Rethinking the Check-up
Goals of the Check-up Promote health Identify risk factors Detect disease
Where do we get our information?
USPSTF Grades
Lucia 17 years old High school senior
First priority: complete history
Physical exam: which elements are needed?
Does Lucia need a pelvic exam? Does she need a Pap smear?
Does Lucia need STI tests?
What about primary prevention? Birth control Emergency contraception Immunizations
HPV immunization Gardasil Cervarix
Summary: what Lucia needs Complete history Depression screening Body mass index Urine gonorrhea/chlamydia HIV test RPR Immunizations Contraception counselling Folic acid supplement
Elizabeth 36-year-old bartender Smokes ½ pack per day “Check me for everything!”
Does Elizabeth need a Pap smear?
How often do women need a Pap smear? ACOG: Every 2 years (age 21-29) Every 3 years (age 30+) ACS: Every 2 years if liquid-based test (under age 30) Every 2-3 years after 3 normal results in a row OR every 3 years with HPV typing (age 30+) USPSTF: At least every 3 years
Bimanual exam
Breast self-exam?
Smoking cessation
What about “routine blood tests?”
Sam 53-year-old “ I need this form filled out for work”
Sam’s complete history reveals…
“Oh, and I need this form filled out.”
Colon Cancer Screening Fecal occult blood testing Flexible sigmoidoscopy Colonoscopy
Prostate Cancer Screening?
Lipid Screening and CHD prevention
ASPIRIN: 10-year CHD risk levels at which benefit of treatment outweighs risk CHD = coronary heart disease.
Summary for Sam Complete history Body mass index Blood pressure HDL and total cholesterol Colon cancer screening
Davida 52 years old Healthy Non-smoker One male sexual partner
Mammography USPSTF: Every 2 years age “B” recommendation ACOG: Every 2 years age Every year age 50+ ACS: Every year age 40+
“A” Recommendations
“B” Recommendations
What about Screening for Diabetes?
“C” Recommendations Depression – when staff supports NOT in place HIV – for those NOT at increased risk Lipids – for women without CHD risk factors Osteoporosis – for women < age 60 or women age NOT at increased risk
“D” Recommendations Aspirin for women < age 55 (& for men < age 45) Carotid Artery Stenosis screening Cervical Cancer screening in women who have had a hysterectomy Genital Herpes (without symptoms) Hepatitis B and C (without symptoms) Gonorrhea (low risk) EKG, stress test (low risk) Ovarian Cancer
Blair New to your practice 77-year-old grandmother Here for “my yearly Pap”
When should we stop cervical cancer screening? ACS Age 70 in women who have had 3 normal pap smears in the past 10 years USPSTF Age 65 – “ if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer” ACOG Age in women who have had 3 normal pap smears in the past 10 years
Osteoporosis Screening
Breast Cancer Screening
“D” Recommendations DO NOT SCREEN FOR: Scoliosis Herpes simplex virus Hep B, Hep C, Gonorrhea, Syphilis with low risk AAA in women, or in men who haven’t smoked Ovarian Cancer Cervical Cancer after Benign Hysterectomy Asymptomatic bacteriuria or bladder cancer CHD with low risk (<5-10% 10-year risk) and…
“D” Recommendations, cont. Carotid artery stenosis Beta-carotene supplementation Testicular cancer Prostate cancer age > 75 Bladder cancer COPD Colorectal cancer age > 85 Lead in asymptomatic pregnant women