Internal Medicine
Curricular Elements:
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Objectives
Case I
Case II
Case III
Adult Vaccination
Cancer Screening
Diabetes Screening
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