Continued Protocol 1974 Page Three Examinations The people to be examined will usually be brought into the cxamination area by automobile. Various Marshallese personnel will assist with inter- Bill Scott will handle the pretation and routing for the examinations. administration and routeing of the people for the various cxaminations. Each person will be given a routeing sheet which will designate the various types of examinations to be done. Routing Exams: Copies of the previous examinations and/or a sunmiary of gach case will be available. ‘The history and physical exam forms have been revised and copies of the revised forms are attached. The history will be taken by a member of the Trust Territory Medical Personnel yet to be designated, The examining physicians should refer to the history and enlarge upon it through the interpreter as indicated. The physicians carrying out the exams other than the diabetic and genetic surveys are: Drs. Wolff, Larsen, Knudsen and Riklon. Dr. Riklon will interpret as necessary, A complete physical exam will be carried out including CAG and oscillometric examinations on certain cases. Routine laboratory work will includes; complete blood study (WBC, differential slides, RBC, platelets, hemoglobin, hematocrit, plasma collection for blood chemistry), urinalyses and microscopic as indicated, chest x rays and other x rays as indicated. Cancers Carcful examination for possible malignancy will include pelvic exam with Pap smears, rectal exams in all people over 40 years of age, skin exams, particularly of residual beta burn scars with color photography as indicated, sputum exams if indicated, x rays as indicated. Leukemia: The hemogram will be carefully evaluated and differential smears scrutinized, Bone marrow exam will be carried out if indicated. Blood smears for alkaline phosphatase will be returned for analysis by Dr. Moloney of Boston, Thyroid: Previous drawings of thyroids with questionable or positive findings will be available. From the history careful assessment of thyroid medication adherence should be evaluated, This is of paramount importance in the operated cases who are nearly all hypothyroid without Synthroid treatment. For the thyroid reserve study (see below) all of the exposed people in that group should be checked to be sure that they have been off Synthroid treatment for the previous 2 months. Thyroid exam should include a sketch of the gland on the neck drawing on the back of the physical exam form in those cases where there are positive or questionable findings. Plasma samples will be obtained routinely for T-4, T-3 and TSH on all exposed and possibly some control people, Thyroid Reserve Study: There are 41, Rongelap people now living who have not developed any significant thyroid abnormalities. advantazc . It would be of “now what the thyroid reserve status is in this group since it is dirricuit to maintain a strict treatment regimen and this information JUES8ET