Screening and preventative care

o Hypertension screening using sphygmomanometer

 Done for preschool and then at 18 years
Repeat every 2 years if <120/80 (2014 guidelines)
• Older guidelines suggest repeating every 5 years
Repeat annually if 120-139/80-89 (2014 guidelines)
• Older guidelines suggest repeating every 3 years
BP measurement if >140/90; follow HTN guidelines
• If 140-159/90-99: measure up to 3 times within a 1-2 months
• If 160-179/100-109: measure up to 3 times within a month
• If 180/110 or more: measure 2-3 times within a week
 Diagnosis of HTN:
If malignant HTN: very high BP and symptomatic start tx
Office reading of >140/90 x3 times in 1-4 weeks interval or:
• Offer ABPM (24 hrs with 15-30 min intervals): average of >130/80 or
daytime >135/85 and nighttime >120/70
o At least 30 valid daytime and 7 valid nighttime measurements
• HBPM for 3-7 days; twice daily: average of >135/85
 Complications screening: begin at time of diagnosis
CBC, FBG& HbA1c, lipid profile, RFT (urea and creatinine), ALB/Cr ratio,

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electrolytes, uric acid, urinalysis, fundoscopy
Repeat annually or as indicated
u
o Dyslipidemia screening: two diff guidelines
 NCEP: Beginning at age 20: obtain a fasting (9 to 12 hour) serum lipid profile

factors
er
consisting of total cholesterol, LDL, HDL and triglycerides Start with non-fast
Repeat every 5 years if normal H
no  United states preventative services task force: > Tchoust > 200 , HDL
<40
Women aged 45 years and older, and men ages 35 years and older undergo LD fasting
screening with a total and HDL cholesterol every 5 years.
• If total cholesterol > 200 or HDL <40, then a fasting panel should be

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obtained
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Begin at 20 years in patients with a history of multiple cardiovascular risk
I factors, diabetes, or family history of either elevated cholesterol levels or
↳5 was premature cardiovascular disease.
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Age
Aug o Diabetes screening (ADA):
 Screening is done for:
0Any overweight/obese adult with one or more risk factors&(HTN, fx,
prediabetes, PCOS, hyperTG..); any age group
All adults at age of 45 and above (40 in BH)
Children and adolescents that are obese with two or more risk factors
RBG > 200 with symptoms) ->
o 25
8)

Pregnant women for GDM at 24-28 weeks; and initial visit if high risk (GTTP/
OGTT)
 If normal; repeat every 3 years, if pre-diabetic stage; repeat annually
 Used tests: HbA1c, FBG, and 2-hours plasma glucose after 75g oral glu intake
 Diagnosis of DM requires two abnormal readings, unless its RBG> 200mg/dL with
symptoms
FBG> 126mg/dL (7 mmol/L) x2 .. if 100-125 mg/dL do 75g oral glucose
tolerance test
RBG> 200mg/dL with symptoms (11.1mmol/L)
2-hr PG>200mg/dL (11.1mmol/L)
A1c> 6.5% or >48mmol/mol
 Complications screening: start after 5 years of T1DM diagnosis and at time of
diagnosis of T2DM
Annual RFT, fundoscopy, foot examination, microalbuminuria
Lipid profile as per guidelines

o Pregnancy screening programs:

 First antenatal visit: CBC with differentials, Blood group and Rh, indirect Coomb test
(for atypical antibodies), Rubella IgG, HIV (ELISA or western blot), HBsAg, Syphilis
(VDRL/RPR), urinalysis and urine culture, HVS for gonorrhea and chlamydia if
symptomatic only, pap smear/cytology per guidelines, hemoglobin electrophoresis/
HPLC, vitamin D, FBG/ OGTT if indicated, TSH.
HbA1c is not reliable during pregnancy
PPD if high risk
 At 24-28 weeks: GDM Giv 509 Glucose >7 8 .

GTTP for everyone (nonfasting):

o
• >200mg/dL is suggestive of GDM but need confirmation by OGTT
• 140-200mg/dL do OGTT 759
OGTT for positive GTTP or high risk (3hrs after -
100g); one abnormality is
diagnostic:
• Fasting >95 mg/dL (5.3mmol/L)
• 1-hr >180mg/dL (10.6mmol/L)
• 2-hr >155mg/dL (9 mmol/L)
• 3-hr >140mg/dL (7.8mmol/L)
 At 35-37 weeks:
Growth scan
GBS screening (very important)
 Visits; every 4 weeks until 28 weeks, then biweekly.. it varies depending on risk
assessment
Every visit: fundal height and other obstetric physical examination, BP
measurement, urinalysis (urine dipstick), FHT by doppler, history..
o Neonatal screening
 APGAR score at birth at 1 minutes (intrauterine environment and birth process) and
5 minutes (transitioning); assess the need for resuscitation
If score equals or more than 7; no further intervention
 Comprehensive history: antenatal and intrapartum (Detailed labor hx)
 Physical examination (head to toe); within first 24 hours
Growth charts: weight, height, weight for length and head circumference
BP measurement in certain conditions; prematurity, LBW, CHD, renal
anomalies
Vision and hearing assessment
Fontanelles
Cataracts, facial anomalies (cleft palate/lip), ears inspection for anomalies
Thyroid gland inspection for goiter
Chest or abdominal wall deformities
Limbs deformities or traumatic birth injuries
Breath sounds and heart sounds
Abdominal organs palpation
Congenital hip dysplasia: barlow and ortolani tests
Skin rashes, jaundice, pallor
Reflexes; moro, grasp, rooting, suckling
 Pulse oximetry to screen for congenital heart defects
 Heel-prick test at day 7 (Gurthie test)
TSH, PKU, MCADD, Hb Electrophoresis, IRT for CF, galactosemia, maple
syrup urine test

