Screening guidelines Practice Questions

Q: A 68-year-old man with a 45 pack-year smoking history presents for a routine visit. He quit smoking 8 years ago. He has hypertension controlled with medication and no other comorbidities. He asks about lung cancer screening. What is the most appropriate screening recommendation for this patient?

Annual low-dose CT scan. ***Annual low-dose CT scan*** - The **USPSTF** recommends annual screening with **low-dose computed tomography (LDCT)** for adults aged **50 to 80 years** who have at least a **20 pack-year** smoking history. - Screening is indicated for those who currently smoke or have **quit within the past 15 years**; this patient qualify as he quit only 8 years ago. *Annual chest X-ray* - **Chest X-rays** lack the sensitivity to detect small, early-stage nodules and have not been shown to reduce **lung cancer mortality**. - Large trials, such as the **NLST**, demonstrated that LDCT is superior to radiography for identifying resectable malignancies. *No screening indicated due to smoking cessation* - Screening should only be discontinued if the patient has not smoked for **15 years** or more, or if they develop a life-limiting condition. - Since this patient only quit **8 years ago**, he remains at an elevated risk that warrants ongoing surveillance. *Low-dose CT scan every 2 years* - The established protocol for lung cancer screening is **annual** (every year), not biennial, to ensure timely detection of rapidly growing tumors. - Changing the frequency to every 2 years significantly decreases the **sensitivity** of a screening program for early intervention. *PET-CT scan annually* - **PET-CT scans** are not used for screening due to high costs, significant **radiation exposure**, and a high rate of false positives. - PET-CT is reserved for the **staging** of confirmed malignancy or characterizing suspicious nodules found on an initial LDCT.

Question 1

A 68-year-old man with a 45 pack-year smoking history presents for a routine visit. He quit smoking 8 years ago. He has hypertension controlled with medication and no other comorbidities. He asks about lung cancer screening. What is the most appropriate screening recommendation for this patient?

Accepted Answer

Annual low-dose CT scan

Answer

Low-dose CT scan every 2 years

Answer

Annual chest X-ray

Answer

PET-CT scan annually

Answer

No screening indicated due to smoking cessation

Question 2

A 52-year-old woman with no significant medical history presents for a routine health maintenance visit. She has no family history of cancer and is a nonsmoker. She asks about when she should start mammography screening. According to current USPSTF guidelines, what is the most appropriate recommendation for this patient?

Accepted Answer

Begin biennial mammography at age 50-74 years with shared decision-making

Answer

Begin annual mammography at age 45 years

Answer

Defer mammography until age 55 years

Answer

Begin mammography only if she develops symptoms

Answer

Begin annual mammography immediately

Screening guidelines — MCQs

Screening guidelines — MCQs

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