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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?.
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Goals of the Check-up Promote health Identify risk factors Detect disease
Lucia 17 years old High school senior
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!”
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
Sam 53-year-old “I need this form filled out for work”
Colon Cancer Screening • Fecal occult blood testing • Flexible sigmoidoscopy • Colonoscopy
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 50-74 “B” recommendation ACOG: Every 2 years age 40-49 Every year age 50+ ACS: Every year age 40+
“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 60- 64 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 stopcervical 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 65-70 in women who have had 3 normal pap smears in the past 10 years
“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