lungs (breath sounds). The tapping helps to iden-
tify areas of unusual density that might suggest
enlargement of the heart, accumulated fluids, or
other circumstances that need further examina-
tion. The chest examination should also include
breast examination for men as well as women, to
detect lumps or other abnormalities.
BackThe doctor may look at the back from the
back and each side when the person is standing, as
a general screen for SCOLIOSIS, KYPHOSIS, and other
back conditions. The doctor may palpate the spine
and have the person raise and lower the arms to
examine the shoulders and shoulder blades. The
back also is a common site for ACNE, ACTINIC KER-
ATOSIS, and other SKINconditions.
Abdomen The doctor palpates the abdomen
from the base of the ribs to the pelvis, feeling for
any usual masses or tenderness. Abdominal palpa-
tion helps detect signs of ASCITES(collected fluid in
the abdominal cavity) abdominal ANEURYSM(weak-
ening and ballooning of the major ARTERYin the
abdomen, the AORTA), LIVERorSPLEENenlargement,
and tenderness of organs such as the GALLBLADDER,
STOMACH, and pancreas. The doctor will also listen
to the abdomen with a stethoscope, further check-
ing for abdominal aneurysm as well as assessing
BOWEL SOUNDS. The doctor may also tap on the
belly, listening for differences in tones that might
suggest changes in density.
Arms and legs The doctor may move the arms
and legs to examine the joints, MUSCLEtone, and
range of motion. Small taps with the reflex ham-
mer test TENDONresponses as well as neurologic
reflexes. The doctor looks for unusual bruising,
swelling or edema, discolorations, and disparities
between sides of the body. The doctor may
observe as the person walks across the room and
back to assess gait and balance. Pulses in the feet
are good indicators of peripheral circulation.
GenitaliaThe doctor will palpate a man’s testi-
cles to check for lumps or swellings, and examine
the PENISfor structural anomalies or discharge. The
familiar “turn your head and cough” instruction
increases pressure in the lower abdomen to reveal
any HERNIA. A woman’s physical examination typi-
cally includes a PELVIC EXAMINATION and PAP TEST.
Depending on age, the doctor may include a DIGI-
TAL RECTAL EXAMINATION(DRE) for men and women.
Job positions with highly physical demands
such as firefighter or police officer, school sports
and athletic programs, return-to-work following
injury, and certifications such as for aviation and
nautical pilots are among the special circum-
stances that may require routine medical exami-
nations. The physical examination and diagnostic
procedures will include any additional tests to
meet the requirements. Appendix X, “Immuniza-
tion and Routine Examination Schedules,” pro-
vides information about how frequently a person
should have a routine medical examination and
what components the examination should
include.
See also HEALTH RISK FACTORS; LIFESTYLE AND
HEALTH; OCCUPATIONAL HEALTH AND SAFETY.routine medical examination 45