The Medical Board's Arithmetic
A candidate, 19 years old, presents for the entrance medical screening in Huambo. Resting measurements taken twice, five minutes apart, are: blood pressure 138/88 mmHg and 136/86 mmHg; pulse 88 and 84 bpm; body mass 71 kg; height 1.74 m. Vision without correction: right eye 0.6, left eye 0.5; with correction both reach 1.0. He reports no chronic illness, but mentions that his father was treated for hypertension at age 52 and that he felt dizzy twice during the physical test that morning. The board must classify him as fit, fit with restriction, or temporarily unfit, and must decide whether the dizziness is relevant to the decision.
1. Compute his body mass index and state, with reasoning, whether it is a disqualifying finding.
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BMI = mass / height² = 71 / (1.74 × 1.74) = 71 / 3.0276 ≈ 23.4 kg/m².
This falls in the normal range (roughly 18.5–24.9). BMI alone is therefore not disqualifying and does not by itself justify restriction. Note that BMI says nothing about body composition or fitness; the board should record it as a baseline datum, not as a verdict.
2. Interpret the blood-pressure readings and explain why two measurements five minutes apart are better than one.
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Both readings (138/88 and 136/86) sit in the high-normal / elevated zone rather than clearly hypertensive territory; the systolic values are close to the usual 140 threshold but do not cross it on either occasion.
Two readings matter because a single measurement is noisy: anxiety about the exam, recent exertion, caffeine, and the measurement technique can each raise pressure by several points. Agreement between the two readings (within a few mmHg) suggests a genuine resting value rather than an artefact. The correct board action is not to disqualify but to note the finding, repeat the measurement on a separate calm occasion, and record it for follow-up.
3. The candidate reports two dizzy spells during the morning's physical test. How should the board weigh this against an otherwise normal examination?
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Dizziness during exertion is a symptom requiring explanation, not a diagnosis. It can arise from benign causes (heat, dehydration, fasting before the exam, sudden effort in an untrained candidate) or from causes that matter for military service (cardiac rhythm disturbance, anaemia, hypoglycaemia).
A defensible judgement: do not declare permanent unfitness on the basis of two episodes with no other findings, but do not simply ignore them either. The proportionate decision is fit with restriction / temporarily deferred pending a basic work-up (repeat examination, blood count, and observation during a supervised effort test). The reasoning principle the exam is testing is that an unexplained symptom outranks a normal-looking set of numbers.