Clinical Cases and Images asked for it, and now you have it. Following up my analysis of Dick Cheney's physical, here's my take on President Bush's recent physical:

President Bush was pronounced "fit for duty" after an annual checkup Saturday that showed that the 59-year-old commander in chief, an avid mountain bike rider, has lost 8 pounds since his last physical exam in December.

How often should a 59-year old have a physical? There is very little data supporting a physical exam. However, 90% of physicians perform them anyways. I typically perform annual preventive exams every year after the age of 50.

On Saturday, the scale showed the nearly 6-foot Bush at 191.6 pounds.

This calculates to a BMI (body mass index) of 26. A body mass index between 25 and 29.9 is classified as "overweight".

Doctors prodded and probed the president for a little more than three hours, checking his heart, lungs, eyes, muscles and skin.

That seems like a long time to me. My typical physicals are scheduled in a 30-minute block.

Doctors used liquid nitrogen to freeze a noncancerous skin growth on his neck. The medical summary indicated the president has skin lesions consistent with sun damage and recommended that he use sun screen and wear a hat.

My guess would be an actinic keratosis. Cryotherapy is typically used to treat this.

Bush's overall cholesterol count remains at a healthy level, despite a slight rise to 178 from 170 seven months ago. There was a small drop in his high-density lipoprotein (HDL) count, or "good" cholesterol, and a small rise in his low-density lipoprotein (LDL) or "bad" cholesterol. Still, both levels were within healthy ranges.

A total cholesterol less than 200 is normal. An HDL above 40 and an LDL below 130 is desirable in his category.

Doctors said cholesterol-lowering drugs were not necessary. The president was advised to continue healthy eating and exercise habits.

If his LDL was above 160, medications would then be considered.

His resting pulse rate dropped to 47 beats per minute from 52. Well-trained athletes typically have resting pulse rate of between 40 and 60 beats per minute.

Doctors made Bush run on a treadmill for more than 26 minutes as part of a test that evaluates the performance of his heart. His heart beat reached 183 beats per minute; no signs or symptoms of cardiovascular problems were noted.

This sounds like an exercise stress test. The USPSTF does not recommend routine cardiac stress testing in asymptomatic patients.

A prostate screening test registered at 0.5. A desirable level is anything under 4.

Discussion of the PSA test for prostate cancer screening should be done yearly. There are recent questions about the efficacy of this test.

Bush suffers from occasional reflux of stomach acid after drinking coffee or eating peppermint, two items that doctors recommended he reduce or eliminate from his diet.

These dietary changes should help. Chronic, untreated GERD can lead to what's known as Barrett's esophagus - which is risk factor for esophageal cancer.

He smokes a cigar now and then, takes a daily multivitamin, low-dose aspirin, Omega 3 fatty acids linked to lower heart disease and glucosamine/chondroitin to ease stiffness in his joints.

Smoking cigars increases the risk of mortality: An American Cancer Society study of 121,278 men greater than or equal to 30 years of age found that current cigar smokers less than or equal to 75 years of age had an increased risk of death from coronary heart disease (adjusted rate ratio 1.3).

Regarding aspirin use, the USPSTF concluded that "the balance of benefits and harms is most favorable in patients at high risk of CHD (5-year risk of greater than or equal to 3 percent) but is also influenced by patient preferences." Thus, if Mr. Bush's Framingham Heart Score estimates a greater 5-year risk than 3 percent, then low dose aspirin is warranted.

There are small studies suggesting mild improvement of glucosamine/chondroitin in the treatment of osteoarthritis.

What else did he have done? I would assume that a screen for colon cancer was discussed, asking about depression, a blood sugar test screening for diabetes, and ensuring his tetanus shot is up to date (a booster is recommended every 10 years).

Presiding over the medical exam were White House physician Richard Tubb and Dr. Kenneth Cooper, the president of the Cooper Aerobics Center in Dallas. Seven other doctors included a radiologist, two skin specialists and a sports physician.

That's certainly more thorough than anything I can accomplish.