Immunizations
PePaw Gator (65 years old) is here for his annual exam. He just moved to the Swamp last month and has not seen a physician for about 5 years. He reports no chronic conditions or medications. You review his immunization history, and he has received all recommended vaccines that were recommended at time of his last annual exam 5 years ago.
In accordance with the CDC, which of the following adult vaccines do you recommend today?
Influenza
HPV
PPSV23 (pneumonia)
Shingles
Td (tetanus)
PPSV23: 1 dose after 65
Influenza: yearly
Aggie (25 years old) is seeing you for their yearly exam. They are currently sexually active, 4 total partners, current partner for 4 months. Occasionally uses protection. No prior history of STD's.
You counsel him today that according to the USPSTF and AAFP, the recommendation on obtaining an HIV screening test is:
(A) The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened.
(A) The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown.
Mrs. Wildcat brings in teenage Wildcat (18 years old) for her final well child exam. Since she is going away to college this fall, Mrs. Wildcat wants to make sure all tests are up to date, especially a pap smear. Teenager tells you that she has never been sexually active and has normal menses.
You counsel them that according to the USPSTF and AAFP, the recommendation for when and how often to screen teenager for cervical cancer is:
(A) The USPSTF recommends screening for cervical cancer
Every 3 years with cervical cytology alone in women aged 21 to 29 years.
For women aged 30 to 65 years
Every 3 years with cervical cytology alone
every 5 years with high-risk human papillomavirus (hrHPV) testing alone
Every 5 years with hrHPV testing in combination with cytology (cotesting)
(D) Women younger than 21 years, women older than 65 years with adequate prior screening, and women who have had a hysterectomy
Do not screen for cervical cancer
Baby Gator (5 months old) is here a bit late for their 4-month WCC. Mom and Dad report that they only drink river water, they don’t like the chemical taste of Gainesville water.
In accordance with the USPSTF and AAFP recommendations, what counsel or anticipatory guidance do you give the Gators about fluoride supplementation to prevent dental caries?
THE USPSTF RECOMMENDS THAT PRIMARY CARE CLINICIANS PRESCRIBE ORAL FLUORIDE SUPPLEMENTATION STARTING AT AGE 6 MONTHS FOR CHILDREN WHOSE WATER SUPPLY IS DEFICIENT IN FLUORIDE.
THE USPSTF RECOMMENDS THAT PRIMARY CARE CLINICIANS APPLY FLUORIDE VARNISH TO THE PRIMARY TEETH OF ALL INFANTS AND CHILDREN STARTING AT THE AGE OF PRIMARY TOOTH ERUPTION.
Mr. Tiger agrees to be screened for depression. What are the available tool(s) that you can use to accomplish this service?
The PHQ-2 or PHQ-9 can be used for screening.
If either is positive, it should be followed by further clinical interview to verify.
MiMi Gator (60 years old) is here for her annual exam. She just moved to the Swamp last month and has not seen a physician for about 10 years. She reports no chronic conditions or medications. ou review her immunization history, and she knows she got a tetanus shot after cutting herself diving 6 years ago.
In accordance with the CDC, which of the following adult vaccines do you recommend today?
Influenza
HPV
PPSV23 (pneumonia)
Shingles
Td (tetanus)
Influenza: yearly
Shingles: 2 doses 2 months apart after age 50 (Shingrix)
Carolina (24 years old) is here for a STD check. She is sexually active with males with 3 total partners in the past. She has been with her current partner for 2 years. She has never had a STD and reports her partner has not tested positive for STD since they started dating. Her urine pregnancy test is negative.
You advise Carolina that the USPSTF and AAFP recommendation for Gonorrhea screening is:
The USPSTF recommends screening for gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection.
Bulldog (50 years old), the Gator family's neighbor mentions that they are disturbed by all the anti-smoking commercials on TV. You find out that they started smoking at age 20 and use about 1 pack per day. They have tried to quit before, but alas, no success.
