Years

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65+ YEARS

Cancer screening

Pap smear 3 years after initiation of intercourse

Annual Pap smear

Annual Pap smear Age 50: stool for occult blood, barium enema every 5 years or colonoscopy every 10 years, annual mammography

Annual stool for occult blood: colonoscopy or barium enema every 5 years; annual mammography

Immunizations

Tetanus booster once between ages 11 and 16 years

Tetanus every 10 years

Tetanus every 10 years

Age 50: annual influenza vaccine

Tetanus every 10 years; pneumococcal vaccine; annual influenza vaccine

Other diseases

Depression: firearms

Cardiovascular diseases

Cholesterol screening every 5 years beginning at age 45 years

Cholesterol screening every 5 years beginning at age 45 years

Most common causes of mortality

1. Motor vehicle accidents

2. Homicide

3. Suicide

1. Motor vehicle accidents

2. Cardiovascular disease

2. Cancer

3. Cerebrovascular disease

Adapted from American College of Obstetricians and Gynocologists. Primary and preventive care: Periodic assessments. ACOG Committee Opinion 246. Washington. DC: American College of Obstetricians and Gynecologists. 2000.

Adapted from American College of Obstetricians and Gynocologists. Primary and preventive care: Periodic assessments. ACOG Committee Opinion 246. Washington. DC: American College of Obstetricians and Gynecologists. 2000.

Comprehension Questions

For each of the patient scenarios described in Questions [53.1] to [53.4[, assign one or more answers (A-I) pertaining to health maintenance.

A. Influenza vaccine

B. Pneumococcal vaccine

C. Barium enema or colonoscopy

D. Mammography every year

E. Cholesterol screening

F. Chest radiograph

G. Urinalysis

H. Pap smear

I. None of above

[53.1 ] A 17-year-old girl engaged in one episode of sexual intercourse 3 years ago but currently is not sexually active.

153.2] A 44-year-old woman denies any health problems.

|53.3| A 59-year-old woman has mild osteoarthritis.

[53.41 A woman, aged 69 years, has mild hypertension that is controlled with an antihypertensive agent.

Answers

[53.1 ] H. Cervical cancer screening via Pap smear is indicated 3 years after a woman was first sexually active or at age 21.

[53.21 H, E. Again, a Pap smear is indicated as well as cholesterol screening.

[53.31 A, C, D, E, H. At age 59 years, breast, cervical, and colon cancer screening are indicated.

[53.4| A, B, C, I), E. At age 69, cancer screening, vaccination including pneumococcal and influenza immunization, and urinalysis are recommended. Cervical cytology screening has not been shown to be cost-effective after age 65.

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