THE ANNUAL PHYSICAL EXAM

Definition

A physical examination is an evaluation of the body and its functions using inspection, palpation (feeling with the hands), percussion (tapping with the fingers), and auscultation (listening).

This is done on a yearly interval to ensure an employee continues to be physically fit for his present job.

THE ANNUAL PHYSICAL EXAM

An APE is considered a major preventive program emphasizing on promoting health, detecting illness at the earliest stage, and determining present health status as a follow-up to previous medical results or findings.

CHSI Annual Physical ExamCHSI Annual Physical Exam

Tailor fitted according to client’s requirementDelivered through “best-in-class” service and equipment– Clinic Based (off-site) – Mobile (on-site)

Fast turn around in delivery of results and evaluation

Inside the Inside the Mobile VANMobile VAN

Mobile VAN FeaturesMobile VAN Features

Unit: 2007 Mitsubishi CANTER FE 639Color: Aspen White

• Complete with drawers, cabinets, faucet and sink, table tops and dark room, exhaust fan

• With built-in X-ray machine, dark room sections, and lead protected surround walls customized for radiation trapping

• With laboratory set-up for blood extraction and routine examination• Vertical clearance of 10 feet, width of 8 feet and length of 20 feet• Comes with a 65 meters cable wire for electrical connections at 60-70

amperes with an electrical output of 220 volts• With metal rod divider for room or sectional divisions for ground set-up• Complete set-up equipment on hand such as drapes and blankets,

pillows, mattresses, weighing scale and the like

Mobile TeamMobile Team

1 – Team Leader1 – Male MD1 - Female MD3 - Nurses3 - Medical Technologists2 - X-ray Technologists1 - Support/ Traffic Officer

PREPARATION OF THE– APE FORM PER EMPLOYEE– ROUTE SLIP PER EMPLOYEE

PRE APE PRE APE –– MASTERLIST SUBMISSIONMASTERLIST SUBMISSION

Other Test:Audiometry, DT,

Etc..

STEP 7:PAP SMEAR

STEP 6:ECG

STEP 5:Chest Xray

Inside Mobile Van

BP, Height, Weight,VISUAL

STEP 4:Physical Exam

System PEFamily History

STEP 3:VITAL SIGNS

STEP 2:LABORATORY

Blood ExtractionSpecimen Submission

APE FLOW/PROCEDURE APE FLOW/PROCEDURE STEP 1:

REGISTRATION

Issuance of:APE Form andRoute Slip

At every stage:Patient’s Route Slip hasto be signed by attending medical staff.

Patient has to submit slip and APE form upon completion of all tests.

APE DeliverablesAPE Deliverables

APE RESULTS PER EMPLOYEEAPE SUMMARY and PROFILING– Delivered within a minimum of 10 working days to

max of15 working days from completion of APE– Results summary, Statistical Information– Graphical Profiling– Findings and Recommendations– Suggested Wellness Programs

APE FORM (upper half)APE FORM (upper half)

APE FORM (lower half)APE FORM (lower half)

APE SUMMARYAPE SUMMARY

Mobile APEMobile APE

Mobile APEMobile APE

Mobile APEMobile APE

Service with a Service with a SMILESMILE

Mobile APEMobile APE

Total number of Examinees per Masterlist 120Total number of Examined during APE 114Compliance Percentage 95%

EMPLOYESS WHO AVAILED OF APE 114EMPLOYEES WHO DID NOT AVAIL OF APE 6

114, 95%

6, 5%

EMPLOYESS WHO AVAILED OF APEEMPLOYEES WHO DID NOT AVAIL OF APE

COMPLIANCE

During the CHSIOn-site MobileANNUAL PHYSICALEXAMINATION

Gender Breakdown NUMBER % Male 106 92.98% Female 8 7.02%TOTAL 114 100.00%

Male, 106, 93%

Female, 8, 7%

EXAMINEESAGE GROUP TOTAL %

BELOW 25 34 47.76%BET 25 - 35 51 26.53%BET 36- 45 27 22.86%46 AND ABOVE 2 2.86%NO AGE DATA 0.00%

TOTAL 114 100.00%

AGE TOTALBEL 34BET 51BET 2746 A 2NO AGE DATA

34

51

27

20

10

20

30

40

50

60

BELOW 25 BET 25 - 35 BET 36- 45 46 AND ABOVE NO AGE DATA

TOTAL

Complete Blood Count (CBC)FINDINGS MOST COMMON DIAGNOSIS RECOMMENDATIONS

LOW HEMATOCRIT and/or LOW HEMOGLOBIN

Anemia Clinical Correlation, Iron rich food and/ or supplement

LEUKOCYTOSIS –Elevated White Blood Cell (WBC) Count

Bacterial Infection Clinical correlation and treatment with antibiotics if indicated

