Difficulty: Medium
Average Score: 95%
Practice
An 84-year-old male with a history of stroke without residual deficit, systolic heart failure, and type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement community and still works part-time on a golf course. He currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily. He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He states he has had over three sexual partners in the last year with intermittent condom use.
Correct answer
D
Rationale
The correct answer is D) Urine testing, blood testing, anal swab, and oropharyngeal swab. In this case, the patient's sexual history, including engaging in high-risk sexual behaviors, puts him at risk for sexually transmitted infections (STIs). Given his age and medical history, it is crucial to conduct a comprehensive screening for STIs. Urine testing can detect infections like chlamydia and gonorrhea, while blood testing can screen for HIV and syphilis. An anal swab is necessary to check for infections like rectal chlamydia and gonorrhea, which are common in individuals engaging in receptive anal sex. Additionally, an oropharyngeal swab is important to screen for STIs like gonorrhea and chlamydia in the throat, especially considering the patient's sexual practices.
Options A, B, and C are incorrect because they do not encompass the comprehensive testing needed for this patient based on his sexual history. Failing to conduct the appropriate screenings could result in undiagnosed and untreated STIs, leading to serious health consequences for the patient.
From an educational standpoint, this case highlights the importance of taking a thorough sexual history and conducting appropriate screenings for STIs in all patients, especially in older adults who may engage in risky behaviors. It emphasizes the need for healthcare providers to be nonjudgmental, thorough, and proactive in addressing sexual health concerns to provide comprehensive care for their patients.
Options A, B, and C are incorrect because they do not encompass the comprehensive testing needed for this patient based on his sexual history. Failing to conduct the appropriate screenings could result in undiagnosed and untreated STIs, leading to serious health consequences for the patient.
From an educational standpoint, this case highlights the importance of taking a thorough sexual history and conducting appropriate screenings for STIs in all patients, especially in older adults who may engage in risky behaviors. It emphasizes the need for healthcare providers to be nonjudgmental, thorough, and proactive in addressing sexual health concerns to provide comprehensive care for their patients.