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Question

Difficulty: MediumPreventive Care and Screening

For each patient presenting to the primary care clinic, select the single most appropriate, guideline-concordant preventive care intervention from the available choices.

  • A 38-year-old man with a BMI of 31 kg/m² and blood pressure of 128/80 mmHg who has not been evaluated by a physician in 5 years.Screen for type 2 diabetes mellitus with a fasting plasma glucose or hemoglobin A1c test.
  • A 48-year-old woman with no notable medical or family history who is presenting for an initial wellness examination and has never undergone malignancy screening.Initiate screening for colorectal cancer via a stool-based test or direct visualization.
  • A 55-year-old man with chronic obstructive pulmonary disease and active tobacco use who received an annual influenza vaccination last week.Administer the 20-valent pneumococcal conjugate vaccine (PCV20).
  • A 24-year-old healthy man presenting for an administrative physical who reports consuming 5 to 6 alcoholic beverages per occasion on most weekends.Perform screening and a brief behavioral counseling intervention for unhealthy alcohol use.

Answer

The 38-year-old man requires diabetes screening due to his age and BMI. The 48-year-old woman requires colorectal cancer screening, which begins at age 45. The 55-year-old man with COPD requires the pneumococcal conjugate vaccine due to his high-risk comorbidities. The 24-year-old man requires alcohol misuse screening and counseling due to his binge drinking behavior.
Each patient's clinical profile directly aligns with an established grade A or B recommendation from the USPSTF or an ACIP adult immunization guideline. The 38-year-old meets the age and BMI criteria for diabetes screening; the 48-year-old requires routine colorectal cancer screening initiated at 45; the 55-year-old has COPD and smokes, warranting pneumococcal vaccination before 65; and the 24-year-old's binge drinking requires behavioral counseling.

Step-by-Step Solution

1
Evaluate the 38-year-old man's risk factors based on his age (38) and BMI (31 kg/m²).
He meets the criteria for metabolic screening.
Current USPSTF guidelines mandate type 2 diabetes screening starting at age 35 for individuals with a BMI greater than or equal to 25 kg/m².
2
Assess the 48-year-old woman's need for age-based cancer screening, noting she has never been screened.
She requires colorectal cancer screening.
The threshold for average-risk colorectal cancer screening is age 45, making this her priority intervention.
3
Identify indicated vaccines for the 55-year-old man with COPD and a history of smoking.
He requires the pneumococcal conjugate vaccine.
While routine pneumococcal vaccination begins at age 65, chronic lung disease and smoking are high-risk conditions warranting early immunization between ages 19 and 64.
4
Determine behavioral counseling needs for the 24-year-old man reporting 5 to 6 drinks per occasion.
He requires alcohol misuse screening and brief counseling.
Consuming 5 or more alcoholic beverages on a single occasion constitutes binge drinking for men, fulfilling the criteria for brief behavioral intervention.

Key Concept

Applying current age- and risk-based USPSTF and ACIP preventive care guidelines to diverse adult ambulatory populations.
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Topics

Preventive Care and Screening

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