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Difficulty: MediumPreventive Care and Screening

A 62-year-old man presents to the clinic for a routine health maintenance visit. His medical history is significant for type 2 diabetes mellitus and stage 3a chronic kidney disease. He smoked one pack of cigarettes daily from age 20 to 50, but quit 12 years ago. He is currently asymptomatic and reports good medication adherence.

His preventive care history includes the following:
- Colonoscopy at age 55 revealed no polyps or abnormalities.
- Recombinant zoster vaccine series was completed at age 55.
- Tetanus, diphtheria, and acellular pertussis (Tdap) booster was administered 5 years ago.
- Annual influenza and updated COVID-19 vaccines were administered last month.
- One-time hepatitis C antibody screening was negative 3 years ago.
- He has never received any pneumococcal vaccinations.

Physical examination is unremarkable. 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 a pneumococcal conjugate vaccineAnswer
  3. C
    One-time abdominal duplex ultrasonography
  4. D
    Annual fecal immunochemical testing
  5. E
    Initiation of daily low-dose aspirin

Answer

Annual low-dose computed tomography of the chest AND Administration of a pneumococcal conjugate vaccine
Annual low-dose computed tomography (LDCT) of the chest is indicated because the patient meets the criteria of being aged 50 to 80 years, having at least a 20 pack-year smoking history (he has 30 pack-years), and having quit within the past 15 years (he quit 12 years ago). Administration of a pneumococcal conjugate vaccine is also indicated because adults aged 19 to 64 years with certain underlying medical conditions, such as diabetes mellitus and chronic kidney disease, require pneumococcal vaccination.

Step-by-Step Solution

1
Evaluate the patient's smoking history and age for lung cancer screening.
The patient is 62 years old with a 30 pack-year history, having quit 12 years ago.
Guidelines recommend annual LDCT for ages 50 to 80 with 20 or more pack-years who currently smoke or quit within the last 15 years.
2
Assess the patient's indication for pneumococcal vaccination.
The patient has type 2 diabetes mellitus and chronic kidney disease.
Adults aged 19 to 64 with these comorbidities are at higher risk and require pneumococcal vaccination.
3
Determine if the patient meets criteria for abdominal aortic aneurysm screening.
The patient is a male former smoker but is only 62 years old.
AAA screening is recommended beginning at age 65 for men who have ever smoked.
4
Check colorectal cancer screening status.
The patient had a normal colonoscopy at age 55.
The next screening is due in 10 years (at age 65). Interval non-invasive testing is not indicated.
5
Evaluate the indication for aspirin for primary prevention.
The patient is 62 years old.
Aspirin is no longer recommended for primary prevention of cardiovascular disease in adults aged 60 and older.

Key Concept

Application of age- and risk-based preventive screening and immunization guidelines in the ambulatory setting.
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Topics

Preventive Care and Screening

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