Physical Exam
The physical exam is
conducted by the treating occupational health
physician and designed to provide an assessment
of your health as it relates to your specific
occupation. The evaluation consists of a
thorough physical exam, as well as a discussion
about your medical history with the physician.
The doctor will inquire further on any positive
responses on your medical history questionnaire
to help determine your physical ability to work.
However, the exam will not cover personal health
issues, which should be referred to your
personal physician.
Blood Pressure
Your blood pressure
test results consists of two numbers. The top
number (or first number) is the systolic blood
pressures and is the tightening of the heart,
which drives the blood into the main artery of
the heart and the lung arteries.
The bottom number (or
second number) is the diastolic blood pressures
and is the period of time between contractions
of the heart. During this time blood enters the
relaxed chambers of the heart to be pumped
throughout the body. The diastolic pressure will
vary with age, sex, weight and emotional state.
A BP Measurement below
<140/90 is considered Normal
A BP Measurement
between 140/90 - 160/105 is Borderline
A BP Measurement above
>160/105 is considered Abnormal
More than one
measurement is needed before an accurate
diagnosis can be made.
If you fall into the
borderline or abnormal area, you should consult
your personal physician. If you are presently on
medication for an existing high blood pressure
problem, then you should remember to take your
medication as it is prescribed.
Chest X-ray
A chest X-ray is used
for screening and diagnostic purposes, providing
images of the chest, lungs, heart, large
arteries, ribs, and the diaphragm.
A serial chest X-ray
(repeated or sequential) may be used to evaluate
changes over time of an abnormality found on a
chest X-ray (for example, an increase in the
size of an abnormality over a period of weeks).
A test is performed at
the health care provider's office by an X-ray
technician. Two views are usually taken: one in
which the X-rays pass through the chest from the
back (posterior-anterior view) and one in which
the X-rays pass through the chest from one side
to the other (lateral view). You stand in front
of the machine and must hold your breath when
the X-ray is taken.
Chest Radiography
Radiographs are
essential in the evaluation of occupational lung
disorders and are sensitive enough procedure to
help identify many lung diseases before evidence
of functional impairment is apparent. The films
should be read in accordance with the
classification established by the International
Labor Organization (ILO) and the World Health
Organization (WHO). Although certified or
qualified radiologists may interpret chest
X-rays. if a pneumoconiosis is suspected,
radiologists certified as B-readers should
preferably read the films. B-readers receive
special training in evaluating the size, nature
and extent of radiographic opacities and pleural
shadows.
Pulmonary Function Test (PFT)
Pulmonary function
testing (PFT), or lung function testing, is a
method of determining how well your lungs and
airways are working. The most common PFT is
called spirometry. This test requires you take
in as deep a breath as possible, and blow out
all of the air as fast and as hard as you can.
Several blows are needed to assure that your
best performance has been measured.
This breathing test
measures a number of parameters. The result is
compared to a level we predict you should have
based on your age, sex, race and height. These
have been published by researchers. Usually, any
value of 80% of predicted is considered normal.
Definition of PFT
Results:
Forced Vital
Capacity (FVC)- Total volume of air that can
be expelled by forceful effort after maximum
inspiration. A low number on this parameter
could be an indicator of restrictive disease.
Forced Expiratory
Volume in One Second (FEV1)- Volume of air
exhaled in one second. A low number on this
parameter could be an indicator of an
obstructive disease.
Ratio of FEV1 to
FVC (FEV1/FVC)- A low number on this
parameter could be an indicator of obstructive
disease.
Audiometric Test
This testing is part
of a hearing conservation program, which is
designed to protect workers with significant
occupational noise exposure from suffering
material hearing impairment. A common
misperception about the hearing test is that it
should be performed in a sound proof booth.
According to OSHA, a soundproof booth is not
required. Rather, rooms used for audiometric
testing shall not have background sound pressure
levels exceeding those specified in OSHA's
occupational noise standard.
Vision Test
Vision tests check
many different functions of the eye. A complete
evaluation of your eyesight involves tests that
measure the ability to see details at near and
far distances (visual acuity), check for gaps or
defects in the field of vision, and evaluate the
ability to see different colors.
