What are appropriate physical examination questions to ask a 36‑year‑old female?

Physical Examination Questions for a 36-Year-Old Female

For a 36-year-old woman, your physical examination should include clinical breast examination every 3 years, cervical cancer screening with Pap test every 3 years, blood pressure measurement, BMI calculation, and comprehensive health counseling about lifestyle factors. 1, 2

Core Physical Examination Components

Vital Signs and Anthropometrics

• Measure blood pressure with a target of <120/80 mm Hg for optimal cardiovascular health 3
• Calculate BMI with a target <25 kg/m² and waist circumference <35 inches for women 3
• Record height and weight as baseline measurements 4

Breast Examination

• Perform clinical breast examination (CBE) every 3 years as part of periodic health examination for women in their 30s 1, 2
• Discuss breast self-examination (BSE) including its benefits and limitations, emphasizing that it's acceptable for women to choose not to do BSE or to do it irregularly 1, 2
• Emphasize prompt reporting of any new breast symptoms such as lumps, skin changes, or nipple discharge 1, 2
• Review BSE technique if the patient chooses to perform self-examination 1, 2

Important caveat: Mammography is not yet indicated at age 36; it begins at age 40 for average-risk women 1, 2, 3

Cardiovascular System

• Auscultate heart for murmurs, gallops, or rubs 4
• Assess peripheral pulses and check for edema 4

Respiratory System

• Auscultate lungs for abnormal breath sounds 4

Abdominal Examination

• Perform inspection, auscultation, and palpation of the abdomen 4

Neurological Assessment

• Test deep tendon reflexes 4
• Perform sensory examination as indicated 4

Skin Examination

• Inspect skin for suspicious lesions, rashes, or abnormalities as part of cancer-related checkup 1, 4

Additional Examinations

• Examine thyroid, lymph nodes, and oral cavity as part of cancer-related checkup 1

Cancer Screening

Cervical Cancer Screening

• Perform Pap test every 3 years with conventional Pap tests, or every 2 years using liquid-based Pap tests 1, 3
• Consider co-testing with HPV (Pap plus HPV DNA test every 3 years) if age 30 or older, though at 36 this is optional 1

No Other Cancer Screening Needed

• Do not order mammography (begins at age 40) 1, 2, 3
• Do not order colorectal cancer screening (begins at age 50 for average-risk individuals) 1, 3

Essential History-Taking Questions

Family History Assessment

• Obtain detailed family history of breast, ovarian, colorectal, endometrial, and gastric cancers in first-degree relatives 1, 2, 3
• Identify candidates for genetic counseling based on family history patterns suggesting hereditary cancer syndromes 1, 2
• Document family history of cardiovascular disease, diabetes, and other hereditary conditions 4

Critical pitfall: More than half of women at increased risk of breast cancer due to family history have no documentation in their chart, so systematic documentation is essential 1

Lifestyle and Social History

• Assess tobacco use and provide cessation counseling if applicable 1, 3, 4
• Evaluate alcohol and substance use 4
• Document physical activity level using categorical answer modes (e.g., "Do you get at least 150 minutes of moderate exercise per week?") rather than open-ended questions, as categorical responses show stronger validity 5, 6
• Review dietary patterns and weight history 4
• Assess sleep behaviors 4

Reproductive and Gynecologic History

• Document obstetric history including pregnancies, deliveries, and complications 1
• Review current contraception methods 1
• Ask about menstrual patterns and any abnormal bleeding 1

Occupational and Environmental Exposures

• Evaluate occupational history and environmental exposures 1, 4

Laboratory Testing (Risk-Based)

Cardiovascular Risk Assessment

• Order lipid panel if cardiovascular risk factors present (smoking, elevated BP, obesity, poor diet, physical inactivity, or family history of premature CVD) 3
• Check fasting blood glucose if risk factors for diabetes exist 3

Other Laboratory Tests

• Consider TSH testing for women with symptoms or risk factors for thyroid disease 4
• Perform urinalysis as part of comprehensive assessment 4

Health Counseling and Education

Lifestyle Counseling

• Prescribe physical activity: at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise, performed in episodes of at least 10 minutes 3
• Provide dietary guidance: emphasize fruits, vegetables, whole grains, fish, and lean protein while limiting saturated fat, cholesterol, alcohol, sodium, and sugar 3
• Counsel on sun exposure and skin cancer prevention 1
• Discuss sexual practices and safe sex 1

Symptom Recognition Education

• Educate about breast cancer symptoms and the importance of developing awareness about breast changes 2
• Emphasize prompt reporting of any new or concerning symptoms 1, 2

Common Pitfalls to Avoid

• Do not order unnecessary screening tests not recommended for this age group, such as mammography or colorectal cancer screening 2
• Do not fail to document family history systematically, as this is frequently overlooked but critical for risk assessment 1, 2
• Do not use open-ended questions for physical activity assessment; categorical answer modes provide superior validity 5
• Do not neglect emotional contact during gynecologic examination, as negative emotional contact is strongly associated with patient discomfort 7
• Do not overlook mental health screening for depression and anxiety, which can affect examination tolerance and overall health 7