Examkin

Question

Difficulty: MediumPreventive Care and Screening

A 66-year-old man presents to the clinic for an annual health maintenance examination. His past medical history is notable for diet-controlled type 2 diabetes mellitus, essential hypertension, and mild osteoarthritis of the right knee. He is a former smoker, having smoked one pack of cigarettes daily for 25 years before quitting exactly 17 years ago. His current medications include lisinopril and acetaminophen as needed.

Review of his preventive health record reveals:
- A screening colonoscopy at age 62 was unremarkable.
- An abdominal aortic aneurysm screening ultrasound at age 65 showed a normal aorta.
- He completed a primary hepatitis B vaccination series at age 55.
- He received the two-dose recombinant zoster vaccine series at age 50.
- He received his annual influenza vaccine last month.
- He has never received any pneumococcal vaccines.

Physical examination today is unremarkable. His blood pressure is 126/78 mm Hg, and his body mass index is 26 kg/m². Which of the following is the most appropriate next step in this patient's preventive care?

  1. Administer the 20-valent pneumococcal conjugate vaccine (PCV20)Answer
  2. B
    Order low-dose computed tomography of the chest
  3. C
    Repeat the abdominal aortic aneurysm screening ultrasound
  4. D
    Order a dual-energy x-ray absorptiometry scan
  5. E
    Administer the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

Answer

Administer the 20-valent pneumococcal conjugate vaccine (PCV20)
Current Advisory Committee on Immunization Practices (ACIP) guidelines state that all adults aged 65 years and older who have not previously received a pneumococcal conjugate vaccine should receive a single dose of the 20-valent pneumococcal conjugate vaccine (PCV20) alone, or a dose of the 15-valent pneumococcal conjugate vaccine (PCV15) followed by a dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least one year later. Because this 66-year-old patient is entirely naive to pneumococcal vaccines, initiating the series with PCV20 is the definitive next step in his preventive care.

Step-by-Step Solution

1
Analyze the patient's demographic and social history against screening guidelines.
The patient is 66 years old and quit smoking 17 years ago, meaning he exceeds the 15-year quit window for lung cancer screening.
To rule out the need for low-dose computed tomography (LDCT) and confirm no other age/smoking-based screenings are missed.
2
Review the patient's prior screening and immunization records.
The patient has already received a normal 1-time AAA ultrasound, is up to date on colonoscopy and zoster/influenza/hepatitis B vaccines, but is naive to pneumococcal vaccines.
To prevent ordering duplicate 1-time tests (like AAA screening) and identify outstanding health maintenance gaps.
3
Apply the current ACIP adult immunization schedule for a 66-year-old.
A 66-year-old pneumococcal vaccine-naive adult requires either a single dose of PCV20, or a dose of PCV15 followed by PPSV23 a year later.
Age over 65 is a direct indication for routine pneumococcal vaccination, and conjugate vaccines must initiate the sequence.

Key Concept

Adult Preventive Care and Immunization Guidelines
Rate this question

Topics

Preventive Care and Screening

More questions from this topic