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Zorluk: Çok zorPreventive Care and Screening

A 67-year-old man presents to the outpatient clinic to establish primary care. His medical history is significant for essential hypertension and compensated cirrhosis secondary to hepatitis C virus (HCV) infection. He completed a course of direct-acting antivirals 4 years ago and achieved a sustained virologic response. He smoked half a pack of cigarettes daily from age 20 to 45 (12.5 pack-years) but quit 22 years ago. His most recent colonoscopy was performed at age 60 and revealed no polyps or abnormalities. He received the two-dose recombinant zoster vaccine series at age 65 but has not received any other vaccinations in adulthood. Which of the following preventive interventions are indicated for this patient today? (Select exactly 3)

  1. Hepatic ultrasonographyCevap
  2. One-time duplex ultrasonography of the abdominal aortaCevap
  3. 20-valent pneumococcal conjugate vaccineCevap
  4. D
    Low-dose chest computed tomography
  5. E
    Fecal immunochemical test
  6. F
    Quantitative hepatitis C virus RNA viral load

Cevap

The indicated interventions are hepatic ultrasonography, one-time duplex ultrasonography of the abdominal aorta, and the 20-valent pneumococcal conjugate vaccine.
Hepatic ultrasonography is indicated because patients with cirrhosis require hepatocellular carcinoma surveillance every 6 months, regardless of the fact that the underlying Hepatitis C was cured. One-time duplex ultrasonography of the abdominal aorta is indicated because the patient is a male between the ages of 65 and 75 who has smoked at least 100 cigarettes in his lifetime. The 20-valent pneumococcal conjugate vaccine is indicated as standard age-based prophylaxis for all adults aged 65 and older who are pneumococcal vaccine-naïve.

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1
Evaluate the patient's liver disease history and current screening requirements.
The patient has cirrhosis from prior HCV. Despite HCV cure, the presence of cirrhosis mandates lifelong hepatocellular carcinoma surveillance via ultrasound every 6 months.
HCV cure stops viral damage, but established cirrhosis maintains a high baseline risk of malignant transformation.
2
Analyze the patient's smoking history against vascular and pulmonary screening guidelines.
The patient is a 67-year-old man with a 12.5 pack-year history who quit 22 years ago. He qualifies for AAA screening but not lung cancer screening.
Abdominal aortic aneurysm screening requires only a lifetime history of 100 cigarettes for men aged 65-75. Lung cancer screening requires a 20 pack-year history AND current smoking or quitting within the past 15 years.
3
Review the patient's immunization history and age-based requirements.
The patient is over 65 and has not received a pneumococcal vaccine. PCV20 is indicated.
Adults aged 65 and older should receive PCV20 (or PCV15 followed by PPSV23) if they lack a history of pneumococcal conjugate vaccination.
4
Assess the patient's colorectal cancer screening status.
The patient had a normal colonoscopy at age 60. No additional screening is needed at age 67.
The standard interval following a normal colonoscopy in an average-risk individual is 10 years. Performing a FIT test before age 70 is inappropriate.

Anahtar Kavram

Application of preventive screening guidelines requires careful parsing of specific risk thresholds (e.g., smoking pack-years vs. lifetime exposure) and recognizing that some risks (like HCC in cirrhosis) persist even when the underlying etiology is cured.
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Preventive Care and Screening

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