What Routine Testing Do I Need?

Posted: Dec 16, 2019

Every year we like to see adults for a routine “health maintenance exam,” but many patients are unsure about what is different about this type of visit. This appointment is great for consolidating all testing you’ve had over the past year and filling in any gaps with new orders, so what do we look for every year?

VACCINES

  • Flu vaccine: every person every year, but especially those with lung conditions like asthma and COPD
  • Tetanus vaccine: every 10 years
  • Pneumonia vaccine
    • PCV13: only need once in a lifetime as an adult. Most people get it once they turn 65, but you might qualify to have it between the ages of 50-64 if you have other conditions like diabetes, COPD, hypertension.
    • PPSV23: this vaccine has more coverage than the PCV13 and is indicated in adults 65+. You can have it done one year after the PCV13.
  • Herpes Zoster (Shingles) vaccine: two options
    • RZV (Shingrix) is the preferred vaccine and is given to patients >50 in a 2-dose series at least 2-6 months apart
    • ZVL (Zostavax) is indicated in patients >60 but is not preferred. You can receive the RZV vaccine 2 months after getting ZVL.
  • HPV vaccine: protects against cervical cancer and genital warts. Indicated for females up to 26 and males up to 21.
    • If 15+: 3 doses at 0, 1-2 months, and 6 months
    • If 9-14: 2 doses at least 5 months apart
  • MMR: protects against measles, mumps, and rubella. If no immunity, need one dose.

EXAM

  • Blood pressure, BMI (Body Mass Index), full physical exam
  • Mental status exam: screening for memory loss, normally needs a separate appointment
  • Depression screen: we use a questionnaire called a PHQ-9 to quantify depression
  • Hearing, vision: if concerns refer to ENT for hearing loss and/or optometry for vision loss
  • Women: Breast exam yearly; pelvic exam with pap smear every 3 years ages 21-65. Pap smears may be done more frequently pending results and history.
  • Men: prostate cancer screening- discuss with your provider
  • Skin cancer screening

TESTING

  • Labs: you might require more or less labs depending on your history
    • Fasting Glucose: to screen for diabetes, if elevated or known diabetic might include A1C as well
    • Fasting Lipid Panel (Cholesterol): for patients with a history of high cholesterol or high risk
    • HIV: high risk
    • STD testing: routinely in women ages 15-25 or high risk patients
    • Hep C screen: for patients born between 1945-1965, done once
    • BRCA 1/2: for patients with a strong family history of breast or ovarian cancer
  • Colonoscopy: roughly every 10 years ages >50. Might be more frequent/earlier if you have a history of polyps or family history of colon cancer.
  • Stool Guaiac cards: screening for blood in stool. Ideally every 3 years age >50
  • Mammogram: yearly in women age >39
  • DEXA scan (Bone density): women age >64 or age >59 with a high risk for osteoporosis
  • Aortic Ultrasound: males >64 with a history of smoking to look for aortic aneurysms
  • Low dose chest CT: screening for lung cancer in patients with a history of smoking. Insurance is very particular with this test, so only some patients will qualify.

COUNSELING

  • Diet/weight/exercise
  • Tobacco/alcohol/substance use
  • Sex/contraceptives/STDs
  • Calcium and vitamin D supplementation in postmenopausal women

And that’s about it! Keep in mind each patient is different and might require more or less testing. Also, certain insurance companies request additional testing, so this visit gives us the opportunity to catch up on everything you might need for the year!