Soru

Zorluk: OrtaPreventive Care and Screening

A 66-year-old woman comes to the clinic for a routine health maintenance examination. She feels well and has no acute complaints. Her medical history is notable for mild primary hypertension, which is well controlled on lisinopril. She does not use tobacco, alcohol, or illicit substances. She has been in a mutually monogamous relationship with her husband for 40 years.

Review of her medical records reveals the following:
- Screening mammography at age 65 was normal.
- Screening colonoscopy at age 60 showed no polyps.
- Dual-energy x-ray absorptiometry at age 65 showed normal bone mineral density.
- Cervical cancer screening via cytology and high-risk human papillomavirus (hrHPV) co-testing was performed at ages 59 and 64; both results were negative.
- She received the 20-valent pneumococcal conjugate vaccine (PCV20) at age 65.
- She received a two-dose series of the recombinant zoster vaccine at age 65.
- She received a Tdap booster at age 61.
- Medical records indicate she has never been screened for hepatitis C.

Vital signs and physical examination findings are within normal limits. Which of the following is the most appropriate next step in preventive care for this patient?

  1. Hepatitis C virus antibody testingCevap
  2. B
    Cervical cytology and high-risk human papillomavirus co-testing
  3. C
    Human immunodeficiency virus antigen and antibody testing
  4. D
    Low-dose computed tomography of the chest
  5. E
    Administration of 23-valent pneumococcal polysaccharide vaccine

Cevap

Hepatitis C virus antibody testing
The correct answer is Hepatitis C virus antibody testing. The USPSTF recommends a one-time screening for hepatitis C virus (HCV) infection in all asymptomatic adults aged 18 to 79 years without known liver disease. Because this patient has no documented prior screening and is within the recommended age range, she should undergo HCV antibody testing now.

Adım Adım Çözüm

1
Evaluate the patient's age and demographic risk factors.
The patient is a 66-year-old female with no history of tobacco use and no high-risk sexual or drug use behaviors.
Age and specific risk factors dictate which USPSTF and ACIP screening guidelines apply.
2
Assess current adherence to age-appropriate screening guidelines.
The patient is up to date on breast cancer, colorectal cancer, and osteoporosis screenings. She meets criteria to discontinue cervical cancer screening and has aged out of routine HIV screening.
Eliminating up-to-date and age-inappropriate screenings narrows down the remaining indicated tests.
3
Identify any omitted routine screening tests.
The patient has never received a one-time screening for the hepatitis C virus.
USPSTF guidelines mandate universal one-time HCV screening for all adults aged 18 to 79 years.

Anahtar Kavram

Application of upper age limits for routine preventive screenings (USPSTF guidelines)
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