During a busy morning in the primary care clinic, a physician evaluates four different adult patients for their routine health maintenance visits. For each patient presentation, identify the single most appropriate, guideline-concordant preventive screening or immunization intervention.
- A 69-year-old man who reports smoking approximately five packs of cigarettes total during his college years but has completely abstained since.One-time screening for abdominal aortic aneurysm with duplex ultrasonography
- A 44-year-old man who was recently diagnosed with stage 3a chronic kidney disease secondary to uncontrolled hypertension.Administration of the 20-valent pneumococcal conjugate vaccine (PCV20)
- A 32-year-old woman presenting to establish care who has no prior documentation of any routine bloodwork or infectious disease testing.One-time screening for human immunodeficiency virus (HIV) infection
- A 56-year-old woman with a 25 pack-year smoking history who successfully and completely abstained from tobacco for the past 8 years.Annual screening for lung cancer with low-dose computed tomography (LDCT)
Answer
The 69-year-old man requires AAA screening; the 44-year-old man with CKD requires pneumococcal vaccination; the 32-year-old woman requires one-time HIV screening; and the 56-year-old former smoker requires annual LDCT.
Each patient profile maps to a highly-tested USPSTF or ACIP preventive care guideline. The 69-year-old man meets the specific 100-cigarette threshold for AAA screening. The 44-year-old man has CKD, a qualifying comorbidity for early pneumococcal vaccination. The 32-year-old woman falls into the universal HIV screening age bracket. The 56-year-old woman meets all three criteria for lung cancer screening (age 50-80, ≥20 pack-years, quit <15 years ago).
Step-by-Step Solution
Key Concept
Guideline-based application of USPSTF and ACIP preventive screening and immunization recommendations tailored to patient age, discrete risk factors, and specific comorbidities.