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 Screening  



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Author11 Posts
  #1

A 41-year-old man presents to his physician for a routine physical examination. He is a new to this office and brings his previous medical record with him. He has no significant past medical history but he does have a strong family history of cancer and heart disease. His father and his brother both had myocardial infarctions before age of 55, and his sister, mother, and aunt had breast cancer. He exercises regularly and eats well, with most of his diet being low in saturated fat and cholesterol. He smokes one pack of cigarettes per week. His review of systems is unremarkable. He is very anxious and would like only minimal interventions done because of his good health. Which of the following is an age-appropriate screening test in this patient?
A. Fasting lipid profile
B. Non-fasting total cholesterol level
C. Oral glucose tolerance test
D. Prostate examination
E. Sigmoidoscopy





  #2

B. Non-fasting total cholesterol.


  #3

B - non fasting total cholesterol.


  #4

Well done! nod

The correct answer is
B. The current recommendations for routine, age-appropriate screening are based, in some measure, on data from clinical trials. Depending on the source of the recommendations, there is considerable variability in these recommendations. One of the more agreed on recommendations is that, at least every 5 years, a random cholesterol level should be checked.

A fasting lipid profile (choice A) is usually obtained only after a screening cholesterol is shown to be greater than 240 mg/dL.

An oral glucose tolerance test (OGTT) (choice C) is given to pregnant women to screen for gestational diabetes. There is no current recommendation for using OGTT in routine screening practice in any age group.

The incidence of prostate cancer is age-related and becomes reasonably prevalent after age 50. Therefore, prostate examinations (choice D) are recommended annually after age 50. Like prostate cancer, colon cancer is also age-related and begins to have significant incidence after the 5th decade.

Sigmoidoscopy (choice E) is indicated every 3-5 years after age 50 to monitor for lesions up to the splenic flexure. Colonoscopy is necessary to survey the entire colon.




  #5

drS if a patient came to you who 6 months back had a screening cholesterol level greater than 240.and now hes come again for a regular check up.now what will u do non fasting or fasting serum cholesterol.?


  #6

good question. Well my personal opinion would be a fasting lipid profile since by now we would have ideally started some sort of treatment (either lifestyle modification of drugs) and we would have had to asses the effect of these on the prognostically important components such as LDL and HDL cholesterol levels. But I'm not sure what the accepted guidelines are. Perhaps someone else can provide some input?


  #7

non fasting serum cholesterol


  #8

Drs I agree with you


  #9

But.. you start doing annual DRE's since 40 years old. This includes a prostate exam. Doesn't that make D the right answer?


  #10

good post DrS


  #11

thsi sounds similar to step 1 are the two exam realyt hat close ck and step 1





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