Visual Acuity Tests
Visual acuity tests
are the most common tests used to evaluate
eyesight. They measure the eye's ability to see
details at near and far distances. The tests
usually involve reading letter or looking at
symbols of different sizes on an eye chart.
Usually, each eye is tested individually and
then both eyes are tested together with and
without corrective lenses (if you wear them).
Snellen test-
The snellen test is a wall chart consisting of
several lines of letters. The letters on the top
line are the largest; those on the bottom line
are the smallest. To test your ability to see at
far distances, you will stand 20ft.(6m) from the
chart. You will be asked to cover one eye with
your hand or with a handheld cover (occluder)
and then read the smallest line of letters you
can see on the chart. If you are unable to cover
your eye, an eye patch will be placed over the
eye.
When you have
completed the test with one eye, you will cover
your other eye and repeat the process. You may
be asked to read a different chart or to read
the lines backward to make sure that you did not
remember the sequence of letters from the
previous test.
Laboratory Test Results
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The
following information is used to help
client employees understand their
laboratory test results. If you have
additional questions that are not
addressed in this document, please
contact your personal physician or call
WorkCare at (800) 455-6155.
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Complete Blood Count (CBC)
This is
usually called CBC with differential
(different types of white blood cells
present on microscopic examination).
This is a very common test that is done
to find out if a person is anemic, has
an infection, or may have a tendency to
bleed.
The main
components of this test are:
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1.
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White
Blood cells (WBC)
These
are cells that usually fight infection.
Each laboratory has a normal range from
4,000 to 10,000. If this count is
elevated it may indicate presence of
infection or steroid treatment, in
addition to many other causes. If the
count is low, it is usually from
medications, infections, autoimmune
diseases, or blood diseases among other
causes.
The white
blood cells are usually divided in
several types, which are called
differential. They all have a normal
range for each type. Minor variations in
these subgroups are not unusual and are
not cause for alarm.
The
different types of white blood cells
are:
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- Neutrophils
These cells are usually elevated
with bacterial infection. On the
opposite end of the spectrum, very
low numbers may be associated with
an increased risk of infection.
- Lymphocytes
These cells are usually elevated in
viral infections. Low numbers of
lymphocytes may be seen in different
diseases such as hepatitis,
lymphoma, or AIDS.
- Eosinophils
These cells are usually are elevated
with allergies or infections with
parasites.
- Monocytes
These cells are elevated in blood
diseases, certain infections or
auto-immune diseases.
- Basophils
These
cells are usually elevated in blood
diseases.
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2.
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Hemoglobin
(Hgb) and Hematocrit (Hct)
These tests
usually indicate the presence of anemia
when they are below normal range. Their
elevation usually occurs in smokers and
a blood disease called polycythemia.
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3.
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Mean
Corpuscular Volume (MCV)
This test is usually used to determine
what type of anemia a person may have.
If elevated, it may indicate anemia from
vitamin deficiency such as Vitamin B12
or folic acid. If it is below normal, it
usually indicates anemia from iron
deficiency.
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4.
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Platelet
Count
Platelets are the smallest of the blood
cells involved in clotting. The platelet
count can be abnormal in many
conditions. The most common disorder is
a lowering of the platelet count (purpura)
due to medication interactions or
antibody formation. In some individuals
with liver disease, the spleen becomes
enlarged as blood flow through the liver
is impeded. This tends to store more
platelets thereby reducing the number in
circulation.
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Chemistry Panel
This test is
usually called Chem followed by a number
(Chem-7, Chem-16, Chem-25), depending on
how many tests are ordered. It is a very
common test that is used to find out if
a person may have diabetes, kidney
problems, problems with electrolytes
such as potassium, liver problems, and
elevation of cholesterol or
triglycerides. Additional testing for
larger panels may include blood
proteins, calcium, phosphorus, serum
iron, and muscle enzymes. The number of
tests included in the panel for each
laboratory is different.
The primary
components in a Chem test include:
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1.
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Glucose
(blood sugar)
This
is usually elevated with diabetes or
with medications such as steroids. It
may be low in patients who have problems
with their pancreas or liver.
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2.
