Routine Tests for Medical Certificate in Adults Over 40
For a medical certificate in adults over 40 years old, particularly those with occupational or travel-related health risks, the essential routine tests include: blood pressure measurement, lipid profile (total cholesterol, HDL, LDL, triglycerides), fasting plasma glucose or hemoglobin A1C for diabetes screening, complete blood count, comprehensive metabolic panel, and urinalysis. 1, 2, 3
Core Cardiovascular and Metabolic Screening
Blood Pressure
- Measure blood pressure at every clinical encounter for all adults over 40, regardless of risk factors 1
- This is a fundamental screening test with proven mortality benefit
Lipid Profile
- Screen with total cholesterol, HDL, LDL, and triglycerides every 5 years if results are normal 3, 1
- Non-fasting samples are acceptable for initial screening 1
- More frequent testing is warranted if borderline results are found 3
Diabetes Screening
- Test all adults over 45 years with fasting plasma glucose (FPG) or hemoglobin A1C 2
- For those aged 40-44, screen if BMI ≥25 kg/m² plus additional risk factors (first-degree relative with diabetes, high-risk ethnicity, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, or physical inactivity) 2, 1
- Repeat every 3 years if normal; annually if prediabetes is detected 2, 1
Baseline Laboratory Panel
Complete Blood Count (CBC)
- Obtain CBC with differential to screen for anemia, infection, and blood disorders 1
- This provides baseline hematologic status important for occupational fitness
Comprehensive Metabolic Panel (CMP)
- Include CMP to assess kidney function, liver function, and electrolyte balance 1
- Particularly important for workers with potential chemical exposures or physically demanding occupations
Urinalysis
- Perform urinalysis with albumin-to-creatinine ratio to screen for kidney disease 1
- Early detection of proteinuria can identify chronic kidney disease
Age-Appropriate Cancer Screening
Colorectal Cancer Screening (Starting Age 45-50)
- Begin colorectal cancer screening at age 45 for average-risk individuals 2, 3, 4
- Options include: annual fecal immunochemical test (FIT), colonoscopy every 10 years, or multitarget stool DNA test every 3 years 2, 4
- African Americans should begin screening at age 45 due to higher incidence and mortality rates 2, 3
Prostate Cancer Screening (Men Age 50+)
- For men aged 50 and older, engage in shared decision-making about PSA testing and digital rectal examination 2, 4
- High-risk men (African Americans, those with family history) should begin discussions at age 45 2
- Screening should only occur after informed discussion of benefits and harms 2
Cervical Cancer Screening (Women)
- Women should undergo Pap testing every 3 years (ages 21-65) or every 5 years with HPV co-testing after age 30 2
- May discontinue after age 65-70 with adequate prior negative screening 2
Breast Cancer Screening (Women Age 40+)
- Annual mammography beginning at age 40 is recommended by the American Cancer Society 2
- Clinical breast examination should be performed annually prior to mammography 2
Cancer-Related Physical Examination
Perform a cancer-related checkup including examination of thyroid, lymph nodes, oral cavity, and skin 2, 4
- For men, include testicular examination 2, 1
- This comprehensive examination should occur annually for adults over 40 2
Additional Considerations for Occupational/Travel Health
Baseline Electrocardiogram
- Consider baseline ECG for adults over 40, particularly those in physically demanding occupations 5
- While not universally recommended for screening, it provides valuable baseline data for occupational medicine
Immunization Status
- Verify tetanus-diphtheria status (booster every 10 years) 5
- Annual influenza vaccination is recommended 2
- Pneumococcal vaccination with appropriate revaccination intervals 2
Tests to Avoid
Do not perform single-panel guaiac fecal occult blood test during digital rectal examination - this has very low sensitivity and is not an adequate screening method 2, 3
Evidence Quality Note
The therapeutic yield of review of systems and physical examination (5-7%) exceeds that of many routine laboratory tests like complete blood count (1.8%), urinalysis (1.1%), or chest radiography (0%) in detecting clinically important diagnoses requiring treatment 6. However, the combination of targeted history, focused physical examination, and selective laboratory testing based on age and risk factors provides the most efficient approach 6, 7.