Physical examination

Summary

The physical examination is typically the first diagnostic measure performed after taking the patient's
history. It allows for an initial assessment of symptoms and is crucial for determining the differential
diagnoses and further steps. Ideally, a complete physical examination should be performed for every
patient. In practice, the physical examination is usually tailored to specific patient concerns. Sensitivity
and specificity of physical examination findings vary widely. In some cases, a diagnosis is possible on the
basis of the physical examination alone. This article covers the basics of the physical examination and
links out to other articles for more specific examinations, including:

 Pediatric history taking and physical examination

 Gynecologic and obstetric history and physical examination
 Mental status examination
 Neurological examination
 Head and neck examination
 Lymph node examination
 Pulmonary examination
 Cardiovascular examination
 Abdominal examination
 Skin examination and nail examination

Approach

Systems

The following sections provide an overview of all the parts of a physical examination that should be
considered, including:

General appearance

Vital signs

Skin and nails

Head and neck

Lymphatics

Heart

Lungs
Abdomen

Pelvic

Neurological

Musculoskeletal

Psychiatric: See mental status examination for more information.

Breast

Obstetric: See prenatal care and childbirth articles for more information.

In some cases, more details can be found in the links provided.

General appearance

Assess physical, behavioral, and emotional state, including:

Physical characteristics: body type, distinguishing characteristics or abnormal formations/symmetry,

development, race

Behavior: alert, active, lethargic, calm, agitated, combative, compliant

Wellness: well, unwell

Color: rosy, pale, flushed, jaundice

Grooming

Posture and movement

Vital signs and measurements

Vital signs

Temperature

Heart rate

Respiratory rate

Blood pressure

Oxygen saturation and supplemental oxygen device (see arterial blood gas analysis and pulse oximetry)

Possibly pain assessment

Body measurements

Weight, height, and possibly BMI

Children: head circumference

Skin and nails

Skin

Inspect skin appearance and examine skin lesions as needed, taking notes of location, size, colors,
texture, shape, and distribution.

See skin examination, benign skin lesions, and classic pathologic hand findings.

Nails

Inspect and palpate nails (fingers and toes) and look for abnormal changes to color, shape, or structures.

See nail exam and alterations of the nails for interpretation of findings.

Head, eyes, ears, nose, throat (HEENT)

Head, face, and neck: inspect, palpate head, sinuses, neck, and lymph nodes

Eyes: pupillary response, extraocular movements (H), visual acuity with Snellen chart, fundoscopic exam
(see examination of the eye)

Ears: inspect, palpation, otoscopic exam ± Rinne/Weber

Nose: inspect

Throat and mouth: open and say “ahh,” stick out tongue, palpate thyroid gland

See head and neck examination for more details.