LEUKOPENIA – Decreased White Blood Cell (WBC) Count

Viral Infection, Leukemia, Auto-Immune Diseases

Clinical correlation, further evaluation

THROMBOCYTOSIS – Elevated Platelet Count

Chronic Leukemia, Polycythemia, Infection, Trauma, Strenuous Exercise

Clinical correlation, further evaluation

THROMBOCYTOPENIA – Decreased Platelet Count

Viral Infection (Dengue H-Fever), Blood Dyscrasias, Carcinomas

Further work-up

NEUTROPENIA- low neutrophils/ segmenters in the diff. countNEUTROPHILIA – high neutrophils/ segmenters

Viral infection, Typhoid, Hepatitis, Tuberculosis, Blood DisordersBacterial Infection, Inflammation

Clinical correlation, further evaluationClinical correlation, antibiotic treatment if indicated

EOSINOPHILIA – high level of eosinophils

Allergy, Asthma, Parasitism Treatment if indicatedCorrelate with Fecalysis

LYMPHOCYTOSIS – high level of LymphocytesLYMPHOCYTOPENIA – low level of lymphocytes

Chronic Infection, Typhoid, Lymphocytic Leukemia, Stress, Trauma, elderly

Clinical correlation and treatment

Correlation

COMPLETE BLOOD COUNT (CBC)

Total number of APE Examinees 114Total number of CBC Performed 112No Blood Specimen 2

TOTAL % NORMAL 108

Total CBC Performed 112 100% WITH FIND 4

Result BreakdownNormal 108 96%With Findings 4 4%

Some of the FindignsLOW HEMOGLOBIN 4LOW HEMATOCRIT 1

*combinat ion of findings also exist

CBC RESULT BREAKDOWNWITH

FINDINGS4

4%

NORMAL10896%

URINALYSIS (U/A)FINDINGS POSSIBLE DIAGNOSIS RECOMMNENDATIONS

PYURIA – indicates presence of pus cells

Urinary Tract Infection Increase oral fluid intake; Suggest repeat urinalysis

CRYSTALLURIA – presence of Uric Acid Crystals

Gout/ Gouty Arthritis, Urinary Tract Stones

Increase oral fluid intake, Blood Uric Acid determination

GLUCOSURIA – presence of Sugar Diabetes Mellitus For FBS determination; Check up with physician for further evaluation

HEMATURIA – presence of red blood cells

Urinary Tract Stones, Urinary Tract Infection

Increase Oral fluid intake; check up with physician for clinical correlation and treatment; suggest repeat urinalysis after 1 week

OXALURIA – presence of Calcium Oxalate

Recurrent Kidney Stones For diagnostic ultrasound if indicated after clinical correlation

URINALYSIS (U/A)

Total number of APE Examinees 114Total number of U/A Performed 109No Urine Specimen 5

TOTAL %Total U/A Performed 109 100%Result Breakdown

Normal 95 87%With Findings 14 13%

Some of the FindignsPYURIA - evaluate for possible infection 8HEMATURIA - evaluate further for presence of blood 3GLUCOSURIA - evaluate further for presence of sugar 1PROTEINURIA - evaluate further for presence of protein 4 NORMAL 95

WITH FIND 14

*combinat ion of findings also exist

U/A RESULT BREAKDOWN

WITH FINDINGS

1413%

NORMAL95

87%

FECALYSIS (F/A))

FINDINGS POSSIBLE DIAGNOSIS RECOMMNENDATIONS

Presence of Red Blood Cells Amoebiasis, Hemorrhoids For correlation, further work-up and evaluation

Presence of ova or parasite (Ascaris, Trichiuris, Amoeba, Giardia Lamblia)

Ascariasis, Trichiuriasis, Amebiasis, Giardiasis

Check-up with physician for proper treatment; Proper hygiene and hand-washing; Repeat stool exam after treatment.

FECALYSIS (F/A)

Total number of APE Examinees 114Total number of F/A Performed 98No Stool Specimen 16

TOTAL %Total F/A Performed 98 100%Result Breakdown

Normal 94 96%With Findings 4 4%

Some of the Findigns GIARDIASIS 4

NORMAL 94*combinat ion of findings also exist WITH FIND 4

F/A RESULT BREAKDOWN

NORMAL94

96%

WITH FINDINGS

44%

CHEST XRAY (CXR)

FINDINGS POSSIBLE DIAGNOSIS RECOMMNENDATIONS

INFILTRATES Pneumonia For pulmonologist evaluation and treatment

DENSITIES Pulmonary Tuberculosis For pulmonologist evaluation and treatment.