o Infancy and childhood screening

 History and physical examination
1-2 weeks old, 1, 2, 4, 6 and 9 months. Then; 12, 15, 18 and 24 months.
Then annually from 3 y/o till 10 y/o
Growth measurements/charts: weight, height, head circumference, weight
for length and then BMI starting from age of 2Y
Developmental milestones for each age; fine motor, social, language and
gross motor
Autism screening using M-CHAT form at 2 years (18-24 months)
• Assess social interactions, communication and behaviors by asking
the mother 20 questions
• Score of 3 or more; referral to psychiatry
Routine visual acuity and hearing screening
Eye inspection for cataracts, red reflex, light reflex
Auscultation of chest (resp+cardio)
Abdominal palpation
Genitalia; labial adhesions, undescended testicles..
BP starting from 3 years; with every visit
  Anemia screening starting from 12 months or for high risk children
 Lead screening per risk assessment evaluation
 TB screening for patients at high risk (pre-school mainly)
 Oral and dental health
 Lipid screening if high risk (family hx, ..)

o Adolescence health
 Annual history, growth measurements and physical examination +/- BP, if
applicable
 Visual acuity at 12, 15 and 18 y/o
 Hearing screening per risk assessment
 BP screening every 5 years if normal (See above)
 Depression screening: annual using PHQ-2
Score of 3 or more requires further intervention
 Anemia screening annually per risk assessment
 TB screening for patients at high risk
 Lipid screening once between 18-21 y/o
 STDs per risk assessment; HIV and HPV

o Adults health
 Screening for DM and dyslipidemia starting at 40-45 y/o
Earlier DM screening if obese with one or more risk factors
Earlier dyslipidemia screening (at 20Y) if at high risk
 BP measurements as above
 TB by PPD for high risk individuals (immigrants, .. )
 STIs for high risk individuals
Women:
• HPV: Pap smear for all women at 21 y/o or after 3 years from sexual
intercourse, every 3 years if normal. If pap test with HPV testing
starting from 30 y/o; every 5 years.. stop at 65 y/o if previous 10
years tests were normal
• Chlamydia (HVS): all sexually active/pregnant women 24 y/o or
younger, older if at risk
• Gonorrhea (HVS): all sexually active women
• HIV 18-65 y/o per risk assessment and during first antenatal visit
• Syphilis (RPR/VDRL) for at-risk individuals
Men:
• HIV
• Syphilis (RPR/VDRL) for at-risk individuals
 Abdominal aortic aneurysm using U/S: once for men of 65-75 y/o who ever smoked
 Osteoporosis screening using DEXA scan for:
All women aged 65 or more
Postmenopausal women with 1-2 FRAX
 Men with high FRAX score
 Cancer screening
Cervical cancer for women: 21-65y/o every 2-3 years or co-testing with HPV
typing starting from 30Y till 65, every 5 years
• Always remember that cervical cancer was once a leading cause of
death with high incidence, that has been regressing because of the
screening programs
Breast cancer for women: mammography every 1-2 years for women 50-75
y/o (in BH; start at 40 years, and include breast examination)
• After 75Y, no evidence of importance of screening mammogram
• Offer BRCA mutation testing for family members after counselling,
for those who desire
Colorectal cancer for both genders at 50-75 years (other sources say start
from 45 Y)
• Annual FOBT
• Sigmoidoscopy every 5 years or colonoscopy every 10 years
Lung cancer screening; starting from age of 55Y to 80Y annually
• Low-dose CT scan for currently smokers or history of one packet per
day for 30 years or 2 packets per day for 15 years
-
Ovarian cancer; not recommended and there is no specific test for it
Prostate cancer using PSA; not recommended
• For 55-69Y: category c; discuss risks and benefits with the patient
• For those aged 70 and more; NO SCREENING is recommended at all
(Category D)
• If screening is in favor, repeat every 2-3 years

Other health promoting measures:

 Immunizations (Childhood + others)
o During this pandemic, be advised to talk about COVID vaccines and other
preventative measures
 Lifestyle advices, including diet, physical exercise and smoking cessation
 Personal hygiene
 Travelling advices/ prophylaxis

Done by Juwaher