Comprehensive Physical Examination Guidelines

Initial Preparation and Vital Signs

• The American College of Physicians recommends measuring blood pressure in both arms to identify potential subclavian artery stenosis 1
• Calculate BMI by measuring height and weight, as recommended by the American Academy of Family Physicians 1, 2
• Assess orthostatic blood pressure changes when evaluating dizziness, falls, or autonomic dysfunction, as suggested by the American College of Cardiology 1

General Appearance Assessment

• Evaluate overall appearance, level of consciousness, and signs of acute distress, as recommended by the American Medical Association 1
• Assess body habitus for wasting, obesity, or lipodystrophy, as suggested by the American Academy of Family Physicians 1
• Note gait and mobility if patient ambulates, as recommended by the American Geriatrics Society 1

Head and Neck Examination

• Inspect for deformities, lesions, and symmetry, as recommended by the American Academy of Otolaryngology 1
• Palpate skull for tenderness or masses, as suggested by the American College of Surgeons 1
• Test visual acuity using Snellen chart or near card, as recommended by the American Academy of Ophthalmology 1, 2

Cardiovascular Examination

• Inspect chest for visible pulsations or deformities, as recommended by the American College of Cardiology 2
• Auscultate heart in all four valve areas for murmurs, gallops, or rubs, as suggested by the American Heart Association 2
• Assess peripheral pulses: femoral, popliteal, dorsalis pedis, and posterior tibial, as recommended by the American College of Cardiology 1, 3

Neurological Examination

• Evaluate orientation to person, place, time, and situation, as recommended by the American Academy of Neurology 1, 2
• Assess memory, attention, and executive function, as suggested by the American Psychological Association 1, 2
• Perform 10-g monofilament testing on plantar surfaces of feet, as recommended by the American Diabetes Association 1, 2, 4

Vascular Assessment

• Palpate all peripheral pulses bilaterally and grade intensity, as recommended by the American College of Cardiology 1, 3
• Assess capillary refill time, as suggested by the American Heart Association 1, 3
• Refer patients with claudication symptoms or absent/decreased pedal pulses for ankle-brachial index, as recommended by the American College of Cardiology 3, 4, 6

Comprehensive Skin and Foot Examination

• Perform systematic inspection of entire skin surface for lesions, ulcerations, rashes, or suspicious changes, as recommended by the American Academy of Dermatology 1, 2
• Inspect skin integrity for ulcers, fissures, calluses, or corns, as suggested by the American Podiatric Medical Association 2
• Assess for foot deformities, as recommended by the American Orthopaedic Foot and Ankle Society 1

Patient Education Components

• Provide instruction on relevant self-examination techniques, as recommended by the American Cancer Society 1
• Teach daily foot inspection and proper footwear selection for diabetic or high-risk patients, as suggested by the American Diabetes Association 3, 4, 6
• Educate on skin self-checks for suspicious lesions, as recommended by the American Academy of Dermatology 1