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Question

Difficulty: MediumPreventive Care and Screening

Review the clinical histories of the following four patients seen in an ambulatory primary care clinic. Match each patient's specific clinical profile with the single most appropriate, guideline-concordant preventive intervention.

  • A 28-year-old primigravida at 28 weeks of gestation who received a standard tetanus-diphtheria toxoid (Td) booster two years ago.Administer the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
  • A 67-year-old man establishing care with a new physician; he reports smoking one pack of cigarettes daily for five years during his early twenties but has not smoked since.Perform a one-time screening ultrasonography of the abdomen.
  • A 54-year-old woman who currently smokes one pack of cigarettes daily and has a 25-pack-year smoking history.Order an annual screening low-dose computed tomography (LDCT) of the chest.
  • A 21-year-old non-pregnant female university student who recently became sexually active with a new male partner and had a normal cervical cytology screen last month.Perform screening with nucleic acid amplification testing for chlamydia and gonorrhea.

Answer

The 28-year-old pregnant woman matches with Tdap vaccination; the 67-year-old man with a 5 pack-year smoking history matches with AAA ultrasonography; the 54-year-old woman with a 25 pack-year smoking history matches with annual LDCT of the chest; and the 21-year-old sexually active woman matches with chlamydia and gonorrhea screening.
Each patient's clinical profile aligns precisely with a specific, evidence-based preventive guideline. The pregnant patient requires Tdap for neonatal protection. The older man with a brief smoking history requires a one-time AAA ultrasound. The middle-aged woman with a heavy smoking history requires annual LDCT. The young, sexually active woman requires routine STI screening.

Step-by-Step Solution

1
Evaluate the preventive needs of the pregnant patient.
Identify that Tdap vaccination is required during the 27-36 week window of every pregnancy.
Maternal immunization provides critical passive immunity against pertussis to the newborn, superseding routine adult 10-year booster intervals.
2
Assess the screening requirements for the older male patient.
Identify that a 67-year-old man who smoked for 5 years meets the criteria for one-time AAA screening.
AAA screening is indicated for men aged 65-75 who have smoked at least 100 cigarettes in their lifetime. A 5 pack-year history far exceeds this minimum.
3
Determine the lung cancer screening eligibility for the middle-aged female patient.
Confirm she meets the criteria for LDCT.
She is between 50-80 years of age and has a smoking history of at least 20 pack-years (she has 25).
4
Analyze the STI and cancer screening needs for the young female patient.
Select chlamydia and gonorrhea screening as the next appropriate step.
Routine screening for these STIs is universally recommended for sexually active women under 25. Cervical cancer screening has already been appropriately managed.

Key Concept

Application of age-, sex-, and risk-specific preventive screening and immunization guidelines (USPSTF and ACIP).
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Topics

Preventive Care and Screening

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