CARDIOMEGALLY Hypertension, Cardiomyopathy For Cardiologist evaluation, further work up and treatment.

NODES Lung Cancer For evaluation and further work-up by pulmonary specialist.

OPACITIES Pulmonary Tuberculosis For Apicolordotic ViewFor pulmonologist evaluation and treatment

CHEST X-RAY (CXR)

Total number of APE Examinees 114Total number of CXR Performed 112No CXR 2For RECALL 1

TOTAL %Total CXR Performed 111 100%Result Breakdown

Normal 108 97%With Findings 3 3%

Some of the FindignsCARDIOMEGALY 2GRANULOMA RELATED 1

NORMAL 108WITH FIND 3

*combinat ion of findings also exist

X-RAY RESULT

WITH FINDINGS

33%

NORMAL10897%

BLOOD PRESSURE (BP)

Total number of APE Examinees 114Total number of BP Performed 113No BP Data 1

TOTAL %Total BP Performed 113 100%Result BreakdownNormal 93 82%With Fin (Elev BP/HPN) 20 18%

TOTALNORMAL 93WITH FIND 20

93

20

0

20

40

60

80

100

120

TOTAL

WITH FINDINGS

NORMAL

ELECTROCARDIOGRAM (ECG)

The electrocardiogram or ECG (sometimes called EKG) is today used worldwide as a relatively simple way of diagnosing heart conditions. An electrocardiogram is a recording of the small electric waves being generated during heart activity.By detecting irregularities in rate and rhythm and abnormalities in the ECG tracing, the clinician will have a strong basis for confirming his diagnosis of a specific heart ailment or combination of heart problems thereby leading to early and accurate treatment and timely prevention of complications including sudden heart attack.Common heart problems easily detected by ECG include enlargement in heart size (hypertrophy), irregularities in rate and rhythm (arrythmias), insufficiency in coronary blood flow due to blocks or obstruction in the vessels (coronary artery disease), myocardial ischemia (insufficient oxygenation of heart muscles predisposing to heart attack) and myocardial infarction (acute heart attack).Correlating the ECG with the clinical manifestations of the patient leads to a more precise diagnosis of heart diseases.

ELECTROCARDIOGRAM (ECG)

NON SIGNIFICANT FINDINGS SIGNIFICANT FINDING

Tachycardia and Bradycardia Premature Atrial Contraction

Poor R-wave Progression Premature Ventricular Contraction

Early Repolarization Pattern Right or Left Atrial Hyperthrophy

Left or Right Axis Deviation (LAD or RAD) Right or Left Ventricular Hyperthrophy

non-specific ST-T wave changes Left of Right Atrila Hemiblock

non-specific T wave changes Left of Right Ventricular Hemiblock

non-specific ST wave changes Atrial Fibrillation

Intraventricular Conduction Delay Myocardial Ischema

Complete or Incomplete Bundle Bunch Block Myocardia Infarction

For Clinical Correlation For Clinical Correlation, For Cardio ReferralRequires further evaluation and examination

ECG (Electrocardiogram)

Total number of ECG Examinees 106

Result BreakdownNormal 66 62%With Abnormal F 40 38%

TOTAL 106 100%

Some Findings

NORMAL SINUS RHYTM (NSR), POOR R WAVE PROGRESSION V1-V3 Normal 66NON SPECIFIC ST-T-WAVE CHANGES (NSSTTWC) Abnormal F 40NSR, INCOMPLETE RIGHT BUNDLE BRANCH BLOCK (IRBBB)SINUS TACHYCARDIA, LAE, OCCASIONAL PVC'SNSR, COMPLETE RIGHT BUNDLE BRANCH BLOCK (CRBBB)SINUS BRADYCARDIANSR, EARLY REPOLARIZATION PATTERNNSR, LAHBSINUS TACHYCARDIANSR, LEFT VENTRICULAR HYPERTROPHY BY VOLTAGENSR, WITH OCCASIONAL PREMATURE VENTRICULAR CONTRACTIONSNSR, LAA

ECG RESULT BREAKDOWN

Abnormal Findings

38%

Normal62%

PAP SMEARThe Pap Smear is a test used to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is to find abnormal cell changes that may arise from cervical cancer or before cancer develops

