Q&A Medicine>>>>>General Medicine
Question 4#

A 22-year-old woman presents for a routine annual physical examination. She has no complaints. She smokes 2 packs of cigarettes per day and drinks 2 glasses of wine per day. She is sexually active with one male partner and two female partners. She reports using oral contraceptive pills for birth control and consistent condom use with her male partner. Her family history is significant for breast cancer on her maternal side (aunt) and colon cancer on her paternal side (father died of colon cancer at the age of 52).

What is the recommended screening measure at this patient’s visit?

A. Colonoscopy
B. Chlamydia trachomatis screening
C. Lipid panel
D. Mammogram

Correct Answer is B


Chlamydia trachomatis screening. This patient is presenting for a routine physical examination and it must be determined what screening measures are recommended at this time. The U.S. Preventive Services Task Force (USPSTF) in 2007 recommended routine screening for Chlamydia trachomatis infection in all sexually active women who are 24 years and younger, in addition to asymptomatic women of all ages who are at increased risk for sexually transmitted infections (including those with sexually transmitted infections and those with new and/or several sexual partners). (A) Although this patient has a family history of colon cancer, the USPSTF recommends colon cancer screening starting at 50 years of age. However, if there is family history in a first-degree relative, then it should be initiated 10 years before the age of that relative’s diagnosis or 40 years of age, whichever comes first. This patient should have her first colonoscopy at the age of 40 (her father got it at 52 years of age, and 52 minus 10 is 42, so 40 comes before 42). (C) Lipid panel screening is recommended by the USPSTF for men of age 35 and older and women of age 45 and older (those with risk factors can be screened earlier at the age of 20). (D) Mammogram screening per USPSTF recommendations should begin at the age of 50 and older and occur every 2 years (for those with average risk). Of note, recommended immunizations for this patient include the Tdap booster and HPV vaccination (if not already done).