Why a health check in a well adult matters
A routine check is a chance to find silent disease, such as high blood pressure, diabetes, raised cholesterol or kidney and liver problems, before it does harm. The results also need explaining well, because an abnormal number in a well person can frighten or be ignored.
What to ask in the history
- Why he has come, and any symptoms at all
- Past illnesses, medicines
- Family history: heart disease, diabetes, cancer
- Smoking, alcohol, diet, exercise, sleep
- Work
- Previous checks and results
Red flags
- Very high blood pressure, or symptoms of damage from it
- Symptoms he did not mention at first, such as chest pain on exertion or weight loss
- Results that are far from normal
What to examine
- Blood pressure, repeated, with the right cuff
- Weight, height, waist
- Pulse
- Heart, lungs and abdomen
- Fundi
- Feet
First investigations
- Fasting glucose or HbA1c
- Cholesterol
- Kidney function and urine for protein
- Liver function
- Full blood count
- ECG
- Further tests depending on what these show
Differential diagnosis of a health check in a well adult
Grouped, not ranked. Which one fits this patient is for you to work out in the case.
Heart and vessel risk
- Hypertension
- Raised cholesterol
- Obesity
Metabolic
- Diabetes or prediabetes
- Fatty liver
- Gout
Kidney and liver
- Chronic kidney disease
- Liver disease
Other
- Incidental findings that need follow-up
Common mistakes
- Diagnosing high blood pressure from a single reading.
- Ignoring results that are only a little abnormal.
- Not explaining the results clearly or arranging follow-up.