for osteoporosis are early menopause, glucocorticoid therapy, sedentary lifestyle, alcohol consumption, hyperthyroidism, hyperparathyroidism, anticonvulsant therapy, vitamin D deficiency, family history of early or severe osteoporosis, or chronic liver or renal disease. These factors would institute early screening in a patient for osteoporosis. A postmenopausal patient presenting with fractures should alert you to suspect osteoporosis.
A 28-year-old patient presents to the office for a health maintenance examination. She is currently on oral contraceptive pills, but reports a history of irregular menses prior to starting them. Her past medical history is otherwise non-contributory. On physical examination, she is 5 feet 2 inches tall and weighs 180 pounds. She has an area of velvety, hyperpigmented skin on the back of her neck and under her arms. What is the next best step in the management of this patient?
The patient is obese, with a BMI of 33. In addition, the skin changes are consistent with acanthosis nigricans, which is closely associated with insulin resistance. Given these risk factors, she should be tested for diabetes.
