GP: Preventative health + screening

Question 1

Features of a good screening test

Hint (COSTCO)

Answer 1

Condition

• Important problem
• Recognisable latent/early symptomatic stage
• Adequately understood natural disease

Options for treatment

• Effective treatment
• Evidence early treatment leads to better outcomes
• Agreed treatment policy of who and how

SCREENING

Test

• Simple
• Safe
• Precise
• Validated
• Acceptable
• Agreed upon cutouts

Consumers
- Informed of evidence so they can make an informed choice about participation

Outcome

• Evidence of improved mortality, morbidity, QOL from screening
• Cost of case finding economically balanced in relation to possible medical care expenditure of finding disease as a whole

Question 2

Middle age health check (age 45)

Answer 2

• Weight, height, BMI, BP
• LIPIDS
• AUSDRISK Diabetes tool
• Fracture risk review for osteoporosis in women
• Absolute CV risk

Question 3

Screening at age 50

Answer 3

Mammography 2yrly
FOBT 2yrly
AUSDrisk, CV risk

Question 4

Vaccinations at age 65

Answer 4

Influenza
Pneumococcal
Zoster (free for over 70)

Question 5

Lipid testing

Answer 5

Test from 45y
Every 5 years: low cvd risk
Every 2 years: mod cvd risk
Every year: high cvd risk

Question 6

HTN goals in diabetes

Answer 6

130/80

Question 7

Diabetes screening

Answer 7

AUSDRISK from age 40 every 3y, from age 18 in ATSI

High risk: (score >12 or >40y + overweight or fam hx/high risk ethnicity/cvd/GDM/PCOS/antipsychotics) –> do fasting BSL or HBA1C every 3y
- If impaired fasting: retest 12mo (5.5-6.9 –> OGTT may be needed)

Question 8

Kidney disease screening

Answer 8

High risk groups: ATSI, CVD, HTN, smoking, obesity, family Hx, AKI Hx

• Do BP, ACR and eGFR 1-2yrly
• If ACR raised arrange 2 further samples over 2mo

Question 9

ACR correlations with Micro and macroalbuminaemia (cut offs in mg/mmol)

Answer 9

Male: Normal <2.5, Micro 2.5-25, Macro >25
Female: Normal <3.5, Micro 3.5-35, Macro >35

Question 10

Osteoporosis screening

Answer 10

Review fracture risk for 12mo
Women from 45, Men from 50

Women >50 + risk factors: DEXA
Men >60 + risk factors: DEXA