While there are specific check-ups for the different age, genders, and people with predisposing risk factors, there are certain tests that are standard for most age groups.
A medical check-up begins once a patient walks into a doctor’s office. There are various things the doctors take note of and tailors 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 tell us whether the key organs are physiologically normal or if there is a need to investigate further.
Baseline laboratory tests can be done once every year. This check-up will include;
1. 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 has also been a useful tool for the early detection of blood malignancies like leukaemia and is therefore an important test.
2. Renal function tests: These are tests that indicate the overall function of the kidneys and look at the overall clearance of toxins, and waste products of the body that can be used to estimate the overall function of the kidney.
The tests measure the urea and creatinine levels and also evaluate the electrolyte levels like sodium, potassium and chloride.
These are important for the early detection of diseases of the kidney, metabolic disorders or obstructive conditions of the urinary tract.
3. Liver function tests: These are used to screen for any conditions affecting or damaging the liver which may raise the index for suspicion for further evaluation.
4. Urinalysis: A urine test screens for conditions that may affect the urinary system or metabolic conditions like diabetes and its complications.
It 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;
5. 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 (LDL) 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 to maintain a healthy lifestyle.
High LDL levels, associated with cardiac disease, 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.
6. Stool tests: These tests are not mandatory but are important in screening for disorders of the gastrointestinal tract.
The test checks for faecal occult blood, ovary and cysts, and can help evaluate/screen for infections, diseases of the gastrointestinal tract, haemorrhoids/ piles and even raise an index of suspicion for malignancies in this tract in patients with constitutional symptoms.
Then there are focused additional tests that are recommended as part of routine medical check-ups for a certain cadre or group of patients. These include;
7. 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 and 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 to 55 years depending on local guidelines, family history or suggestive symptoms from the history.
It is important to note that many other factors may influence the PSA levels and these are discussed with the patient before taking a blood sample for screening.
8. 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.
Different screening techniques are recommended for different age group ranges and younger age groups may require a Pap smear alone, while ages from 30-60 may require HPV and cytology testing yearly or every three years if cytology alone is done.
9. 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, and Radiological Imaging like Ultrasonography, mammography or an MRI.
A clinical breast examination should be offered every one to three years to people ages 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.
Dr Kimondo is a general practitioner at Aga Khan University Hospital, Nairobi.
