1. Routine screening tests Hai Ho, M.D.

2. Most expensive part of medical practice? Your Pen

3. Case 55-year-old male comes to you for a routine physical examination. He is a nonsmoker who takes no medications and has no signs of acute or chronic disease, and he has not seen a doctor in years. What blood work should you order for this patients?

4. Complete metabolic panel? $212

5. Basic metabolic panel $175

6. CBC? $36.40

7. Urinalysis? $23.80 Microscopic Examination $30.80 Total $54.60

8. Cost of FCC welcoming package? Chemistry$212 CBC$36.40 Urinalysis$54.80 Total$303.20

9. Cost of ER welcoming package? Chemistry$212 CBC$36.40 Urinalysis$54.80 Total CK$86 CK-MB$86 PT$49 PTT$61.60 Total $585.80

10. Pap smear after hysterectomy

11. Recommended screening tests  The disease must have high prevalence in the population tested  Favorable outcome when the disease is detected early  High sensitivity and specificity  Not too expensive

12. Fasting plasma glucose – adults?  Age ≥ 45, and if normal q3 years

13. Fasting plasma glucose - adults  Younger or more frequently Obese >120% of ideal body weight or BMI ≥ 27 kg/m 2 First-degree relative with diabetes High-risk ethnicity – African American, Latino, Native American, Asian-American, Pacific Islander Delivered a baby weighed > 9 lbs. or history of GDM Hypertension HDL ≤ 45 mg/dl and/or TG ≥ 250 mg/dl Glucose intolerance on previous testing Associated insulin resistance – hypertension, hyperlipidemia, PCOS

14. Fasting plasma glucose - children  Overweight BMI > 85 percentile for age and sex Weight for height > 85 percentile >120% of ideal body weight for height PLUS:  Any two of the following Family history of type 2 diabetes in first or second degree relative Ethnicity – Native American, African-American, Latino, Asian-American, Pacific Islander Associated insulin resistance – hypertension, hyperlipidemia, PCOS  Every 2 years

15. Lipid panel  Lipid panel Total cholesterol, LDL, HDL, TG Cost: $95  Age ≥ 20  Every 5 years  Metabolic syndrome – diabetes mellitus, hypertension

16. Chlamydia  AAFP: Annually all sexually active female age ≤ 25 and other women at increased risk for chlamydia  Molina or IEHP: Annually all female age 16-26, identified as sexually active

17. Fecal occult blood testing Annually for adults age ≥ 50