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Difficulty: MediumPreventive Care and Screening

A 4545-year-old man comes to the office to establish care. He has not seen a physician in over a decade. The patient feels well and has no acute complaints. Medical history is notable for asthma, for which he uses an albuterol inhaler as needed. He has smoked 11 pack of cigarettes daily for the past 25 years. He drinks alcohol occasionally. Family history is significant for a father who died of a myocardial infarction at age 70. Vital signs are temperature 37.0∘C37.0^\circ\text{C} (98.6∘F98.6^\circ\text{F}), blood pressure 122/80122/80 mm Hg, pulse 7676/min, and respirations 1414/min. Body mass index is 29 kg/m229 \text{ kg/m}^2. Physical examination reveals a well-appearing man. The lungs are clear to auscultation bilaterally. Cardiac examination shows a regular rate and rhythm without murmurs. Which of the following preventive interventions are indicated for this patient at this time? (Select all that apply)

  1. Screening for colorectal cancerAnswer
  2. Screening for hepatitis C virus infectionAnswer
  3. Administration of 20-valent pneumococcal conjugate vaccineAnswer
  4. D
    Screening for lung cancer with low-dose computed tomography
  5. E
    Screening for abdominal aortic aneurysm with ultrasonography

Answer

The correct interventions are screening for colorectal cancer, screening for hepatitis C virus infection, and administration of the 20-valent pneumococcal conjugate vaccine.
This patient requires three specific preventive interventions based on his age, medical history, and lack of prior care. First, the USPSTF recommends average-risk screening for colorectal cancer beginning at age 45. Second, a one-time screening for hepatitis C virus infection is recommended for all adults aged 18 to 79. Finally, the ACIP recommends pneumococcal vaccination for adults aged 19 to 64 with chronic medical conditions; his history of asthma fulfills this criterion, making the 20-valent pneumococcal conjugate vaccine indicated.

Step-by-Step Solution

1
Evaluate the patient's age-based screening requirements.
The patient is 45 years old, which is the exact starting age for average-risk colorectal cancer screening.
Current USPSTF guidelines recommend starting colorectal cancer screening at age 45 to reduce mortality.
2
Assess the patient for infectious disease screening indications.
He has no record of prior hepatitis C virus (HCV) testing. All adults aged 18 to 79 should receive one-time HCV screening.
HCV infection is often asymptomatic, and early detection and treatment prevent long-term complications such as cirrhosis and hepatocellular carcinoma.
3
Determine immunization needs based on age and comorbid conditions.
The patient has a diagnosis of asthma.
Asthma increases the risk of severe pneumococcal disease, making it a qualifying indication for pneumococcal vaccination in adults aged 19 to 64.
4
Review the patient's smoking history for specific screening indications.
He has a 25 pack-year smoking history but is only 45 years old.
Both lung cancer screening (starting at age 50) and abdominal aortic aneurysm screening (starting at age 65) are not yet indicated due to his young age, despite his heavy smoking history.

Key Concept

Evidence-based preventive care requires tailoring screening and immunization recommendations based on age, chronic medical conditions (e.g., asthma), and specific risk factors (e.g., smoking history).
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Topics

Preventive Care and Screening

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