Periodic Health Assessment
F a m i l y M e d i c i n e
o Definition: evaluation of overall health status, screening for risk factors
& diseases & providing preventative interventions.
o Components:
Risk identification.
Screening.
Immunization.
Education.
o Purpose:
Primary prevention: prevention of disease before onset.
Secondary prevention: prevention of disease complications.
Updating patient’s clinical data.
Fostering patient-physician relationship.
Screening
o Definition: examination of asymptomatic people to detect those with
probability of having a disease.
o Wilson’s Criteria:
1 The condition is an important health problem
2 There should be a treatment for the condition
3 Facilities must be available
4 There should be a latent stage of the disease.
5 There should be a test for the disease.
6 Test should be acceptable for population
7 Natural Hx of the disease must be understood adequately
8 Should have agreed policy for whom to treat
9 Total cost must be economically balanced
10 Case-finding should continuous process
Hypertension
o Age: from age 18.
Screening o Follow up: every encounter.
Obesity
o Age: > 18.
o BMI: > 30.
Thyroid Disease o Age:
o Age: > 50. 21-29 Cervical cytology.
o Follow Up: every 5 years. Co-testing.
30-65
Cervical cytology accepted.
Congenital Hypothyroidism Discontinue screening if no Hx of CIN2 or higher if:
❖ 3 consecutive –ve cytology.
> 65
o Age: all children at 3rd day. ❖ Or 2 consecutive –ve co-test in previous 10 years + recent test
within 5 years.
DM
Annual screening not recommended
o Type 1: no need.
o Type 2:
If BMI > 25 + 1 RF: Prostate Cancer
Sedentary lifestyle. o Not routinely.
Hx of prediabetes. o Test: PSA, DRE.
Family Hx of DM. o Early PSA:
HTN, hyperlipidemia, IHD. > 50 years.
Hx of GDM. > 45 years + family Hx of prostate Ca.
Hx of delivery of > 4.5 kg baby. o Follow up: every 2 years.
Pregnant ladies.
Hx of PCOS. Colorectal Cancer
Non of previous criteria:
o Age:
45 years normal every 3 years.
50-70 years.
GDM 40 years: if youngest relative was diagnosed.
o Test + Follow up:
o Time: 24-28 weeks of gestation. Fecal occult test every 2 years.
Hypercholesterolemia Sigmoidoscopy every 5 years.
Colonoscopy every 10 years.
o Test: fasting lipid profile.
o Follow up: every 5 years. Breast Cancer
o Age: Age Test Follow Up
Men > 35. 20-40 Clinical exam Every 1-3 years
Women > 45. Clinical exam Every 1 year.
40-52
> 20 if risk for CHD. Mammogram Every 1-2 years.
Clinical exam Every 1 years.
> 52
Cervical Cancer Mammogram Every other years.
o Test: pap smear.
o Cervical cytology: every 3 years.
o High-risk HPV: every 5 years.
o Co-testing: every 5 years.
Osteoporosis
o Women:
65 years OR have RF.
All females > 50 years 1200 mg Ca + 400-800 IU/day vit D.
o Men: > 70 years OR 50-69 + RF.
o Perimenopausal / Postmenopausal: < 65 years.
o Any adult: > 50 years OR condition associated with low bone mass or
bone loss.
IDA
o Pregnant ladies:
1st & 3rd trimester: Hb < 11.
2nd trimester: Hb < 10.5.
o Children: > 1 year OR < 6 months if premature.
o Men / Postmenopausal: nothing.
Sickle Cell Disease
o Children 2-16 years:
Do transcranial Doppler US risk of stroke.
o 10 years: ischemic retinopathy & renal disease screening annually.
G6PD
o All newborns.