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Zorluk: OrtaPreventive Care and Screening

A 68-year-old woman presents to the clinic for a routine health maintenance visit. Her medical history includes hypertension and osteoarthritis. She takes amlodipine and uses as-needed acetaminophen for joint pain. She mentions experiencing mild, intermittent lower back pain after gardening, which resolves entirely with rest; she denies any radiating pain, leg weakness, or changes in bowel or bladder function. She smoked one pack of cigarettes daily for 30 years before quitting 8 years ago.

Review of her preventive care records reveals the following:
- Screening mammogram 1 year ago (normal)
- Colonoscopy 6 years ago (normal)
- Dual-energy x-ray absorptiometry (DEXA) scan at age 65 (normal bone mineral density)
- Total hysterectomy with bilateral salpingo-oophorectomy at age 55 for symptomatic uterine fibroids

Her immunizations are up to date, including an inactivated influenza vaccine last month, a recombinant zoster vaccine series completed at age 65, and a Tdap booster 5 years ago. She has never received any pneumococcal vaccinations.

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

  1. Low-dose computed tomography of the chestCevap
  2. Administration of 20-valent pneumococcal conjugate vaccineCevap
  3. C
    Screening mammography
  4. D
    Fecal immunochemical testing
  5. E
    Magnetic resonance imaging of the lumbar spine

Cevap

The indicated interventions for this patient are low-dose computed tomography of the chest and administration of the 20-valent pneumococcal conjugate vaccine.
Based on current guidelines, two interventions are indicated. First, annual lung cancer screening with low-dose computed tomography (LDCT) is recommended by the USPSTF for adults aged 50 to 80 years who have a 20 pack-year smoking history and either currently smoke or quit within the past 15 years. This patient is 68, has a 30 pack-year history, and quit 8 years ago, fully meeting these criteria. Second, the ACIP recommends that all adults ≥65 years of age who have not previously received a pneumococcal conjugate vaccine receive a single dose of PCV20 (or PCV15 followed by PPSV23). Because this patient has no history of pneumococcal vaccination, administering PCV20 is appropriate.

Adım Adım Çözüm

1
Evaluate the patient's smoking history and age for lung cancer screening eligibility.
The patient is 68 years old, has a 30 pack-year smoking history, and quit 8 years ago.
Current guidelines recommend annual low-dose computed tomography (LDCT) for adults aged 50-80 with a ≥20 pack-year history who smoke or quit within the last 15 years.
2
Review the patient's age and vaccination history for indicated adult immunizations.
The patient is over 65 and has never received a pneumococcal vaccine.
All adults ≥65 years require pneumococcal vaccination (PCV20 alone, or PCV15 followed by PPSV23) to prevent invasive pneumococcal disease.
3
Review the timing of previous cancer screenings.
Mammogram was 1 year ago (due every 2 years) and colonoscopy was 6 years ago (due every 10 years).
Applying appropriate screening intervals prevents over-screening and unnecessary testing.
4
Assess the clinical presentation of back pain.
The back pain is mechanical, relieved by rest, with no red flags.
Determining the presence or absence of red flags guides the decision of whether advanced imaging is necessary.

Anahtar Kavram

Application of age- and risk-based preventive screening guidelines (USPSTF) and adult immunization schedules (ACIP).
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Preventive Care and Screening

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