Examkin

Question

Difficulty: HardPreventive Care and Screening

During a comprehensive health maintenance visit, a primary care physician evaluates a 4545-year-old male with a history of extensive ulcerative colitis. The patient was diagnosed with the condition 99 years ago and is currently in clinical remission on maintenance adalimumab therapy. His social history reveals a 1010-pack-year smoking habit; he currently smokes 1010 cigarettes daily. He reports that his last lower gastrointestinal endoscopy was performed at the time of his diagnosis. He has received no immunizations over the past decade. The physician is planning his preventive care and cancer surveillance strategy. Based on current guidelines, which of the following is the most appropriate combination of screening and immunization interventions for this patient?

  1. Recombinant zoster vaccination and screening colonoscopyAnswer
  2. B
    Live-attenuated zoster vaccination and fecal immunochemical testing
  3. C
    Low-dose chest computed tomography and screening colonoscopy
  4. D
    Recombinant zoster vaccination and computed tomography (CT) colonography
  5. E
    2020-valent pneumococcal conjugate vaccination and fecal immunochemical testing

Answer

Recombinant zoster vaccination and screening colonoscopy
The correct combination is recombinant zoster vaccination and screening colonoscopy. This patient requires surveillance colonoscopy because he has a history of extensive ulcerative colitis for 99 years. Guidelines strongly recommend initiating surveillance colonoscopy 88 years after the onset of symptoms to evaluate for dysplasia, making non-invasive modalities like fecal immunochemical testing or CT colonography inadequate. Furthermore, because he is on adalimumab, an immunosuppressive TNF-alpha inhibitor, he is at increased risk for herpes zoster. The recombinant zoster vaccine is specifically indicated for immunocompromised adults aged 1919 years and older.

Step-by-Step Solution

1
Determine the appropriate colorectal cancer screening modality based on the patient's medical history.
The patient has a 99-year history of ulcerative colitis, necessitating a screening colonoscopy.
Patients with inflammatory bowel disease require surveillance colonoscopy starting 88 years after diagnosis to detect dysplasia; non-invasive tests like fecal immunochemical testing are inadequate for this high-risk population.
2
Evaluate the patient's immunization needs based on his age and medication profile.
The patient requires the recombinant zoster vaccine and should avoid all live-attenuated vaccines.
He is on adalimumab (a TNF-alpha inhibitor), which contraindicates live vaccines but qualifies him for the recombinant zoster vaccine, which is indicated for immunocompromised adults aged 1919 and older.
3
Assess the need for lung cancer screening based on the patient's smoking history.
Lung cancer screening is not indicated at this time.
The patient is under 5050 years old and has less than a 2020 pack-year smoking history, failing to meet USPSTF criteria for low-dose chest CT.

Key Concept

Patients with extensive ulcerative colitis require surveillance colonoscopy starting 88 years after diagnosis regardless of age. Furthermore, adults on biologic immunosuppressants should receive the recombinant zoster vaccine and avoid all live-attenuated vaccines.
Estimated Time:1m 30s
Rate this question

Topics

Preventive Care and Screening

More questions from this topic