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Difficulty: MediumPreventive Care and Screening

A 54-year-old woman comes to the clinic for a routine health maintenance examination. She feels well and has no acute complaints. Her medical history is significant for hypertension and stage 3a chronic kidney disease secondary to hypertensive nephrosclerosis. Her current medications include lisinopril and amlodipine. She smoked 1 pack of cigarettes daily for 25 years but successfully quit 10 years ago. Her most recent screening colonoscopy was performed 9 years ago and revealed no polyps. She underwent a screening mammogram 1 year ago, which was normal. She received the two-dose recombinant zoster vaccine series 2 years ago, the annual influenza vaccine last month, and a Tdap booster 3 years ago. She has not received any other immunizations in adulthood. Vital signs are within normal limits. Physical examination is unremarkable. Which of the following interventions are indicated for this patient today? (Select all that apply)

  1. 20-valent pneumococcal conjugate vaccine (PCV20)Answer
  2. Low-dose computed tomography (LDCT) of the chestAnswer
  3. C
    Routine renal ultrasound
  4. D
    Screening colonoscopy
  5. E
    Screening mammography

Answer

The indicated interventions for this patient are the 20-valent pneumococcal conjugate vaccine (PCV20) and low-dose computed tomography (LDCT) of the chest.
The correct interventions are the 20-valent pneumococcal conjugate vaccine (PCV20) and low-dose computed tomography (LDCT) of the chest. According to the Advisory Committee on Immunization Practices (ACIP), adults aged 19 to 64 years with specific underlying medical conditions, including chronic kidney disease (CKD), should receive pneumococcal vaccination. As this patient is vaccine-naive for pneumococcus, a single dose of PCV20 (or PCV15 followed by PPSV23) is indicated. Furthermore, the US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with LDCT for adults aged 50 to 80 years who have a 20 pack-year or greater smoking history and currently smoke or have quit within the past 15 years. This 54-year-old patient has a 25 pack-year history and quit 10 years ago, making her eligible.

Step-by-Step Solution

1
Evaluate the patient's vaccination requirements based on her age and medical history.
Because she has stage 3a chronic kidney disease, she meets criteria for pneumococcal vaccination before age 65.
The ACIP recommends pneumococcal vaccination for adults aged 19-64 with specific risk factors, including chronic kidney disease.
2
Assess the patient's eligibility for lung cancer screening.
She is 54 years old, has a 25 pack-year smoking history, and quit 10 years ago, meeting all criteria for LDCT.
The USPSTF recommends annual LDCT for adults aged 50 to 80 years with a ≥20 pack-year history who smoke or quit within the last 15 years.
3
Review the intervals for her previously completed cancer screenings.
Her last colonoscopy was 9 years ago (due in 1 year) and her last mammogram was 1 year ago (due in 1 year).
Guidelines recommend colonoscopy every 10 years and mammography every 2 years for average-risk adults.

Key Concept

Application of condition-specific adult immunization guidelines and interval-based cancer screening protocols.

Alternative Method

When evaluating complex preventive care vignettes, systematically separate interventions into three categories: Age-based, Risk/Exposure-based, and Interval-based to ensure no overlapping criteria are missed.
Estimated Time:1m 30s
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Topics

Preventive Care and Screening

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