Hi! Thank you for your inquiry!
The answer to your question, what are the criteria for annual physicals in
adults, is somewhat dependent upon the patients age, sex, and risk factors for
disease. It is also questionable that a complete physical examination (CPE)
needs to be done annually.
Generally, a CPE starts at the head and proceeds all the way down to the toes.
However, the precise procedure will vary according to the needs of the patient
and the preferences of the medical examiner.
The following information is taken from the Hendrick AccessMed Online Health
First, the examiner will observe the patient's appearance, general health, and
behavior, along with measuring height and weight. The vital signsincluding
pulse, breathing rate, body temperature, and blood pressureare recorded.
With the patient sitting up, the following systems are usually reviewed:
·Skin. The exposed areas of the skin are observed; the size and shape of any
lesions are noted.
·Head. The hair, scalp, skull, and face are examined.
·Eyes. The external structures are observed. The internal structures can be
observed using an ophthalmoscope (a lighted instrument) in a darkened room.
·Ears. The external structures are inspected. A lighted instrument called an
otoscope may be used to inspect internal structures.
·Nose and sinuses. The external nose is examined. The nasal mucosa and internal
structures can be observed with the use of a penlight and a nasal speculum.
·Mouth and pharynx. The lips, gums, teeth, roof of the mouth, tongue, and
pharynx are inspected.
·Neck. The lymph nodes on both sides of the neck and the thyroid gland are
palpated (examined by feeling with the fingers).
·Back. The spine and muscles of the back are palpated and checked for
tenderness. The upper back, where the lungs are located, is palpated on the
right and left sides and a stethoscope is used to listen for breath sounds.
·Breasts and armpits. A woman's breasts are inspected with the arms relaxed and
then raised. In both men and women, the lymph nodes in the armpits are felt
with the examiner's hands. While the patient is still sitting, movement of the
joints in the hands, arms, shoulders, neck, and jaw can be checked.
Then while the patient is lying down on the examining table, the examination
·Breasts. The breasts are palpated and inspected for lumps.
·Front of chest and lungs. The area is inspected with the fingers, using
palpation and percussion. A stethoscope is used to listen to the internal
The head should be slightly raised for:
·Heart. A stethoscope is used to listen to the heart's rate and rhythm. The
blood vessels in the neck are observed and palpated.
The patient should lie flat for:
·Abdomen. Light and deep palpation is used on the abdomen to feel the outlines
of internal organs including the liver, spleen, kidneys, and aorta, a large
·Rectum and anus. With the patient lying on the left side, the outside areas
are observed. An internal digital examination (using a finger), is usually done
if the patient is over 40 years old. In men, the prostate gland is also
·Reproductive organs. The external sex organs are inspected and the area is
examined for hernias. In men, the scrotum is palpated. In women, a pelvic
examination is done using a speculum and a Papamnicolaou test (Pap test) may be
·Legs. With the patient lying flat, the legs are inspected for swelling, and
pulses in the knee, thigh, and foot area are found. The groin area is palpated
for the presence of lymph nodes. The joints and muscles are observed.
·Musculoskeletel system. With the patient standing, the straightness of the
spine and the alignment of the legs and feet is noted.
·Blood vessels. The presence of any abnormally enlarged veins (varicose),
usually in the legs, is noted.
In addition to evaluating the patient's alertness and mental ability during the
initial conversation, additional inspection of the nervous system may be
·Neurologic screen. The patient's ability to take a few steps, hop, and do deep
knee bends is observed. The strength of the hand grip is felt. With the patient
sitting down, the reflexes in the knees and feet can be tested with a small
hammer. The sense of touch in the hands and feet can be evaluated by testing
reaction to pain and vibration.
·Sometimes additional time is spent examining the 12 nerves in the head
(cranial) that are connected directly to the brain. They control the sense of
smell, strength of muscles in the head, reflexes in the eye, facial movements,
gag reflex, and muscles in the jaw. General muscle tone and coordination, and
the reaction of the abdominal area to stimulants like pain, temperature, and
touch would also be evaluated.
Hendrick AccessMed Online Health Information Library,
An example of a typical physical examination form can be found at Georgetown
Universities website for their college athletes:
You can also download free physical examination forms from the U.S. General
Services Administration website:
Also of possible interest in an excerpt from Plainsense, a general health
Many physicians still believe the annual physical is a necessary part of
preventive healthcare. But, many professional groups -- the National Academy of
Sciences, the American Medical Association, the Canadian Task Force on the
Periodic Health Exam, and the U.S. Preventive Services Task Force, among
others -- disagree. These groups feel that routine annual physicals for healthy
adults are largely unnecessary. Instead, they recommend periodic health exams
and age and risk-related tests designed to screen for specific medical
Although a paid subscription is necessary to view most of the articles, there
are a few that are free that give supporting evidence towards the AMAs belief
that the annual complete physical examination (CPE) is unnecessary. To view an
example of one of these, visit the following link to the American Medical
Please remember that this information is just an example of a typical adult
annual physical, and that each physical will vary according to patient needs
and practitioner preferences.
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