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Zorluk: ZorPreventive Care and Screening

A 60-year-old woman presents to the clinic for a routine health maintenance examination. She has a history of type 2 diabetes mellitus and early-stage right breast cancer, which was treated with lumpectomy and local radiation therapy at age 52. She declined adjuvant endocrine therapy. Her diabetes is well-controlled with metformin. She has a 35-pack-year smoking history but successfully quit 8 years ago.

Her preventive care history is as follows:
- Colonoscopy at age 54 was completely normal.
- Screening mammogram 2 months ago showed no evidence of malignancy.
- Hepatitis C antibody test at age 55 was negative.
- Received a Tdap booster 4 years ago.
- Completed the sequence of PCV15 followed by PPSV23 one year ago.
- She has never received a zoster vaccine.

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

  1. A
    Dual-energy x-ray absorptiometry scan
  2. Low-dose chest computed tomographyCevap
  3. Recombinant zoster vaccineCevap
  4. D
    Screening colonoscopy
  5. E
    20-valent pneumococcal conjugate vaccine

Cevap

The indicated preventive interventions are low-dose chest computed tomography (LDCT) and the recombinant zoster vaccine.
Low-dose chest computed tomography (LDCT) is indicated because the USPSTF recommends annual screening for adults aged 50 to 80 years with a 20 pack-year smoking history who currently smoke or quit within the past 15 years. This patient meets all criteria. The recombinant zoster vaccine is indicated because the ACIP recommends a 2-dose series for all adults aged 50 years and older to prevent herpes zoster. Since she has never received it, the first dose should be administered.

Adım Adım Çözüm

1
Evaluate the patient's lung cancer risk based on her age and smoking history.
The patient is 60 years old, has a 35-pack-year smoking history, and quit 8 years ago.
To determine if she meets the current USPSTF criteria for annual LDCT screening.
2
Assess the patient's vaccination status against ACIP adult schedules.
The patient is 60 (eligible for the zoster vaccine, which starts at age 50) and has already completed her indicated pneumococcal series.
To identify any missing age-based or risk-based immunizations.
3
Review the intervals for previously performed screening tests.
The patient had a normal colonoscopy 6 years ago (next due in 4 years) and is 60 years old without elevated fracture risk (DEXA due at 65).
To prevent premature or redundant testing.

Anahtar Kavram

Evidence-based preventive care involves applying age-, gender-, and risk-specific guidelines (e.g., USPSTF, ACIP) to determine the appropriate timing and intervals for cancer screenings and immunizations.
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Konular

Preventive Care and Screening

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