Health History and Physical Examination · 3 min read
Vital Signs, Anthropometrics and the General Examination
This chapter covers blood pressure measurement and classification, BMI and waist circumference, and how vital signs and general findings feed into women's health decisions.
Blood Pressure Measurement
Accurate blood pressure measurement is a common exam topic because errors change diagnosis. Correct technique: patient seated with back supported and feet flat for at least 5 minutes, no caffeine, exercise or smoking for 30 minutes, empty bladder, arm supported at heart level, bare arm, correct cuff size (bladder encircling about 80% of the arm), no talking. A cuff that is too small, an arm below heart level, an unsupported back or a full bladder all falsely raise the reading. Take two or more readings and average them. Confirm an elevated office reading with out-of-office measurement (home or ambulatory monitoring) before diagnosing hypertension, because of white coat hypertension, and to detect masked hypertension.
Adult Blood Pressure Categories (ACC/AHA)
| Category | Systolic | Diastolic |
|---|---|---|
| Normal | Under 120 | and under 80 |
| Elevated | 120-129 | and under 80 |
| Stage 1 hypertension | 130-139 | or 80-89 |
| Stage 2 hypertension | 140 or higher | or 90 or higher |
In pregnancy, hypertension is defined differently: 140/90 or higher. Severe-range blood pressure is 160/110 or higher, and in pregnancy or postpartum it requires urgent treatment. Pregnant patients should be measured seated or in left lateral position, not supine, because the gravid uterus compresses the vena cava after about 20 weeks.
Exam Tip: Before combined hormonal contraception, a blood pressure measurement is the only examination needed. A pelvic exam, breast exam or cervical cytology is not required to start the pill, patch or ring.
Anthropometrics
Body mass index (BMI) is weight in kilograms divided by height in meters squared. Adult categories: underweight under 18.5; normal 18.5-24.9; overweight 25.0-29.9; obesity 30 or higher (class 1, 30-34.9; class 2, 35-39.9; class 3, 40 or higher). Asian American patients have higher cardiometabolic risk at lower BMI, so a BMI of 23 or higher is used as the overweight threshold for diabetes screening in that group. Prepregnancy BMI sets the gestational weight-gain target.
Waist circumference measures central adiposity; more than 35 inches (88 cm) in women raises cardiometabolic risk and is one criterion of metabolic syndrome. Measure at the top of the iliac crest at the end of normal expiration.
In older women, height loss of more than about 1.5 inches (4 cm) from peak, or a measured loss of about 0.8 inch (2 cm), suggests vertebral fracture and may prompt spine imaging.
General Survey and Skin
Look for findings that point to endocrine disease or violence:
Hirsutism (terminal hair in a male pattern: upper lip, chin, chest, linea alba, back), scored with the modified Ferriman-Gallwey scale; acne; androgenic alopecia. Rapid onset with clitoromegaly, voice deepening or increased muscle mass is virilization and suggests an androgen-secreting tumor.
Acanthosis nigricans (velvety hyperpigmentation of the neck, axillae) suggests insulin resistance, common with PCOS.
Signs of injury in different stages of healing, patterned bruises, or injuries inconsistent with the history suggest intimate partner violence.
Key Takeaways
Correct blood pressure technique: seated 5 minutes, arm at heart level, correct cuff, two readings; a small cuff falsely raises the reading.
Stage 1 hypertension is 130-139/80-89 outside pregnancy; in pregnancy 140/90 is hypertension and 160/110 is severe.
BMI 30 or higher is obesity; Asian American patients use 23 as the overweight threshold for diabetes screening; waist over 35 inches is high risk.
Height loss in older women suggests vertebral fracture.
Rapid virilization, not slowly progressive hirsutism, signals a possible androgen-secreting tumor.
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