# A health check for life insurance in a 50-year-old: a case to work up

> An internal medicine case for medical students: a well 50-year-old having a health check for life insurance. What to ask, how to examine, which tests to order, and how to handle what you find.

- Internal Medicine · Beginner · about 15 minutes
- Web page: https://www.medikarya.in/case-studies/50-year-old-man-having-a-health-check-for-life-insurance
- Work up this patient: https://www.medikarya.in/case-studies/50-year-old-man-having-a-health-check-for-life-insurance

## How the patient presents

A 50-year-old man feels perfectly well and has come for a health check because his life insurance company asked for one.

## 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.

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A study guide for medical students, not medical advice. Follow your institution's protocols in practice.