1)Proper Element — Two blood pressure measurements 2 minutes apart on each arm – again looking for coarctation of the aorta or other anatomical anomalies (a cause of secondary hypertension)
2)Proper Element — Calculate the BMI – usually overweight or obese.
3)Proper Element — Fundiscopic exam – looking for AV nicking, papilledema (seen in hypertensive emergencies), cotton wool spots, hemorrhages.
4)Not a Proper Element — Assess the tympanic membranes – although part of a general examination, this is not part of the focused physical exam on a patient with hypertension.
5)Proper Element — Examine the thyroid – looking for thyromegaly or polyps or other signs of hyperthyroidism (a cause of secondary hypertension)
6)Proper Element — Check for neck bruits (cardiovascular disease)
7)Proper Element — Ausculate the heart for rate and murmurs (cardiovascular or valvular disease)
8)Proper Element — Check the PMI (point of maximal impact) looking for signs of hypertrophy or cardiomegaly
9)Proper Element — Check for abdominal bruits (cardiovascular disease)
10)Not a Proper Element — Check for hepato-splenomegaly – although part of a general examination, this is not part of the focused physical exam on a patient with hypertension.
11)Not a Proper Element — Perform a genital examination – although part of a general examination, this is not part of the focused physical exam on a patient with hypertension.
12)Proper Element — Assess peripheral veins (cardiovascular or diabetic disease)
13)Proper Element — Evaluate for lower extremity edema (cardiovascular disease)
14)Proper Element — Getting a good baseline neurological exam is important even if the examination is non focal.
15) Not a Proper Element — Perform a general skin examination – although part of a general examination, this is not part of the focused physical exam on a patient with hypertension.