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Blood
Urea Nitrogen (BUN)
This
test is elevated with kidney problems.
It may be low in patients with liver
disease, pregnancy and certain diets.
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3.
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Creatinine
This test is
usually elevated with kidney problems.
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4.
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Electrolytes
These
usually include:
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- Sodium
This test is usually elevated with
dehydration from different causes.
It may be low in patients who sweat
profusely or are on a water pill.
- Potassium
This test may increase with kidney
problems, potassium supplements, or
certain water pills. It may decrease
in patients with kidney problems,
vomiting or diarrhea.
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5.
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Liver
Function Tests
These
usually include:
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- Alanine
aminotranferase (ALT)
ALT is an enzyme produced in
hepatocytes. The level of ALT in the
blood is increased in conditions in
which hepatocytes are excessively
damaged or die. As cells are
damaged, ALT leaks out into the
bloodstream. All types of hepatitis
(viral, alcoholic,
medication-induced, etc.) can lead
to elevations in the serum ALT
activity.
- Aspartate
aminotransferase (AST)
AST is an enzyme, similar to ALT,
but less specific for liver disease.
It is produced in muscle and can be
elevated in other conditions. In
many cases of liver inflammation,
the ALT and AST activities are
elevated roughly in a l:l ratio.
- Alkaline
phosphatase
Alkaline phosphatase is a family of
related enzymes, produced in the
bile ducts, intestine, kidney,
placenta and bone. An elevation in
the level of serum alkaline
phosphatase, especially in the
setting of normal or only modestly
elevated ALT and AST activities,
suggests disease of the bile ducts.
Alkaline phosphatase can also be
increased in some bone disorders. It
is also elevated in growing children
and early adulthood often up to age
22.
- Gamma-glutamyltranspeptidase
(GGT)
GGT is an enzyme produced in the
bile ducts and elevated in the serum
of patients with bile duct disease.
GGT may be elevated in virtually any
liver disease and even sometimes in
normal individuals. GGT is also
induced by many medications and
alcohol. Its serum activity may be
increased in heavy drinkers--even in
the absence of liver damage or
inflammation. There are some
families with higher levels because
of genetic make-up. It may also be
increased in conditions known as
fatty liver when the liver is
actively metabolizing high lipid
levels.
- Bilirubin
Bilirubin is the major breakdown
product that results from the
destruction of old red blood cells.
Bilirubin concentrations are
elevated in the blood either by
increased production, decreased
uptake by the liver, decreased
conjugation, decreased secretion
from the liver or blockage of the
bile ducts. Many different liver
diseases, as well as conditions
other than liver diseases can cause
the serum bilirubin concentration to
be elevated.
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6.
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Albumin
Albumin
is the major protein that circulates in
the bloodstream. It is synthesized by
the liver and secreted into the blood.
Low serum albumin concentrations could
indicate poor liver function,
malnutrition, some kidney disease and
other rare conditions.
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7.
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Uric
Acid
This
substance is a by-product of cell
metabolism, and can sometimes cause
gout.
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8.
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Lipid
Panel
This
blood test measures total cholesterol,
triglycerides and further breaks
cholesterol down into its components:
HDL and LDL. The clinician uses this to
help estimate heart disease and stroke
risk.
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Urinalysis
This test is
usually called a UA, which is used to
check for urinary tract infection and
presence of blood, sugar, or protein in
the urine.
Different
components of urinalysis are as follows:
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1.
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White
Blood Cells
Usually
indicate presence of possible infection
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2.
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Nitrites
A
positive test also may indicate
infection.
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3.
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Leukocyte
estrase
A positive
test may indicate infection.
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4.
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Ketones
Usually seen in
diabetes, fasting, dieting or starvation
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5.
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Glucose
This
usually shows up in the urine test when
blood sugar is over 180. This means
presence of possible diabetes.
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6.
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Red
Blood cells
This
may indicate bleeding in the urinary
tract, infection, or may be related to
menstruation. The cause should always be
determined especially in men.
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7.
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Protein
A
positive test may be seen with kidney
problems, diabetes, and bone cancer
among other causes.
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8.
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Urobilinogen
A
positive test may be seen in liver
disease, breakage of blood cells and
medication.
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