What are the components of a complete general physical examination?

Components of a Complete General Physical Examination

A complete general physical examination should include vital signs, anthropometric measurements, and a systematic head-to-toe assessment of all major organ systems, with the specific components tailored to the patient's age, presenting concerns, and risk factors. 1

Initial Assessment and Vital Signs

• Measure and document all vital signs: blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation 1
• Record anthropometric measurements: height, weight, and body mass index (BMI) for all patients 1
• Measure head circumference in children under 3 years of age and plot against standard growth curves 1, 2
• Assess overall body habitus for evidence of obesity, cachexia, or lipodystrophy (particularly in patients on antiretroviral therapy) 1

Head, Eyes, Ears, Nose, and Throat (HEENT)

• Examine the head and face for signs of trauma, dysmorphic features, or asymmetry 1
• Perform funduscopic examination or arrange ophthalmology referral for patients with advanced HIV disease (CD4 count <50 cells/mm³), children with difficulty performing adequate funduscopy, or those with ocular symptoms 1
• Test red reflex bilaterally to detect ocular media abnormalities 2
• Examine the oropharynx for candidiasis, oral hairy leukoplakia, Kaposi sarcoma, aphthous ulceration, periodontal disease, and dental caries 1, 3
• Auscultate the neck for carotid bruits 1

Skin Examination

• Inspect all skin surfaces for seborrheic dermatitis, Kaposi sarcoma, folliculitis, fungal infections, psoriasis, prurigo nodularis, stigmata of coagulopathies, embolic lesions (Janeway lesions, Osler nodes), signs of trauma, or injection drug use 1
• Document extent of any skin lesions using body surface area percentage and body mapping when indicated 1

Lymphatic System

• Palpate all accessible lymph node regions (cervical, supraclavicular, axillary, inguinal), noting that persistent generalized lymphadenopathy is common in HIV but does not correlate with prognosis 1
• Evaluate localized lymphadenopathy further as it may indicate infection or malignancy 1

Cardiovascular Examination

• Auscultate the heart for rate, rhythm, murmurs, and abnormal heart sounds 1
• Examine for signs of congestive heart failure: jugular venous distension, peripheral edema, and pulmonary rales 1
• Assess peripheral vascular system including peripheral pulses and signs of peripheral vascular disease 1

Pulmonary Examination

• Auscultate all lung fields for air entry, wheezes, rales, or other adventitious sounds 1
• Assess respiratory pattern and effort 1

Abdominal Examination

• Inspect, auscultate, and palpate the abdomen 1
• Assess for hepatomegaly or splenomegaly, which may indicate infection or malignancy and warrant further evaluation 1
• Palpate for masses or tenderness 1

Genitourinary and Rectal Examination

• Perform anogenital examination for evidence of sexually transmitted diseases, condylomata, herpes simplex infection, rectal cancer, and prostate cancer in men 1
• Conduct pelvic examination in women including breast palpation and visual inspection of external genitalia 1
• Examine external genitalia in children for normal development and any abnormalities 2

Musculoskeletal and Neurological Examination

• Assess muscle bulk, tone, and strength through observation and palpation 2
• Observe gait, posture, and functional motor skills including ability to rise from floor without assistance (Gower maneuver suggests proximal muscle weakness) 2
• Evaluate joint range of motion and stability 1
• Perform neurological examination including level of consciousness, orientation, cranial nerves, motor function, sensory function, reflexes, coordination, and gait 1, 2
• Use standardized assessment tools such as the National Institutes of Health Stroke Scale when neurological deficits are present 1

Age-Specific and Risk-Based Components

For HIV-infected patients:

• Focus on opportunistic infection signs and antiretroviral therapy complications including lipodystrophy 1

For patients planning vigorous exercise (men >45 years, women >55 years with diabetes or ≥2 cardiovascular risk factors):

• Consider electrocardiographic stress testing after comprehensive cardiovascular examination 1

For patients with diabetes:

• Assess for complications including neuropathy, retinopathy risk, and cardiovascular disease 1

For children:

• Plot growth parameters on appropriate growth curves and assess developmental milestones 2, 3

Common Pitfalls to Avoid

• Do not skip the funduscopic examination in high-risk patients (advanced HIV, diabetes) as this can miss sight-threatening conditions like CMV retinitis or diabetic retinopathy 1
• Do not overlook subtle signs of lipodystrophy in patients on long-term antiretroviral therapy, including dorsocervical fat pad, facial lipoatrophy, or abdominal protuberance 1
• Do not dismiss localized lymphadenopathy as benign persistent generalized lymphadenopathy without proper evaluation for infection or malignancy 1
• Do not forget to assess for signs of injection drug use and perform a thorough sexual history in an open, nonjudgmental manner 1