Periodic Screening Tests March What is the

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					                                 Periodic Screening Tests
                                 March 8, 2004 - Questions

1. What is the recommended frequency of periodic health exams for healthy patients...

   a. At age 19-39?

   b. At age 40-64?

   c. At age ≥ 65?

2. Sandy is a 20 year-old WF who presents to your clinic as a new patient. She is a smoker
   but is complaint-free and has no significant family history. She simply wants a check-up.

   a. Which of the below screenings are recommended for her?

   [ ] Height, weight        [ ] Lipids        [ ] EKG               [ ] Fecal occult blood
   [ ] Blood pressure        [ ] CBC           [ ] Mammogram         [ ] Flex-sig or
   [ ] Vision / hearing      [ ] BMP           [ ] Fasting glucose      colonoscopy
   [ ] Thyroid exam          [ ] TSH           [ ] Pulsoximetry      [ ] Flu shot
   [ ] Pelvic & pap smear    [ ] Urinalysis    [ ] CXR               [ ] Tetanus booster
   [ ] Breast exam           [ ] STD screen    [ ] DEXA              [ ] Hep B vaccine
   [ ] Digital rectal exam   [ ] PPD           [ ] ETT               [ ] Pneumovax


   b. How does the answer change if Sandy is 40 years old?

   c. How does the answer change is Sandy is 50 years old?

   d. How does the answer change if Sandy is 70 years old?

   e. How does the answer change if Sandy is 90 years old?

3. Further examination reveals that Sandy is actually an oddly dressed white male. What are
   the age indications & recommended periodicity (when to start screening & how often) for
   the following male-specific screenings?

   [ ] Testicular exam               [ ] PSA        [ ] Digital rectal / prostate exam

4. What are the specific screening tests and their recommended frequency for patients with
   diabetes?
                                    Periodic Screening Tests
                                    March 8, 2004 - Answers

1. What is the recommended frequency of periodic health exams for healthy patients...

   a. At age 19-39? 1-3 years (Annual pap smears are indicated for females unless
      they’ve had 3 consecutive normal smears, allowing pap smears every 3 years.)

   b. At age 40-64? 1-3 years

   c. At age ≥ 65?       annually

2. Sandy is a 20 year-old WF who presents to your clinic as a new patient. She is a smoker
   but is complaint-free and has no significant family history. She simply wants a check-up.

   a. Which of the below screenings are recommended for her?

   YES    Height, weight        USPSTF: “periodically”
   YES    Blood pressure        USPSTF: “periodically”; ACP recommends every 1-2 years.
    ?     Vision / hearing      USPTF: symptom-driven only, routine screening in the “elderly”;
          screen                American Optometric Assoc: q 2-3 years in age 20-60, annually > 60
     ?    Thyroid exam          USPTF: only for patients with hx of upper-body irradiation;
                                ACS: every 3 years for age 20-39, annually for age >39
   YES    Pelvic & pap smear    USPTF: annually (every 3 years if negative consecutively x3)
    ?     Breast exam           USPTF: annually beginning at age 50; begin at age 35 if high risk (1st
                                degree relative with premenopausal breast CA);
                                ACS: every 3 years from age 20-39;
                                AC-OB/GYN: annually after 18 years old
     no   Digital rectal exam   USPTF: insufficient evidence;
                                ACS: with flex-sig every 5 years;
                                AC-OB/GYN: annually for ages > 50
   YES    Lipids                USPTF: begin at age 35, but okay to start earlier. Non-fasting total
                                cholesterol is an adequate screening test if no risk factors are present.
                                Obtain FLP if TC > 200 or if other risks factors (obesity, diabetes, family
                                hx of CAD, hyperlipidemia). Repeat every 5 years if normal;
                                ACS & NCEP: every 5 years starting at age 20
    no    CBC                   symptom-driven only + pregnancy
    no    BMP                   symptom-driven only
    no    TSH                   USPSTF: no routine screening;
                                ACP: no routine screening, but for age >50 use low threshold for symptom-
                                driven testing
    no    Urinalysis            USPSTF: no routine screening, but obtain ua & cx in all pregnant women;
                                ACP: no routine screening except in pregnant women
    no    STD screen            USPSTF: “periodic” screening if high risk (adolescent, prior STD, high
                                prevalence, multiple partners)
     ?    PPD                   CDC & USPSTF: perform on all patients at high risk (close contacts of
                                persons with TB, HIV patients, illicit drug use, health care workers,
                                foreign-born persons if immigrated within last 5 years from high
                                prevalence country, medical underserved, low-income populations, nursing
                                home residents, medical risk factors – diabetes/ESRD/malignancies/
                                silicosis/malabsorptive-dz/GI-cancers/immunosuppression.); repeat testing
                                frequency is based upon potential continued exposure
no    EKG                      USPSTF: no routine screening unless airline pilot, etc;
                               screen men > 40 years old if ≥ 2 cardiac risk factors
no    Mammogram                ACP, USPSTF, AMA, ACS: annually if age >50;
                               ACP: no routine screening if < 50;
                               USPSTF: insufficient evidence to recommend for or against if age <50,
                               stop at age 70; (American Geriatrics Soceity says stop at age 85);
                               AMA & ACS: every 1-2 years for ages 40-49
no    Fasting glucose          only in high risk groups (family hx, obesity, gestational diabetes hx,
                               hypertension, hyperlipidemia, PCO); repeat at 3 year intervals (or more
                               often if multiple risk factors)
no    Pulsoximetry             symptom-driven only
no    CXR                      symptom-driven only
no    DEXA                     USPTF: all women > 65, high risk women at age 60 (smokers, weight <
                               70kg, family hx, alcohol use)
no    ETT                      symptom-driven only
      Fecal occult blood       USPTF: annually for ages > 50
no    Flex-sig /               ACS & American Gastroenterology Assn: flex-sig every 5 years or
      colonoscopy              colonoscopy every 10 yrs (+ annual fecal occult);
                               USPTF: begin screening at age 50 (insufficient evidence to determine
                               optimal approach or periodicity)
 ?    Flu shot                 annually in patients > 50 yo; annually in any age if high risk (nursing home
                               resident, asthma, DM, renal disease, immunosuppressed, pregnancy, health
                               care providers); annually to anyone who requests it
YES   Tetanus booster          CDC: one dose booster every 10 years
 no   Hep B vaccine series     CDC: for persons with medical, behavioral, occupational indications
                               (asplenia, DM, chronic liver dz, COPD, heart dz, renal failure, HIV,
                               malignancies)
no    Pneumovax                CDC: single dose to all adults age >65 (repeat once if vaccine given under
                               age 65 & given > 5 yrs ago); give to younger persons in high risk groups
                               (chronic lung dz, CVD, DM, chronic liver dz, CRI, asplenia, etc); repeat
                               one time after 5 years in persons with CRI, nephrotic syndrome, asplenia,
                               immunosuppression & chemotherapy

