A 54-year-old man comes to the clinic to establish primary care. He has a 5-year history of type 2 diabetes mellitus, which is currently managed with metformin. He also has a 30-pack-year smoking history and continues to smoke 1 pack of cigarettes daily. The patient has not seen a physician or received any preventive care in the past 15 years. He feels well and reports no chest pain, shortness of breath, claudication, or changes in bowel habits. His blood pressure is 138/88 mm Hg, and his body mass index is 31 kg/m². Physical examination is unremarkable. Which of the following preventive interventions are currently indicated for this patient? (Select all that apply)
- Low-dose computed tomography of the chestAnswer
- 20-valent pneumococcal conjugate vaccineAnswer
- CAbdominal duplex ultrasonography
- DProstate-specific antigen testing
- ECarotid duplex ultrasonography
Answer
The indicated interventions are low-dose computed tomography of the chest and the 20-valent pneumococcal conjugate vaccine.
The patient requires low-dose computed tomography (LDCT) of the chest and the 20-valent pneumococcal conjugate vaccine (PCV20). The 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 with a 30-pack-year history clearly meets these criteria. Additionally, the Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination for adults aged 19 to 64 years who have underlying medical conditions such as diabetes mellitus or who are current cigarette smokers. This patient meets both of these high-risk criteria for early pneumococcal vaccination.
Step-by-Step Solution
Key Concept
Application of age- and risk-factor-specific preventive screening and immunization guidelines.