Surgery

A 65-year-old heavy smoker is coming for a general examination..

What is the best screening test for him?

  1. A Osteoporosis
  2. B Colon cancer
  3. C AAA Correct answer
  4. D didn't recall

Explanation

Core Concept: Screening for Abdominal Aortic Aneurysm (AAA) in high-risk populations based on age and smoking history.

Clinical Presentation:

  • Typically asymptomatic until expansion or rupture (sudden severe abdominal/back pain, pulsatile mass, hypotension).
  • Complications: Rupture leading to massive hemorrhage, shock, and death.

Diagnosis:

  • First-line & Gold standard: One-time screening with abdominal ultrasound, which is highly sensitive and specific.

Management:

  • Acute: Emergent surgical or endovascular repair (EVAR) if ruptured or symptomatic.
  • Long-term: Surveillance with serial ultrasounds for small aneurysms; elective repair is indicated if the diameter exceeds 5.5 cm or expands rapidly (>0.5 cm in 6 months). The USPSTF recommends one-time ultrasound screening for AAA in men aged 65-75 who have ever smoked.

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