b. How does the answer change if Sandy is 40 years old?

YES   Mammogram                  AMA & ACS: every 1-2 years for ages 40-49;
                                 ACP, USPSTF, AMA, ACS: annually if age >50;

c. How does the answer change is Sandy is 50 years old?

YES   Breast exam                USPTF: annually beginning at age 50; begin at age 35 if high risk (1st
                                 degree relative with premenopausal breast CA);
                                 ACS: every 3 years from age 20-39;
                                 AC-OB/GYN: annually after 18 years old
YES   Fecal occult blood         USPTF: annually for ages > 50
YES   Flex-sig / colonoscopy     ACS & American Gastroenterology Assn: flex-sig every 5 years or
                                 colonoscopy every 10 yrs (+ annual fecal occult);
                                 USPTF: begin screening at age 50 (insufficient evidence to determine
                                 optimal approach or periodicity)
   d. How does the answer change if Sandy is 70 years old?

    no    Pelvic & pap          stops at age 65 unless high risk (frequently positive pap smears or
                                previous cervical CA)
    ?     TSH                   USPSTF: no routine screening;
                                ACP: no routine screening, but for age >50 use low threshold for
                                symptom-driven testing;
                                AC-OB/GYN: obtain TSH every 3-5 years in all women > 65 years old
   YES    DEXA                  USPTF: all women > 65, high risk women at age 60 (smokers, weight <
                                70kg, family hx, alcohol use)
   YES    Pneumovax             CDC: single dose to all adults age >65 (repeat once if vaccine given
                                under age 65 & given > 5 yrs ago); give to younger persons in high risk
                                groups (chronic lung dz, CVD, DM, chronic liver dz, CRI, asplenia, etc);
                                repeat one time after 5 years in persons with CRI, nephrotic syndrome,
                                asplenia, immunosuppression & chemotherapy

   e. How does the answer change if Sandy is 90 years old?

    no    All screenings        Screenings unnecessary if < 10 years life expectancy

3. Further examination reveals that Sandy is actually a oddly dressed white male. What are
   the age indications & recommended periodicity (when to start screening & how often) for
   the following male-specific screenings?

     ?    Digital rectal exam   USPSTF: insufficient evidence to recommend; ACS recommends annual
                                screening for ages > 50
     ?    Testicular exam       USPSTF: insufficient evidence to recommend; ACS recommends
                                screening every 3 years for ages 20-39, annually for age> 39
     ?    PSA                   USPSTF: not recommended routinely;
                                American Urological Assoc: annually in men > 50 years old



4. What are the specific screening tests and their recommended frequency for patients with
   diabetes?

   Annual eye exam, foot exam, flu shot, FLP, peripheral neuropathy assessment and urine
   microalbumin. HbA1c at least twice per year (goal 6.5%). One life-time dose of
   pneumovax, repeated once at age 65. PPD screening once; repeat if suspected continued
   TB exposure.
References:

USPSTF Guide to Clinical Preventive Services, 3rd Edition, Periodic Updates
http://www.ahrq.gov/clinic/gcpspu.htm

Clinician’s Handbook of Preventive Services, 2nd Edition. 1998.
http://www.ahrq.gov/clinic/ppiphand.htm

National Cholesterol Education Program - Adult Treatment Panel III
http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf

Standards of Medical Care for Patients With Diabetes Mellitus; Diabetes Care, Volume 26,
Supplement 1; 2003 January (page 33S-50S).
http://www.utmem.edu/gim/articles/2003-01-diabetes.pdf

CDC Adult Immunization Schedule
http://www.cdc.gov/nip/recs/adult-schedule.htm

				
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