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Old 12-01-2011
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Question One pack of cigerettes per day

A 34-year-old woman comes to your office to establish primary care. While she has no current complaints and reports herself to be “fairly healthy,” she wishes to see a doctor regularly for preventive medicine. She does regular breast examinations on herself, has a good diet and exercise, and has no family history of malignancy or chronic disease. While all of her other habits are healthy, she reluctantly admits to smoking a pack of cigarettes a day. She had a “cervical smear” in her twenties, which she says was normal, and has never had a mammogram or ultrasound of her breasts. She reports being sexually active, and that she practices safe sex. Physical examination reveals a young woman in no apparent distress, with unremarkable vital signs. Her examination, including a breast and genitourinary exam, is normal. Which of the following is the most appropriate screening exam at this time?

A. Bone density measurement to screen for osteoporosis
B. Lipid level to screen for dyslipidemia
C. Mammogram to screen for breast cancer
D. Papanicolaou smear to screen for cervical cancer
E. X-ray of thorax to screen for lung and breast cancer
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Old 12-01-2011
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D Pap smear to screen for cervical cancer
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Old 12-01-2011
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D. Papanicolaou smear to screen for cervical cancer
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D - pap smear
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Old 12-02-2011
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D. Papanicolaou smear to screen for cervical cancer
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Old 12-02-2011
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The correct answer is D. Pap smears should be performed annual in sexually active women. Once a patient has had at least three normal pap smears, the frequency can be reduced. This patient, however, has only had one Pap smear.
Bone density measurement (choice A) is a recommended screening technique in older women (age 65) or younger women with significant risk factors for osteoporosis. At this young age, it is advised to discuss osteoporosis risk reduction, but testing is not recommended.
A lipid panel (choice B) is recommended for women over the age of 45, unless there is reason to suspect dyslipidemia.
Mammograms (choice C) have not been proven to be effective screening for younger women. This patient should have a screening mammogram in her forties to establish a baseline, and then regular mammograms in her fifties. Were a palpable mass to be felt on a breast exam, either by the patient or the physician, a diagnostic mammogram may be ordered. In younger patients, however, an ultrasound may provide better breast-tissue visualization.
X-rays of the chest (choice E) are not effective screening techniques for lung or breast cancer. Currently, there is no recommended screening study for lung cancer in high-risk groups (smokers).
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