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Rethinking the Check-up

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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Rethinking the Check-up

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  1. Rethinking the Check-up

  2. Goals of the Check-up Promote health Identify risk factors Detect disease

  3. Where do we get our information?

  4. USPSTF Grades

  5. Lucia 17 years old High school senior

  6. First priority: complete history

  7. Physical exam: which elements are needed?

  8. Does Lucia need a pelvic exam?Does she need a Pap smear?

  9. Does Lucia need STI tests?

  10. What about primary prevention? Birth control Emergency contraception Immunizations

  11. HPV immunization Gardasil Cervarix

  12. Summary: what Lucia needs Complete history Depression screening Body mass index Urine gonorrhea/chlamydia HIV test RPR Immunizations Contraception counselling Folic acid supplement

  13. Elizabeth 36-year-old bartender Smokes ½ pack per day “Check me for everything!”

  14. Does Elizabeth need a Pap smear?

  15. 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

  16. Bimanual exam

  17. Breast self-exam?

  18. Smoking cessation

  19. What about “routine blood tests?”

  20. Sam 53-year-old “I need this form filled out for work”

  21. Sam’s complete history reveals…

  22. “Oh, and I need this form filled out.”

  23. Colon Cancer Screening • Fecal occult blood testing • Flexible sigmoidoscopy • Colonoscopy

  24. Prostate Cancer Screening?

  25. Lipid Screening and CHD prevention

  26. ASPIRIN: 10-year CHD risk levels at which benefit of treatment outweighs risk CHD = coronary heart disease.

  27. Summary for Sam Complete history Body mass index Blood pressure HDL and total cholesterol Colon cancer screening

  28. Davida 52 years old Healthy Non-smoker One male sexual partner

  29. 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+

  30. “A” Recommendations

  31. “B” Recommendations

  32. What about Screening for Diabetes?

  33. “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

  34. “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

  35. Blair New to your practice 77-year-old grandmother Here for “my yearly Pap”

  36. 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

  37. Osteoporosis Screening

  38. Breast Cancer Screening

  39. “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…

  40. “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

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