Gastrointestinal: Normal. Colonoscopy was last performed in June 2002. Surveillance colonoscopy is not indicated until 2007.
Cardiology: Physical examination of the circulatory system was normal. The resting EKG revealed sinus bradycardia consistent with previous exams and aerobic conditioning. Fasting Lipid panel: total cholesterol: 170 (last year 167, "desirable"<200); HDL: 57 (last year 45, goal >40); LDL: 97 (last year 112, "optimal"<100, "desirable"/"near optimal"<130); total cholesterol/HDL ratio 3.0 (last year 3.7, "optimal" < 4.5); Triglycerides: 48 (<150). C-reactive protein analysis was 0.2170 placing him in the "lowest risk category" (0.000-0.744). Homocysteine was 9.9 placing in the "optimal"/"lowest risk" category (5.4-11.9). Ultra-fast computed tomography of the coronary arteries yielded a coronary calcification score of 24 corresponding to a "minimal"/mild plaque burden" (range for "mild plaque burden" is 11-100). The President underwent Balke protocol exercise treadmill testing (ETT) with echocardiogram. He exercised for a total of 23:20 minutes achieving a maximum heart rate of 182. No signs or symptoms of cardiovascular pathology were noted. Stress echocardiogram was normal.
Dermatology: A small pigmented lesion on left shoulder clinically consistent with an inflamed benign seborrheic keratosis was removed. (Pathology results will be available within the next week). * *Facial actinic keratoses were also noted.
Musculoskeletal: General musculoskeletal exam was unremarkable. Examination of the lower extremities revealed full range of motion and full motor strength without knee effusions or instability. Examination of the previous "calf" injury is unremarkable.
Genitourinary System: Exam was within normal limits without evidence of prostate nodularity or hypertrophy. PSA was 0.71 (last year 0.77; normal < 4.0).
A standard battery of routine screening laboratory tests was performed and was unremarkable. Tuberculosis skin test was negative (no evidence of exposure).
The President remains in excellent health and "fit for duty". All data suggest that he will remain so for the duration of his Presidency. Based on an overview of his examination and history the following clinical diagnoses are made:
1. The President remains in the "superior" fitness category for men his age. (top fifth percentile for 55-59 year-old men, Cooper data).
"Low" to "very low" coronary artery disease risk profile. Evidence of minimal/mild coronary artery calcification noted on anatomic study (coronary artery computed tomography). Coronary artery disease (CAD) "activity-marker" evaluation (including C-reactive protein, homocysteine, and lipids), and "functional" studies (exercise treadmill test) stratify the President to a "low" coronary risk category. A daily aspirin and "statin" are recommended.
Sinus bradycardia, asymptomatic, non-pathologic, consistent with a conditioned heart.
History of vasovagal syncope without pathology, sequelae, or recurrence.