Examkin

Question

Difficulty: MediumPreventive Care and Screening

A 71-year-old man visits his primary care physician for an annual health maintenance examination. He feels well and reports no new symptoms. His medical history includes essential hypertension and hyperlipidemia. He is a former smoker with a 30-pack-year history, having quit entirely 12 years ago. Medical records confirm he underwent a screening colonoscopy at age 63, which was normal. An abdominal aortic ultrasound performed at age 67 revealed no aneurysm. His only vaccinations over the past decade have been annual influenza shots and appropriate COVID-19 boosters. He takes lisinopril and atorvastatin. Vital signs today are within normal limits. Which of the following preventive interventions are currently indicated for this patient? (Select all that apply)

  1. Annual low-dose computed tomography of the chestAnswer
  2. Administration of the recombinant zoster vaccineAnswer
  3. C
    Repeat screening colonoscopy
  4. D
    Routine prostate-specific antigen testing
  5. E
    Repeat abdominal aortic aneurysm screening ultrasound

Answer

The currently indicated interventions are annual low-dose computed tomography of the chest and administration of the recombinant zoster vaccine.
This patient requires annual lung cancer screening with low-dose computed tomography (LDCT) because he meets all current USPSTF criteria: he is between the ages of 50 and 80, has at least a 20 pack-year smoking history, and quit within the past 15 years (he quit 12 years ago). Additionally, the recombinant zoster vaccine (RZV) is recommended as a two-dose series for all adults aged 50 years and older to prevent shingles and postherpetic neuralgia. Since his only recent vaccines are influenza and COVID-19, he is due for the RZV series.

Step-by-Step Solution

1
Evaluate lung cancer screening eligibility.
Indicated.
The patient is 71 years old, has a >20 pack-year smoking history, and quit <15 years ago, meeting USPSTF criteria for annual LDCT.
2
Evaluate vaccination needs.
Recombinant zoster vaccine indicated.
The RZV series is universally recommended for adults over age 50, and his immunization history indicates he has not received it.
3
Evaluate colorectal cancer screening status.
Not indicated today.
His last normal colonoscopy was at age 63; the normal interval is 10 years, meaning his next screening is due at age 73.
4
Evaluate prostate cancer screening appropriateness.
Not indicated.
The USPSTF recommends against routine PSA screening in men aged 70 and older.
5
Evaluate AAA screening status.
Not indicated.
He already had his required one-time AAA screening ultrasound at age 67, which was normal.

Key Concept

Application of age- and risk-appropriate preventive screening and immunization guidelines in the ambulatory setting.
Rate this question

Topics

Preventive Care and Screening

More questions from this topic