Examkin

Soru

Zorluk: ZorPreventive Care and Screening

During a routine wellness assessment, a 66-year-old retired mechanic is evaluated in the ambulatory clinic. The patient has a history of type 2 diabetes mellitus and essential hypertension, both well-controlled on metformin and lisinopril. He smoked a pack of cigarettes daily for 25 years but successfully quit at the age of 48. His surgical history is notable for an appendectomy in his twenties. Review of his prior preventive care records reveals the following:

- At age 65, he underwent an abdominal duplex ultrasound which showed an aortic diameter of 2.12.1 cm.
- At age 58, a screening colonoscopy demonstrated excellent bowel preparation and two 44-mm hyperplastic polyps in the distal rectum, which were completely excised.
- At age 65, he received the 20-valent pneumococcal conjugate vaccine (PCV20).
- He completed the two-dose recombinant zoster vaccine series five years ago.
- His influenza vaccination is current for the season.

His electronic health record contains no documentation of prior viral hepatitis screening, and he reports never having been tested. Physical examination today is unremarkable. Vital signs are within normal limits. Based on current evidence-based guidelines, which of the following is the most appropriate next step in this patient's preventive care?

  1. One-time screening for hepatitis C virus infectionCevap
  2. B
    Annual low-dose computed tomography (LDCT) of the chest
  3. C
    Surveillance colonoscopy
  4. D
    Repeat abdominal duplex ultrasonography
  5. E
    Administration of the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

Cevap

One-time screening for hepatitis C virus infection
The correct answer is one-time screening for hepatitis C virus infection. The United States Preventive Services Task Force (USPSTF) recommends a one-time screening for hepatitis C virus (HCV) infection in all asymptomatic adults aged 18 to 79 years. This patient falls within this age range and has no documented history of prior HCV screening, making it the most appropriate and unequivocally indicated next step in his preventive care today.

Adım Adım Çözüm

1
Evaluate the patient's eligibility for lung cancer screening based on his smoking history.
The patient has a 25 pack-year smoking history but quit at age 48 (18 years ago).
Current USPSTF guidelines recommend stopping annual LDCT screening once a patient has not smoked for 15 years.
2
Assess the need for colorectal cancer surveillance based on prior colonoscopy findings.
The prior colonoscopy 8 years ago found only small, distal hyperplastic polyps.
Small (<10 mm) hyperplastic polyps in the rectum are non-neoplastic and do not increase colorectal cancer risk, meaning the standard 10-year screening interval applies. He is not due until age 68.
3
Determine if additional pneumococcal or shingles vaccinations are needed.
The patient received PCV20 at age 65 and completed the Shingrix series 5 years ago.
ACIP guidelines state that a single dose of PCV20 is sufficient for adults 65 and older, requiring no follow-up with PPSV23.
4
Identify missing age-based universal screening tests.
The patient is 66 years old and has never been screened for hepatitis C.
The USPSTF recommends a one-time screening for hepatitis C virus (HCV) infection in all adults aged 18 to 79 years.

Anahtar Kavram

Application of nuanced USPSTF and ACIP preventive care guidelines for older adults
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Konular

Preventive Care and Screening

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