You counsel Bulldog, that because of their smoking history, according to the USPSTF, the recommendation for lung cancer screening for them is:
(B) The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT)
Adults aged 50 to 80 years
Have a 20 pack-year smoking history
Currently smoke or have quit within the past 15 years.
Little Hurricane (18 months old) is here for their well child exam. The parents are concerned that Little H is not behaving like the other kids at daycare. They want to know if you can test the child for developmental issues.
You counsel the Hurricanes that, per the AAP, today you will administer the following developmental assessments:
The AAP recommends that all children be screened for ASD at ages 18 and 24 months, along with regular developmental surveillance.
Conduct developmental screening using evidence-based tools at 9, 18 and 30 months.
Conduct developmental surveillance at every health supervision visit
Bulldog (50 years old) is here for their annual physical. They have no current chronic medical conditions or medications. They had a diabetes screen and ASCVD risk stratification labs last year. They want to know if there are any other disease screening labs to get such as for hepatitis.
You advise Bulldog that according to the USPSTF and AAFP, the recommendation for when and how often to screen for Hepatitis C is:
The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years.
Lady Bulldog (21 years old) is here for a STD check. She is sexually active with males with 2 total partners in the past. She has been with her current partner for 1 year. She has never had a STD and reports her partner has not tested positive for STD since they started dating. Her urine pregnancy test is negative.
You advise Lady bulldog that the USPSTF and AAFP recommendation for Chlamydia screening is:
The USPSTF recommends screening for chlamydia in sexually active women age 24 years and younger and in older women who are at increased risk for infection.
While you continue to review Mr. Gator's (48 years old) chart, he decides to ask you about prostate cancer screening.
You counsel him that according to the USPSTF, AAFP (and pretty much everyone else) that the recommendation for when to start and how often he should be screened for prostate cancer is:
(C) For men aged 55 to 69 years
PSA screening for prostate cancer should be an individual one.
(D) The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older
Timmie is here for a 1 year WCC. His parents remember his brother getting poked at this visit. What would the AAP recommend you check?
I recommendation per USPSTF
Mr. Commodore (60 years old) is here for his Wellness Exam. He has no current chronic medical conditions and stopped smoking 3 years ago. He wants to make sure he does not have an aneurysm.
As you review health maintenance tests with him today, you advise him that according to the USPSTF and AAFP, the recommendation for him to get an abdominal aortic ultrasound is:
The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
Mr. Wildcat (21 years old) is here for a STD check. He is sexually active with males with 5 total partners in the past. He has been with his current partner for 1.5 years. He has never had a STD and reports his partner has not tested positive for STD since they started dating.
You advise Mr. Wildcat that the USPSTF and AAFP recommendation for syphilis screening is:
The USPSTF recommends screening asymptomatic, nonpregnant adults and adolescents who are at increased risk for syphilis infection
Mr. Gator (48 years old) is here for his annual physical. He has seen a lot of commercials talking about colon cancer screening made easy with the happy talkative box. He has no known family history of colon cancer or other risk factors.
You counsel him that according to the AAFP and USPSTF, the recommendation for when and how often he should undergo screening for colon cancer with fecal DNA is:
(A) The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.
Fecal DNA is conducted every three years
Auntie Gator (65 years old) is here for her first Medicare Annual Wellness visit. She is worried that her bones might be ‘fragile’ and break when she goes swimming. She became postmenopausal 10 years ago. She have no chronic diseases and has never smoked.
In accordance with the USPSTF recommendations, what do you counsel Auntie Gator about screening for osteoporosis today?
(B) The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
(B) The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.
Mrs. Gator (45 years old) is here for her annual physical. She is concerned about breast cancer because some older friends at the local lake have recently been diagnosed with breast cancer. She has no known family history of breast cancer or other risk factors for breast cancer.
You counsel her that according to the USPSTF andAAFP, the recommendation for when and how often she should get a mammogram is:
(B) The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
The AAFP recommends against clinicians teaching women Breast Self Examination (BSE).