A 71-year-old G2P2 presents to your gynecology office for a routine examination. She says she is very healthy and denies taking any medication. She has no history of abnormal Pap smears and has only had one sexual partner in her lifetime. She is a nonsmoker and has an occasional cocktail with her dinner. She does not have any complaints. In addition, she denies any family history of cancer. The patient tells you that she is a widow and lives alone in an apartment in town. Her grown children have families of their own and live far away. She states that she is self-sufficient and spends her time visiting friends and volunteering at a local museum. Her blood pressure is 140/70 mm Hg. Her height is 5 ft 4 in and she weighs 130 lb.
Which of the following are the most appropriate screening tests to order for this patient?
In postmenopausal women, routine screening for colon cancer is recommended with a colonoscopy to be performed every 10 years. Alternatively, flexible sigmoidoscopy can be performed every 5 years along with a yearly fecal occult blood test. Mammography should be performed every 1 to 2 years in all women 50 to 74 years of age. Postmenopausal women, who are not on hormone replacement therapy, and all women 65 years or older should be screened for osteoporosis with a DEXA scan to determine bone mineral density. Screening for cervical cancer with Pap smears may be discontinued after the age of 65 years in women with adequate negative prior screening results and no history of CIN II or higher. Adequate prior screening is defined as three consecutive negative Pap smears or two consecutive negative HPV co-test results within the previous 10 years, with the most recent test performed in the last 5 years. Women with a history of CIN II, CIN III, or adenocarcinoma in situ should continue screening for a total of 20 years after treatment. Tuberculosis skin testing need to be performed only in individuals with HIV infection, those who have close contact with individuals suspected of having TB, who are IV drug users, who are residents of nursing homes or long-term-care facilities, or who work in a profession that is health care related. This patient does not have any risk factors that would necessitate TB testing. Auditory testing is not a routine screening test.
A 72-year-old G5P5 presents to your office for well-woman examination. Her last examination was 7 years ago, when she turned 65. She has routine checks and laboratory tests with her internist each year. Her last mammogram was 6 months ago and was normal. She takes a diuretic for hypertension. She is a retired school teacher. Her physical examination is normal.
Which of the following is the best vaccination to recommend for this patient?
Women older than 65 years should have all of the following immunizations: tetanus-diphtheria booster every 10 years, influenza virus vaccine annually, and a one-time pneumococcal vaccine. Hepatitis B vaccine would be indicated only in individuals at high risk (ie, international travelers, intravenous drug users, and their sexual contacts, those who have occupational exposure to blood or blood products, persons with chronic liver or renal disease, or residents of institutions for the developmentally disabled, and inmates of correctional institutions). Herpes zoster is indicated for women older than 65 years if not previously immunized.
A 65-year-old G3P3 presents to your office for annual checkup. She had her last well-woman examination 20 years ago when she had a hysterectomy for fibroids. She reports no medical problems, except some occasional stiffness in her joints early in the morning. She takes a multivitamin daily. Her family history is significant for cardiac disease in both her parents and breast cancer in a maternal aunt at the age of 42 years. Her physical examination is normal.
Which of the following is the most appropriate set of laboratory tests to order for this patient?
Women older than 65 years should undergo cholesterol testing every 5 years, fasting glucose testing every 3 years, screening for thyroid disease with a TSH every 5 years, and periodic urinalysis is recommended in women older than 65 years. CA-125 testing is not recommended for screening for ovarian cancer. There are many benign conditions which can cause an elevated CA-125, such as pregnancy, endometriosis, fibroids, menses, pelvic inflammatory disease, peritoneal disease, and liver disease.
You are following up on the results of routine testing of a 68-year-old G4P3 for her well-woman examination. Her physical examination was normal for a postmenopausal woman. Her Pap smear revealed parabasal cells, her mammogram and lipid profile was normal, and the urinalysis shows hematuria.
Which of the following is the most appropriate next step in the management of this patient?
A urinalysis that is positive for blood should be followed up with a urine culture to evaluate for an asymptomatic urinary tract infection before further workup is done or referral to a urologist is made. Parabasal cells on a Pap smear indicate lack of estrogen, and are a normal finding in postmenopausal women. It requires no further evaluation.
A 74-year-old woman presents to your office for well-woman examination. Her last Pap smear and mammogram were 3 years ago. She has hypertension, high cholesterol, and osteoarthritis. She stopped smoking 15 years ago, and does not use alcohol.
Based on this history, which of the following medical conditions should be this patient’s biggest concern?
In order of decreasing incidence, the leading causes of death in women older than 65 years are the following: diseases of the heart, cancer, cerebrovascular diseases, chronic obstructive pulmonary diseases, Alzheimer disease, diabetes, pneumonia and influenza, accidents, renal disease, and septicemia.
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