A 40-year-old man presents for periodic medical evaluation. He has not been evaluated by a physician for many years. He feels that his health is excellent, and he takes no medications and has no allergies. He mentions that his mother was found to have colon cancer at 54 years of age. His 49-year-old brother was recently found to have multiple large adenomatous colon polyps. His 52-year-old sister underwent hysterectomy for endometrial cancer at age 48. His maternal grandmother had stomach cancer. At what age do you recommend starting colonoscopy for colon cancer screening?

A 55-year-old man comes into the urgent care clinic at your medical facility with a hand laceration. He accidentally cut his finger with a kitchen knife while preparing to slice vegetables. He has a 1.5-cm laceration on the palmar surface of his left middle finger, overlying the proximal phalanx. Flexor tendon and vascular structures are intact. He has no record of prior tetanus vaccinations but believes that he probably had “baby shots” because his mother was a nurse. He served in the U.S. Army during the Vietnam War and recalls getting many vaccinations while in basic training. He cannot recall getting any vaccinations since leaving military service. You clean and suture the laceration. Which of the following do you recommend for tetanus prophylaxis?

A 28-year-old Somali woman comes into your office for a refugee health evaluation. A tuberculin (PPD) skin test shows 10 mm of induration after 48 hours. She spent 1 year in a refugee camp in northern Kenya and then 5 years in a private residence in Nairobi, Kenya, before immigrating to the United States. She is not aware of exposure to anyone with active pulmonary tuberculosis (TB). She denies TB symptoms. Physical examination findings are normal. Chest radiography shows fibrotic changes in both upper lobes and a nodule in the right upper lobe. What do you recommend

A 35-year-old man is concerned about possible rabies exposure. Approximately 3 months ago he was staying in a cabin in northern Minnesota and awoke during the night with a bat flying around the bedroom. He killed the bat with a tennis racket, picked it up with his hands, and disposed of it in a garbage can. He recently spoke with a friend about the incident, and his friend mentioned that bats can carry rabies. He cannot recall if he had any cuts, abrasions, or other skin breaks on his hands when he handled the bat. He is currently asymptomatic. What do you recommend?

A 28-year-old woman is concerned about possible exposure to chickenpox. She has never had chickenpox. Varicella serology was negative 1 year ago. She did not receive varicella vaccine because she was trying to become pregnant when the serology results were available. Three days ago she visited a family that recently immigrated to the United States. A child in the family had an illness with skin lesions, which was subsequently diagnosed as chickenpox. The patient had a couple of days of spotting at her last two menstrual periods, instead of her usual 5- to 7-day menstrual flow. A urine pregnancy test is positive. What do you recommend?