Check- up: The essential tests you should have

Many of us only go to the doctor when we are unwell. Rarely do we just book an appointment for a check-up, yet routine check-ups are very important.

Routine check-ups help us prevent certain diseases and detect a disease in its early stages, which is important in the overall management and treatment outcomes.

These check-ups are also important to help us identify risk factors especially in those suffering from chronic illnesses or with comorbidities.

What are the essential check-ups?

A medical check-up begins once a patient walks into a doctor’s office. There are various things the doctors take note of, and tailor the check-up to fit the desired target population.

This withstanding a baseline clinical history and physical examination is done where the doctor gets to know the patient and asses for any recent illness or complaint, past medical history, comorbidities and so on.

The doctor then carries out a physical examination where all systems are assessed, which includes a quick head-to-toe assessment. The doctor may decide to further evaluate a system of interest depending on the physical examination findings, and this is what makes a medical check-up personalised.

The vital signs are taken as part of a medical check-up, which includes: blood pressure, pulse rate, respiratory rate, temperature and oxygen saturation.

Additional biometric tests include weight and height, which will be used to calculate the Body mass index for purposes of nutritional assessment and recommendations.

The doctor may then include a test for random blood sugar, which screens for conditions such as diabetes, and if noted to be higher than the normal range, further evaluation will be recommended.

From the above assessment, the patient will then be sent for laboratory baseline tests that basically tells us whether the key organs are physiologically normal or if there is need to investigate further.

This check-up will include;

Full hemogram: This contains a variety of blood tests that include a white cell count, a Haemoglobin (HB) level, and platelet count, among others.

These are important in screening for diseases of the blood, like infections, anaemia or bleeding disorders, which can be further evaluated and managed.

A full hemogram is also a useful tool for early detection of blood malignancies like leukaemia and is therefore an important test.

Renal Function Tests: These are tests that indicate the overall function of the kidneys and look at the overall clearance of toxins, waste products of the body, which can be used to estimate the overall function of the kidneys.

The tests measure the urea and creatinine levels and also evaluate the electrolyte levels like sodium, potassium and chloride. These are important for early detection of diseases of the kidney, metabolic disorders or obstructive conditions of the urinary tract.

Liver function tests: These tests are used to screen for any conditions affecting or damaging the liver, which may raise the index for suspicion for further evaluation.

Urinalysis: A urine test screens for conditions that may affect the urinary system or metabolic conditions like diabetes and its complications.

A urinalysis checks for the appearance, concentration and content of urine. All these are used to screen and early detection of certain disease processes, both infectious and non-infectious like kidney disease and diabetes, which may require further evaluation.

There are also other additional tests which are important. These include;

Cholesterol

This test looks at the level of cholesterol, which can be divided into two categories; High-density Lipoprotein, which is the “good cholesterol” and Low-density lipoprotein, which sometimes is referred to as the “bad cholesterol”.

An additional cholesterol test is a Triglyceride level. All these tests guide the nutritional assessment and play an important role in general recommendations given to patients, especially those who have underlying comorbidities like hypertension or pre-hypertensive patients and those with a higher body mass index (BMI) to maintain a healthy lifestyle.

High LDL levels have been associated with cardiac disease and may predispose one to a stroke. It is important to maintain a healthy lifestyle, which includes regular exercise and a proper diet to prevent such conditions.

Stool Tests

These tests are not mandatory but are important in screening for disorders of the gastro-intestinal tract. The test checks for Faecal occult blood, ova and cysts, and can help evaluate/screen for infections, diseases of the GI tract, haemorrhoids/ piles and even raise an index of suspicion for malignancies in this tract in patients with constitutional symptoms.

Focused additional tests

These are tests that are recommended as part of routine medical check-ups for certain cadre or group of patients. These include.

Prostate Specific antigen (PSA): A PSA is a protein produced by normal prostate cells and rising levels of these proteins are associated with various conditions like Prostate cancer, infections of the prostate also known as prostatitis or Benign prostatic hyperplasia.

Most clinicians determine which men should undergo PSA testing based on age, symptoms, family history, general medical condition, physical examination findings and sometimes patient’s requests.

The decision to do a PSA should be made after the doctor has explained the benefits and risks and probable follow up recommended with the different ranges of PSA values.

The recommended age group range for a PSA screening is between 40- 55 years depending on local guidelines, family history or suggestive symptoms from the history. It is important to note that there are many other factors that may influence the PSA levels and these are discussed with patient before taking a blood sample for screening.

Cervical cancer screening: Cervical cancer is still the most common malignancy in women worldwide, and remains the leading cause of cancer-related mortality in women in developing countries. Cervical cancer screening is also dependent on the age group, based on different local guidelines.

The American College of Obstetrician guidelines (ACOG) recommends screening form ages twenty-one to women of more than sixty-five years.

Different screening techniques are recommended for different age group ranges and younger age group may require a pap smear alone, while those ages from 30-60 may require HPV and cytology testing every five years or every three years if cytology alone is done.

Breast cancer screening: Breast cancer screening is also recommended in medical check-ups and has different modalities of screening that include Breast self-examination, Clinical breast examination where the doctor does the evaluation, Radiological Imaging like Ultrasonography, mammography or an MRI.

The American College of Obstetricians recommends that a clinical breast examination should be offered every one to three years to people of ages of 25-39 and annually for patients who are 40 years or older.

The mammogram offers the gold standard for breast cancer detection and is recommended in patients aged 40-49 years with an interval screening of annually or biennially.

The writer is Assistant Professor and Consultant Family Physician at Aga Khan University Hospital, Family Medicine Department