The Cardio-Focused Physical Exam

Given the widespread and increasing prevalence of metabolic dysfunction,1 being able to rapidly assess patient risk during a short encounter has become increasingly important. Obesity is a known risk factor for a host of health complaints, but approximately 20% of normal weight individuals are estimated to also have metabolic disturbances.2 Moving beyond BMI and using advanced physical exam skills provides clues to insulin resistance.

For a patient who isn’t a textbook example of insulin resistance, how do you know to pursue that possibility? The physical exam offers numerous ways to zero in on nutritional and metabolic concerns—and IFM’s Cardiometabolic Advanced Practice Module (APM) teaches you how to see these signs.

Shilpa P. Saxena, MD, an IFM educator at the Cardiometabolic APM, discusses the many ways to detect, assess, and evaluate metabolic function:

Many cues are available to help practitioners identify patients at risk of metabolic dysfunction. Shilpa P. Saxena, MD, discusses some of the physical signs described in depth at the Cardiometabolic APM.

Manifestations of insulin resistance on the skin may be more reliable than other forms of diagnosis.3 It may also indicate severity of metabolic syndrome.4 Even in children and adolescents, acanthosis nigricans offers a reliable physical exam clue for metabolic syndrome.5

Join Dr. Saxena and other expert educators at the Cardiometabolic APM to refresh your technique in the physical exam, update your clinical knowledge on metabolic risk factors, and gain tools to help improve patient outcomes. You can intervene early and help your patients improve their metabolic function.

Register for the Cardiometabolic APM


  1. Kelli HM, Kassas I, Lattouf OM. Cardio Metabolic Syndrome: A Global Epidemic. J Diabetes Metab. 2015;6(3):513. doi:10.4172/2155-6156.1000513.
  2. Stefan N, Schick F, Häring HU. Causes, Characteristics, and Consequences of Metabolically Unhealthy Normal Weight in Humans. Cell Metab. 2017 Aug 1;26(2):292-300. doi:1016/j.cmet.2017.07.008.
  3. González-Saldivar G, Rodríguez-Gutiérrez R, Ocampo-Candiani J, González-González JG, Gómez-Flores M. Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management. Dermatology and Therapy. 2017;7(1):37-51. doi:10.1007/s13555-016-0160-3.
  4. Huang Y, Chen J, Wang X, Li Y, Yang S, Qu S. The Clinical Characteristics of Obese Patients with Acanthosis Nigricans and Its Independent Risk Factors. Exp Clin Endocrinol Diabetes. 2017 Mar;125(3):191-195. doi:10.1055/s-0042-123035.
  5. Velazquez-Bautista M, López-Sandoval JJ2, González-Hita M, Vázquez-Valls E, Cabrera-Valencia IZ, Torres-Mendoza BM. Association of metabolic syndrome with low birth weight, intake of high-calorie diets and acanthosis nigricans in children and adolescents with overweight and obesity. Endocrinol Diabetes Nutr. 2017 Jan;64(1):11-17. doi:10.1016/j.endinu.2016.09.004.

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