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  #1  
Old 06-01-2012
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Question Screening This 65 Year Old Woman?

A 62-year-old woman is evaluated during a follow-up visit for hypertension. She has no symptoms and is monogamous with her husband of 35 years. Her only medication is hydrochlorothiazide. She received an influenza vaccination 3 months ago and a herpes zoster vaccination 1 year ago. Her last Pap smear was 14 months ago and results were normal, as
were results of the previous three annual Pap smears. On physical examination, blood pressure is 136/72 mm Hg and weight is 62 kg (136 lb). Other general physical examination findings are normal. The total cholesterol level is 188 mg/dL (4.9 mmol/L) and the HDL-cholesterol level is 54 mg/dL (1.4 mmol/L).

Which of the following is the most appropriate health maintenance intervention for this patient?

(A) Abdominal ultrasonography
(B) Dual-energy x-ray absorptiometry
(C) Pap smear
(D) Pneumococcal vaccine
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(A) Abdominal ultrasonography
(B) Dual-energy x-ray absorptiometry
a+b ==== never screening tests

(C) Pap smear --- 3 consecutive negative. can stop testing.
normally sto at 65 years.. but this patient is LOW risk for HPV. hence can stop earlier

(D) Pneumococcal vaccine-- given to everyone over 60 years of age
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A is indicated in male smoker >50 for AAA
B dexa scan is indicated in all women >65 without risk factors 4 osteoporosis
C not need at this time - 2 years later from now will be
D is indicated in all >60, my ans
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Quote:
Originally Posted by mbbs2010 View Post
(A) Abdominal ultrasonography
correction --- USG is never used as a screening test only for GYN pts...
not otherwise.


and dexa is for over 65 as bisho said.
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Quote:
Originally Posted by tyagee View Post
A 62-year-old woman is evaluated during a follow-up visit for hypertension. She has no symptoms and is monogamous with her husband of 35 years. Her only medication is hydrochlorothiazide. She received an influenza vaccination 3 months ago and a herpes zoster vaccination 1 year ago. Her last Pap smear was 14 months ago and results were normal, as
were results of the previous three annual Pap smears. On physical examination, blood pressure is 136/72 mm Hg and weight is 62 kg (136 lb). Other general physical examination findings are normal. The total cholesterol level is 188 mg/dL (4.9 mmol/L) and the HDL-cholesterol level is 54 mg/dL (1.4 mmol/L).

Which of the following is the most appropriate health maintenance intervention for this patient?

(A) Abdominal ultrasonography
(B) Dual-energy x-ray absorptiometry
(C) Pap smear
(D) Pneumococcal vaccine
(C) Pap smear

Both DEXA & Pneumococcal vaccine are indicated for patients over 65 but she is on hydrochlorothiazide (decreases Calcium excretion)

Quote:
Screening should stop about age 65 unless there is a recent abnormal tests or disease. There is probably no benefit screening women aged 60 or over whose previous tests have been negative.[12] If a woman's last three Pap results were normal, she can stop at age 65, according to the USPSTF, ACOG, ACS and ASCP

Last edited by Novobiocin; 06-01-2012 at 01:24 PM.
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Quote:
Originally Posted by Novobiocin View Post
(C) Pap smear

Both DEXA & Pneumococcal vaccine are indicated for patients over 65 but she is on hydrochlorothiazide (decreases Calcium excretion)
yea its 65, , but even papsmear is somehow still wrong, but better fit
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Quote:
Originally Posted by bisho View Post
yea its 65, , but even papsmear is somehow still wrong, but better fit
According to history she haven't had her third Pap Smear after 60 yr
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Quote:
Originally Posted by tyagee View Post
Her last Pap smear was 14 months ago and results were normal, as
were results of the previous three annual Pap smears.
anz iz dexa scan
why?
reason given dexa done before 65 in patient at high risk. they include many like cigarrate smoke, alcohol , previous history of fracture, RA , and weight less than 70kg.
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Quote:
Originally Posted by tyagee View Post
anz iz dexa scan
why?
reason given dexa done before 65 in patient at high risk. they include many like cigarrate smoke, alcohol , previous history of fracture, RA , and weight less than 70kg.
Where can I find the reference for weight as a "sole criteria" without the height?

Maybe she is just 4 feet tall since height is not given in the question stem.
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Dual-energy x-ray absorptiometry is an appropriate screening test for this patient. Guidelines recommend that screening for osteoporosis begin at age 65 years for women. Women aged 60 to 64 years should be screened if they are at higher than average risk for osteoporosis. The most predictive risk factor for osteoporosis is weight below 70 kg (154 lb), as in the patient presented. A screening interval of 2 years is appropriate for women 65 years or older but can reasonably be extended to 5 years for women younger than 65 years.
Osteoporosis in men is underdiagnosed. A clinical practice guideline from the American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men; screening for osteoporosis is recommended for men who are at increased risk for osteoporosis and are candidates for drug therapy. The most important risk factors in men are age older than 70 years, low body weight (BMI 20-25 or below), weight loss in recent years, physical inactivity, use of oral corticosteroids, and previous fragility fracture.


The U.S. Preventive Services Task Force (USPSTF) recommends against screening for abdominal aortic aneurysm in women because of the low prevalence of abdominal aortic aneurysm in this group. Abdominal ultrasonography, therefore, is not indicated.


After three consecutive negative annual cytology smears, the risk of cervical cancer is reduced to approximately 1/100,000 person-years. In this monogamous patient with three consecutive normal Pap smears whose last Pap smear was 14 months ago, it would be reasonable to increase the screening interval to every 2 to 3 years, with consideration of stopping screening at age 65 years if her Pap smears continue to be normal.


Pneumococcal vaccine is indicated for persons aged 65 years and older or for those younger than 65 years who live in long-term care facilities or who have chronic illnesses, or who are Alaskan natives or American Indians. This patient has no indication for pneumococcal vaccination at this time.
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My point was that she is on hydrochlorothiazide which is actually used to prevent osteoporosis.
Quote:
Thiazides are also used in the treatment of osteoporosis. Thiazides decrease mineral bone loss by promoting calcium retention in the kidney, and by directly stimulating osteoblast differentiation and bone mineral formation.
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Old 02-06-2013
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According to the USPSTF the decision to screen women between 50 and 65 is based on them having a 10 year fracture risk similar to that of a 65yo Caucasian women. Race is not mentioned in the vignette, but even assuming a Caucasian woman, it would be difficult for her to reach such risk level based on BMI alone, unless she has other risk factors. Only a very tall 62 year old woman would have this indication (she would have to be like 6'3'')
see http://www.uspreventiveservicestaskf...is/osteors.htm
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The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.
In this woman i love to go with DEXA scan but there are no fracture risk that
equal to or greater than that woman of a 65-year-old?
So i would go with
(D) Pneumococcal vaccine

Last edited by heartbeat; 02-06-2013 at 10:32 PM.
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Old 02-07-2013
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Quote:
Originally Posted by heartbeat View Post
The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.
In this woman i love to go with DEXA scan but there are no fracture risk that
equal to or greater than that woman of a 65-year-old?
So i would go with
(D) Pneumococcal vaccine
But Pneumococcal vaccine is only recommended in adults aged 65 years or older too?

Quote:
All adults 65 years of age or older should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine.
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Old 02-09-2013
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Yeah, i have no evidence for ans D, just pick it by exclusion
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