Handbook for Medical Examiners - Immigration New Zealand

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D10 cardiovascular system Assessment includes: • cyanosis, pallor, peripheral temperature and oedema • size and consistency of thyroid gland, including any masses • pulse rate and rhythm • blood pressure • jugular venous pressure • palpation for thrills and character of apex beat • auscultation of heart sounds, extra sounds and murmurs • peripheral vascular system: carotid, radial, femoral, posterior tibial and dorsalis pedis, and • carotid and femoral bruits, and • ECG if any abnormalities found on history or examination. All abnormalities must be noted on the medical certificate. Blood pressure must be measured in all applicants over 15 years using an appropriate cuff size. If the blood pressure is elevated, repeat after the patient has rested for five minutes and, if necessary, again after 10 minutes. Applicants with heart murmurs or evidence of heart valve disease or cardiomegaly require an echocardiogram. Referral to an appropriate physician is necessary for: • five-year cardiovascular disease (fatal and non-fatal) risk level over 20 per cent using New Zealand cardiovascular risk charts www.nzssd.org.nz/cvd • previous cardiovascular event such as angina, myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, severe peripheral vascular disease, diabetes with nephropathy (albumin: creatinine ratio >30mg/mmol or urinary albumin >200mg/L) • persistent uncontrolled hypertension • cardiomyopathy • aortic aneurysm • unstable, progressive, symptomatic or complicated conditions, or • any condition likely to significantly affect the applicant’s ability to function at home, study or work or perform activities of daily living. A recent report less than six months old is acceptable. All reports must be attached to the medical certificate. D11 Respiratory system Assessment includes: • respiratory rate • any respiratory distress, cyanosis and accessory muscle use • position of trachea • cervical lymphadenopathy • chest shape and expansion • percussion of the chest • auscultation of breath sounds • finger clubbing • peak expiratory flow rate, and • good quality spirometry if possible. All abnormalities must be noted on the medical certificate. For applicants with 20 pack year or more smoking history, note the peak expiratory flow rate on the application form. If possible, also arrange spirometry and attach results to the application form. 20 – Handbook for Medical Examiners - September 2012
Tuberculosis must be considered in any applicant who: • is from a country with a high risk of tuberculosis • has a history of cough persisting longer than three weeks, night sweats, haemoptysis, chest pain, unexplained weight loss, HIV, close contacts with TB, abnormal chest X-ray, abnormal sputum, skin or blood tests, etc, or • has abnormalities on auscultation. If tuberculosis is suspected then three sputum samples must be obtained, preferably early morning. • These samples should be sent as soon as possible prior to the specialist visit. • The sputum samples must be collected at least 24 hours apart. • The sputum samples must be collected at the clinic. • The sputum samples must be promptly transported to the laboratory by appropriate transport (not the applicant). • Specimens must be cultured for at least six weeks with a final report at eight weeks. • Drug sensitivity testing must be performed on all positive cultures. All reports must be attached to the medical certificate. Referral to an appropriate physician is necessary for: • tuberculosis, suspected or confirmed • severe and/or progressive restrictive (including interstitial) lung disease: – progressive exertional dyspnoea, dry or productive cough lasting longer than three weeks, chest pain, haemoptysis, decreased exercise tolerance, recurrent chest infections, severe fatigue, or – spirometry is suggestive: FEV1/FVC ratio is normal or high and FVC is reduced for height, weight and ethnicity • severe and/or progressive obstructive lung disease: – history of breathlessness, wheeze, night-time cough, personal or household smoking, use of inhalers, nebulisers or oral medications, time off work or school, limitation of physical activities, hospital admissions – severe chest deformity – clubbing, cyanosis, respiratory distress, or – 40 per cent or less of predicted FEV1 • use of domiciliary oxygen • cystic fibrosis: a hereditary disease of the exocrine glands, usually developing during early childhood and affecting mainly the pancreas, respiratory system, and sweat glands. It is characterised by the production of abnormally viscous mucus by the affected glands, usually resulting in chronic respiratory infections and impaired pancreatic function. It is also called mucoviscidosis • unstable, progressive, symptomatic or complicated conditions, or • any condition likely to significantly affect the applicant’s ability to function at home, study or work or perform activities of daily living. A recent report less than three months old is acceptable. All reports must be attached to the medical certificate. D12 ear, nose and throat Assessment includes: • external ear, auditory canal, ear drums, general hearing • nasal obstruction and discharge • oral cavity, tongue and pharynx • teeth and gingiva, and • any masses, leukoplakia and other abnormalities. All abnormalities must be noted on the medical certificate. Handbook for Medical Examiners - September 2012 – 21
Page 1 and 2: Information about this guide This g
Page 3 and 4: TaBle of conTenTs Information about
Page 5 and 6: Privacy Act 38 Data matching 39 Rev
Page 7 and 8: • remaining accountable for any p
Page 9 and 10: Immigration decision The medical ex
Page 11 and 12: supporting identification INZ consi
Page 13 and 14: Where an applicant has been advised
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Page 17 and 18: B11 cancer, malignancy or organ tra
Page 19: Timely medical tests All other medi
Page 23 and 24: • gait • Romberg’s test, and
Page 25 and 26: D19 Musculoskeletal system Assessme
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Page 31 and 32: completing section f Medical examin
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Handbook for Medical Examiners - Immigration New Zealand

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