A 50-year-old woman comes to the clinic for her first health maintenance examination in over a decade. Her medical history is significant for type 2 diabetes mellitus and hypertension. She currently smokes 1 pack of cigarettes daily and has done so since age 20 (30 pack-years). Her only medications are metformin and lisinopril. BMI is 31 kg/m². Blood pressure is 138/88 mmHg, and hemoglobin A1c is 7.2%. She reports feeling well and has no specific complaints. She has not received any vaccinations or cancer screenings since she was in her thirties.
Which of the following preventive interventions are indicated for this patient today? (Select all that apply)
- Low-dose computed tomography of the chestAnswer
- Recombinant zoster vaccinationAnswer
- Primary high-risk human papillomavirus testingAnswer
- DDual-energy x-ray absorptiometry
- EAdministration of 23-valent pneumococcal polysaccharide vaccine as initial immunization
Answer
The correct interventions are low-dose computed tomography of the chest, recombinant zoster vaccination, and primary high-risk human papillomavirus testing.
The patient meets criteria for three specific preventive interventions. Lung cancer screening with low-dose computed tomography is indicated for adults aged 50 to 80 years with at least a 20 pack-year smoking history who currently smoke. The recombinant zoster vaccine is universally recommended for immunocompetent adults starting at age 50. Furthermore, cervical cancer screening is indicated since she is between 21 and 65 years old and has not been screened in over a decade; primary high-risk human papillomavirus testing is an appropriate modality.
Step-by-Step Solution
Key Concept
Age- and risk-based application of preventive care guidelines, including cancer screening and adult immunizations.