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Zorluk: OrtaPreventive Care and Screening

A 51-year-old woman comes to the ambulatory clinic to establish care. She recently changed jobs and has not seen a healthcare provider in over seven years. The patient has no acute complaints today but notes she recently entered menopause, as her last menstrual period was 14 months ago. Her past medical history is notable for mild intermittent asthma. Her body mass index is 33 kg/m². She previously smoked one pack of cigarettes daily from age 20 until she successfully quit at age 42 (22 pack-year history). She consumes one glass of wine occasionally on weekends. Vital signs today are within normal limits. Physical examination reveals a well-appearing adult with no focal abnormalities. Which of the following preventive interventions are indicated for this patient during today's visit? (Select all that apply.)

  1. Measurement of hemoglobin A1cCevap
  2. Non-contrast chest computed tomographyCevap
  3. C
    Dual-energy x-ray absorptiometry
  4. Primary high-risk human papillomavirus testingCevap
  5. E
    Resting 12-lead electrocardiography

Cevap

The indicated interventions are measurement of hemoglobin A1c, non-contrast chest computed tomography, and primary high-risk human papillomavirus testing.
Measurement of hemoglobin A1c is indicated because the patient is between the ages of 35 and 70 and has a BMI classified as obese (≥30 kg/m²), meeting criteria for prediabetes and type 2 diabetes screening. Non-contrast chest computed tomography is required because she falls into the 50-80 age bracket, has accumulated a smoking history of ≥20 pack-years, and quit less than 15 years ago. Primary high-risk human papillomavirus (hrHPV) testing is indicated because routine cervical cancer screening (via primary hrHPV or co-testing every 5 years) is recommended for women aged 30 to 65, and she has not received preventive care in over seven years.

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1
Evaluate metabolic screening indications based on demographics.
The patient is 51 years old with a BMI of 33 kg/m².
Current USPSTF guidelines mandate diabetes screening for adults aged 35-70 with overweight or obesity.
2
Assess lung cancer screening eligibility.
She is 51, has a 22 pack-year smoking history, and quit 9 years ago.
Screening is required for adults aged 50-80 with at least a 20 pack-year history who quit within the last 15 years.
3
Determine cervical cancer screening status.
She is a 51-year-old woman who has not had any healthcare visits in over 7 years.
Standard screening intervals are 3 years for Pap testing alone or 5 years for primary hrHPV or co-testing, meaning she is overdue.
4
Identify non-indicated interventions.
Dual-energy x-ray absorptiometry and resting electrocardiography are not supported by guidelines for this asymptomatic patient.
She is under 65 without a known high-risk profile for osteoporotic fractures, and routine ECG is not indicated for asymptomatic, low-risk individuals.

Anahtar Kavram

Application of age- and risk-based preventive screening guidelines for cancer and metabolic disease in the ambulatory setting.
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Konular

Preventive Care and Screening

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