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Zorluk: ZorPreventive Care and Screening

A 68-year-old biological female presents to the outpatient clinic for a routine health maintenance evaluation. She generally feels well but has a history of rheumatoid arthritis, for which she takes methotrexate and rituximab. She has a 35-pack-year smoking history and currently smokes one pack of cigarettes daily. At age 45, she underwent a total abdominal hysterectomy for symptomatic benign leiomyomas.

Her prior preventive health screenings include:
- A screening colonoscopy 9 years ago, which revealed no polyps or abnormalities.
- A screening mammogram 2 months ago, which was interpreted as normal (BI-RADS 1).
- A dual-energy x-ray absorptiometry scan 3 years ago that showed normal bone density.

Regarding her immunization history, she received the 15-valent pneumococcal conjugate vaccine (PCV15) 2 years ago, but did not return for follow-up vaccination. She received a tetanus, diphtheria, and acellular pertussis (Tdap) booster 6 years ago. She received her annual influenza vaccine 2 weeks ago at a local pharmacy. She has never received a vaccine against herpes zoster.

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

  1. Administration of 23-valent pneumococcal polysaccharide vaccineCevap
  2. Administration of recombinant zoster vaccineCevap
  3. Low-dose computed tomography of the chestCevap
  4. D
    Screening colonoscopy
  5. E
    Vaginal cuff cytology

Cevap

The indicated preventive interventions for this patient today are low-dose computed tomography of the chest, administration of the recombinant zoster vaccine, and administration of the 23-valent pneumococcal polysaccharide vaccine.
The correct interventions are the administration of the 23-valent pneumococcal polysaccharide vaccine (PPSV23), the administration of the recombinant zoster vaccine (RZV), and low-dose computed tomography (LDCT) of the chest. First, the patient is due for PPSV23 because it has been over a year since her dose of PCV15. Second, RZV is indicated for all adults aged 50 and older; because it is an inactivated recombinant vaccine, it is safe despite her use of immunosuppressive rituximab. Third, annual LDCT of the chest is indicated based on USPSTF guidelines for adults aged 50 to 80 years who have a 20 pack-year or greater smoking history and currently smoke or have quit within the past 15 years.

Adım Adım Çözüm

1
Evaluate the patient's respiratory and smoking history to determine lung cancer screening eligibility.
The patient is 68 years old, has a >20 pack-year smoking history, and is a current smoker.
The USPSTF recommends annual LDCT for adults aged 50 to 80 with these specific criteria, making it indicated today.
2
Evaluate the patient's age and immune status to determine zoster vaccination needs.
The patient is over 50, has never received the zoster vaccine, and is on immunosuppressive therapy (rituximab).
The recombinant zoster vaccine (RZV) is a non-live vaccine indicated for all adults ≥50 years, and it is safe and recommended for immunocompromised patients.
3
Review the patient's pneumococcal vaccination sequence.
The patient received PCV15 two years ago but missed the follow-up dose.
ACIP guidelines mandate a dose of PPSV23 at least 1 year (or ≥8 weeks if immunocompromised) after PCV15, so she is due for PPSV23 today.
4
Assess the patient's gastrointestinal screening timeline.
The patient's last screening colonoscopy was normal 9 years ago.
The standard interval after a normal screening colonoscopy is 10 years; thus, it is premature to repeat it this year.
5
Assess the patient's gynecologic history for cervical cancer screening.
The patient has a history of a total abdominal hysterectomy for benign disease (leiomyomas).
The USPSTF recommends against screening (including vaginal cuff cytology) in women who have had a total hysterectomy for benign reasons.

Anahtar Kavram

Application of current evidence-based preventive care and screening guidelines in an older adult with multiple comorbidities, focusing on lung cancer screening, immunization sequencing, and appropriate screening intervals.
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Preventive Care and Screening

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