A careful history and a physical examination are important parts of the periodic health examination. The patient history elicits recent and current symptoms or complaints; medications being taken (and any allergies to medications); an accounting of the past medical history of the patient; the social factors that may impact on the health of the patient (e.g., marital status, household makeup, employment); a family history of illnesses affecting family members; and a review of signs and symptoms for each of the organ systems in the body. The physical examination consists of three modalities to gather information: inspection, auscultation, and palpation. These methods are applied in a systematic way to the major systems of the body. Inspection involves observation of the body part being examined. The general appearance, color, and any other visual characteristics are noted. Auscultation involves listening, often with the aid of a stethoscope. The quality of any sound is noted, including loudness, musical tones, and effect of change in position. Palpation involves feeling both the size and texture of organs under examination. The major areas of the body to be examined are the head and neck, chest, abdomen, extremities, skin, musculoskeletal system, and nervous system. Using the three modalities in conjunction with the patient's medical history and screening tests allows an assessment of the overall health of a patient.
Screening involves the utilization of a diagnostic procedure to check for the presence of a disease prior to the manifestation of clinical symptoms. Hypertension is a risk factor for coronary heart disease, stroke, and renal disease. Hypertension in adults is defined as having a systolic blood pressure greater than 140 mmHg (millimeters of mercury) and/or a diastolic blood pressure of greater than 90 mmHg on at least three separate occasions. It is well established that decreases in elevated blood pressure, particularly an average 5 to 6 mmHg reduction in diastolic blood pressure reduces the incidence of coronary heart disease and stroke. By measuring the blood pressure at routine health examinations for adult men and women, as shown in Tables 2 and 3, the presence of hypertension can be detected and treatment can be instituted, prior to the development of further complications of the disease. Treatments include weight and diet modification, increased physical activity, assessment for other risk factors or concomitant disease, and prescription of
Clinical Preventive Services for Normal-Risk Men
SOURCE: Guide to Clinical Preventive Services, 2nd ed. (1996). Alexandria, VA: Report of the U.S. Preventive Services Task Force, International Medical Publishing Inc.