Examkin

Question

Difficulty: MediumPreventive Care and Screening

An asymptomatic 68-year-old retired teacher presents for an annual wellness assessment. He reports feeling well with no active complaints. His past medical history includes well-controlled essential hypertension and hyperlipidemia. He has a 40 pack-year smoking history but successfully quit 8 years ago. He consumes alcohol occasionally and walks briskly for 30 minutes three times a week.

His immunization history shows a tetanus, diphtheria, and acellular pertussis (Tdap) booster 3 years ago, completion of the two-dose recombinant zoster vaccine series at age 65, and a recent annual influenza vaccination. He has no history of receiving any pneumococcal vaccines. A screening colonoscopy performed 5 years ago was entirely normal. Physical examination today reveals a blood pressure of 126/78 mmHg, a heart rate of 72/min, and a body mass index of 27 kg/m².

Which of the following interventions are indicated for this patient at this visit? (Select all that apply)

  1. Administration of the 20-valent pneumococcal conjugate vaccineAnswer
  2. Annual screening for lung cancer with low-dose computed tomographyAnswer
  3. One-time screening for abdominal aortic aneurysm with ultrasonographyAnswer
  4. D
    Screening for asymptomatic carotid artery stenosis with duplex ultrasonography
  5. E
    Screening for coronary artery disease with a resting electrocardiogram

Answer

The indicated interventions are the administration of the 20-valent pneumococcal conjugate vaccine, annual screening for lung cancer with low-dose computed tomography, and a one-time screening for abdominal aortic aneurysm with ultrasonography.
Based on current preventive care guidelines, this 68-year-old former smoker requires three specific interventions. First, as a man aged 65 to 75 who has ever smoked, he meets the criteria for a one-time screening for abdominal aortic aneurysm with ultrasonography. Second, because he is between 50 and 80 years old, has a smoking history of at least 20 pack-years, and quit less than 15 years ago, he requires annual lung cancer screening with low-dose CT. Third, as an adult over 65 who has never received pneumococcal immunization, he should receive the 20-valent pneumococcal conjugate vaccine (or PCV15 followed by PPSV23).

Step-by-Step Solution

1
Evaluate the patient's age and vaccination history.
The patient is 68 years old and has never received a pneumococcal vaccine.
Current ACIP guidelines recommend pneumococcal vaccination for all adults aged 65 and older.
2
Assess the patient's smoking history against age-specific screening guidelines.
The patient is a 68-year-old male with a 40 pack-year smoking history who quit 8 years ago.
This qualifies him for both annual lung cancer screening (indicated for ages 50-80, ≥20 pack-years, quit within 15 years) and a one-time abdominal aortic aneurysm screening (indicated for men ages 65-75 who have ever smoked).
3
Review the clinical indications for cardiovascular and carotid screening in asymptomatic patients.
The patient is asymptomatic with no history of transient ischemic attack or cardiovascular symptoms.
Routine screening for carotid artery stenosis and coronary artery disease using ECG in asymptomatic adults is not recommended and can lead to unnecessary downstream testing.

Key Concept

Evidence-Based Preventive Care and Screening in Older Adults
Rate this question

Topics

Preventive Care and Screening

More questions from this topic