Internal Medicine
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PREVENTION & SCREENING

CASE #2

E.B. is a 48-year-old female HMO patient with a 12 year history of moderate persistent asthma. She is seeing you as a primary care physician in a community group practice. She has been hospitalized twice for asthma attacks which occurred after upper respiratory tract infections. She has never needed ICU admission or intubation for her asthma. She can control most of her symptoms with a steroid inhaler and albuterol.

Medical History:

              Adult 1) Asthma   2) Allergic Rhinitis

Meds: albuterol inhaler, steroid inhaler, Claritin

Allergies: PCN

Surgery: C-section age 27

Habits: Drinks 4 beers a night, no smoking, recreational cocaine use twice a mo x 2 yrs

Social: Secretary, married 25 years

Family: Father - CAD

Repro: G normal Pap 2 months ago, husband is only sexual partner.
            No recent breast exam or mammogram in last 2 years

Vaccines: Td-3 years ago, Rubella booster age 22, primary childhood series complete

Diet: Low fat, high fiber

Exercise: Swims four times a week

QUESTIONS FOR DISCUSSION

1. Which vaccines is she eligible for. Can you describe their indications, duration, and
     efficacy?

2. Which screening tests should she be offered and why?

3. How would you council her on the following topics:

a) Osteoporosis prevention

b) Diet

c) Drug and alcohol use