Components of a Complete Physical Examination for Healthy Adult Patients
A complete physical examination for healthy adult patients should include vital signs, a comprehensive head-to-toe assessment, and targeted screening based on age, sex, and risk factors.
Core Components
Vital Signs
- Blood pressure measurement 1
- Height and weight with BMI calculation 1
- Temperature
- Heart rate and respiratory rate
- Orthostatic blood pressure (when indicated) 1
General Appearance
Head and Neck Examination
- Fundoscopic examination (or referral to eye specialist) 1
- Thyroid palpation 1
- Oral cavity inspection 1
- Lymph node examination 1
- Carotid artery examination (auscultation for bruits) 1
Cardiovascular Examination
- Heart auscultation (rate, rhythm, murmurs)
- Peripheral pulse assessment 1
- Assessment for peripheral edema
- Evaluation for signs of peripheral vascular disease 1
Respiratory Examination
- Lung auscultation
- Respiratory effort assessment
- Chest percussion and inspection
Abdominal Examination
- Inspection for distention or asymmetry
- Auscultation for bowel sounds
- Palpation for organomegaly, masses, or tenderness
- Assessment for hernias
Neurological Examination
- Mental status and cognitive assessment 1
- Cranial nerve examination
- Motor strength assessment
- Sensory examination
- Deep tendon reflexes
- Coordination and balance testing
Skin Examination
- Inspection for lesions, rashes, or abnormalities
- Assessment for acanthosis nigricans 1
- Examination of nail beds
Musculoskeletal Examination
- Joint range of motion
- Spine examination
- Assessment for deformities
- Muscle strength testing
Extremity Examination
- Comprehensive foot examination including:
Sex-Specific Components
For Men
- Testicular examination
- Prostate examination (for appropriate age groups)
- Inguinal region examination 2
For Women
- Breast examination
- Pelvic examination as indicated
Age-Specific Considerations
For Adults 65 Years and Older
- Functional performance assessment 1
- Cognitive performance screening 1
- Fall risk assessment
- Hearing and vision screening
Risk-Based Components
- Targeted cardiovascular risk assessment for those with risk factors 1
- One-time abdominal aortic aneurysm screening for men 65-75 who have ever smoked 2
- Skin examination with particular attention to sun-exposed areas for those with risk factors
Important Caveats
Individualized Approach: While these components represent a comprehensive examination, the depth of each component should be guided by the patient's age, risk factors, and presenting concerns 3.
Evidence-Based Focus: Some components of the traditional "complete physical" have limited evidence supporting their routine use in asymptomatic adults 4, 5. Focus on elements with proven benefit for morbidity and mortality outcomes.
Documentation: Thorough documentation of all examination findings is essential, particularly noting any abnormalities that require follow-up or intervention 6.
Common Pitfalls:
- Rushing through components, particularly neurological and musculoskeletal examinations
- Omitting comprehensive foot examination, which can identify early signs of peripheral neuropathy or vascular disease 1
- Neglecting to assess for orthostatic hypotension in appropriate patients 1
- Incomplete skin examination, particularly in hard-to-see areas
Integration with History: The physical examination should be informed by a thorough history that includes medical, family, and social history components 1.
By systematically performing these components, clinicians can conduct a thorough physical examination that identifies potential health issues early and establishes a baseline for future comparison, ultimately improving patient outcomes through early detection and intervention.