A Pap Smear is an important part of a woman’s routine health care because it can detect abnormalities that may lead to invasive cancer of the cervix. These abnormalities can be treated before cancer develops. Most invasive cancers of the cervix can be prevented if women have Pap Smears regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early

Most laboratories use a standard set of terms called the Bethesda System to report test results. Under the Bethesda System, Pap test samples that have no cell abnormalities are reported as “negative for intraepithelial lesion or malignancy.”Samples with cell abnormalities are divided into several categories and should be consulted with your personal physician for interpretation and advice

PAP SMEAR

Total number of Examinees 4

Result BreakdownNormal 2 40%With Abnormal F 3 60%

TOTAL 5 100%

Some Findings

MILD TO MODERATE INFLAMMATION Normal 2SEVERE INFLAMMATION Abnormal F 3BACTERIAL VAGINOSIS

Normal40%

Abnormal Findings

60%

Body Mass Index Result Summary

Number of Employees w/ BMI data 113

Results: Total % RecommendationsUnderweight below 18.5 kg/m2 6 5% Increase Caloric DietNormal 18.5-24.9.0 kg/m2 60 53%Overweight 25.0-29.9 kg/m2 40 35% Low Fat and Caloric Diet, ExerciseMild Obese 30.0-34.9 kg/m2 6 5% Low Fat and Caloric Diet, ExerciseModerate Obese 35.0-39.9 kg/m2 0 0% Low Fat and Caloric Diet, Regular ExerciseMorbidly Obese above 40.0 kg/m2 1 1% Low Fat and Caloric Diet, Reg. Exercise, Weight Management

Total 113 100%

Underweight 6Normal 60Overweight 40Mild Obese 6Moderate Obese 0Morbidly Obese 1

BMI Result

Underweight5%

Morbidly Obese1%

Moderate Obese0%

Mild Obese5%

Normal54%

Overweight35%

MOST COMMON FINDINGS CORRESPONDING RECOMMEDATIONS

WITH DENTAL FINDINGS 66 58% DENTAL REFERRALHYPERCHOLESTEROLEMIA 29 56% LOW FAT DIET, BLOOD CHEM MONITORINGHYPERTRIGLYCERIDEMIA 26 50% LOW FAT DIET, BLOOD CHEM MONITORINGWEIGHT ABNORMALITIES 47 42% DIET MODIFICATION, REGULAR EXERCISE

ECG FINDINGS 40 38% ECG FOR CLINICAL CORRELATION ( CARDIO REFERRAL FOR SIGNIFICANT FINDINGS

ELEVATED URIC ACID OR HYPERURICEMIA 16 31% LOW PURINE DIET, REPEAT BUA AFTER 6 MONTHS

ELEVATED BP/HPN 20 18% FOR BP MONITORING, LOW SALT DIET, (CARDIO REFERRAL FOR HYPERTENSIVE)

AUDIO FINDINGS 17 15% ENT REFERRAL

ELEVATED FBS OR HYPERGLYCEMIA 4 8% LOW SUGAR DIET, ENDO REF, (DM DIET FOR DIABETIC PATIENTS

PRESENCE OF PUS IN URINE 8 7% INCREASE ORAL FLUID INTAKE, REPEAT URINALYSISPRESENCE OF PROTEIN IN URINE 4 4% INCREASE ORAL FLUID INTAKE, REPEAT URINALYSISLOW HEMOGLOBIN/LOW HEMATOCRIT 4 4% IRON RICH FOOD DIET, DAILY IRON SUPPLEMENTPRESENCE OF BLOOD IN URINE 3 3% INCREASE ORAL FLUID INTAKE, REPEAT URINALYSISXRAY FINDINGS 3 3% FOR CLINICAL CORRELATIONERROR OF REFRACTION 2 2% OPHTHA REFERRALPRESENCE OF SUGAR IN URINE 1 1% INCREASE ORAL FLUID INTAKE, REPEAT URINALYSIS

PAP SMEAR FINDINGS 60% OB GYNE Referral

GENERAL RECOMMENDATIONS

RECOMMENDED ACTIONS:– Disseminate APE Results per employee and those with FINDINGS be asked to report

to clinic or consult physician for fup checkup, corrective actions, health counsellingRECOMMENDED PROGRAMS

– Implement WEIGHT MANAGEMENT awareness programs focused on behavioural modification towards regular exercise, healthy diet and lifestyle

– Implement HYPERTENSION PREVENTION Programs through regular BloodPressure check ups and monitoring

HEART CARE PROGRAMS– Implement Heart Care Programs that creates awareness on various risk factors

related to heart disease

Thank You!