What screenings are recommended for a 20-year-old during a physical?

Screening Recommendations for a 20-Year-Old Physical Examination

For a healthy 20-year-old, focus on cardiovascular risk factor assessment, lifestyle counseling, and age-appropriate cancer screening, while avoiding unnecessary testing like routine ECGs or extensive laboratory panels unless specific risk factors are present.

Cardiovascular Screening

Risk Factor Assessment

• Begin comprehensive cardiovascular risk factor screening at age 20, including family history of coronary heart disease, smoking status, diet, alcohol intake, and physical activity assessment 1
• Measure blood pressure at every visit (at least every 2 years if normal) 1, 2
• Calculate and record body mass index (BMI) and waist circumference at each visit 1, 2
• Obtain fasting lipid profile (total cholesterol, HDL, LDL, triglycerides) at least every 5 years, or every 2 years if risk factors are present 1, 2
• Check fasting blood glucose according to diabetes risk, at least every 5 years 1

What NOT to Do

• Do not perform routine 12-lead ECG screening in asymptomatic 20-year-olds without known cardiovascular disease or significant risk factors 1
• Do not require stress testing before initiating low-to-moderate intensity exercise programs like walking in healthy young adults 1
• Men under 45 and women under 55 who are asymptomatic without known cardiovascular disease generally do not need cardiovascular work-up unless there are extenuating circumstances such as family history of sudden death at young age 1

Physical Examination Components

Vital Signs and General Assessment

• Record height, weight, BMI, and blood pressure 2
• Assess pulse to screen for atrial fibrillation 1
• Perform visual acuity assessment 2

System-Specific Examination

• Cardiovascular: Auscultate for murmurs, gallops, or rubs 2
• Respiratory: Auscultate lungs for abnormal breath sounds 2
• Abdominal: Inspect, auscultate, and palpate 2
• Neurological: Assess sensory examination and deep tendon reflexes 2
• Skin: Inspect for suspicious lesions, rashes, or abnormalities 2

Cancer Screening (Gender-Specific)

For Women

• Begin cervical cancer screening with Pap test approximately 3 years after initiating vaginal intercourse, but no later than age 21 3
• Perform clinical breast examination every 3 years for women in their 20s 3
• Conduct cancer-related checkup every 3 years (ages 20-39) examining thyroid, ovaries, lymph nodes, oral cavity, and skin 3
• Discuss breast self-examination benefits and limitations, emphasizing prompt reporting of new breast symptoms 3
• Do NOT perform mammography at age 20 (begins at age 40) 3

Family History Assessment

• Take complete family history focusing on cancer, particularly breast cancer in first-degree relatives, to identify patients who may benefit from genetic counseling 3, 2

Lifestyle and Preventive Counseling

Physical Activity Recommendations

• Recommend at least 150-300 minutes per week of moderate-intensity aerobic activity OR 75-150 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination 4, 5
• Advise muscle-strengthening activities involving all major muscle groups on 2 or more days per week 4, 5
• Emphasize that moving more and sitting less benefits nearly everyone, with even modest increases in activity providing substantial health benefits 4

Health Behavior Counseling

• Provide tobacco cessation counseling if applicable 1, 2
• Discuss diet and nutrition guidance 1, 2
• Address alcohol and substance use 2
• Counsel on sun exposure and skin cancer prevention 3
• Discuss sexual practices and risk reduction 3
• Address environmental and occupational exposures 3, 2

Laboratory Testing

Recommended Tests

• Fasting lipid profile (total, LDL, HDL cholesterol, triglycerides) 1, 2
• Fasting blood glucose 1, 2
• Consider complete blood count (CBC) and comprehensive metabolic panel (CMP) based on clinical indication 2

Tests NOT Routinely Needed at Age 20

• Hemoglobin A1C (unless diabetes risk factors present) 2
• Thyroid-stimulating hormone (TSH) (reserved for women with symptoms or older adults) 2
• Prostate-specific antigen (PSA) (for men over 50) 2

Common Pitfalls to Avoid

• Do not order unnecessary screening tests not recommended for this age group, such as mammography, colorectal cancer screening, or routine ECGs 3
• Do not perform annual Pap tests when guidelines recommend less frequent screening 3
• Do not fail to provide adequate education about recognizing and reporting new symptoms 3
• Do not overlook family history that might indicate need for earlier or more intensive screening 3
• Do not require medical evaluation or stress testing before initiating walking or equivalent moderate-intensity exercise in healthy young adults 1