PHYSICAL EXAMINATION
All physical findings should be compared to the examination at the previous visit. An examination relevant to the nutritional, gastrointestinal and respiratory manifestations of CF should be completed at each visit. A complete physical examination (including vision and hearing screening) should be completed annually by either the CF specialist or the-primary care provider
The following physical findings should be documented at each visit:
A. Findings Relevant to Nutritional Status
1.  Weight measured at all visits on all patients
2.  Weight and height measured and plotted on an age-appropriate growth  grid for all patients < 18 years at all visits
3.  Midarm circumference and triceps skin-fold thickness performed by  an RD annually on ail patients < 18 years, or more frequently as indicated
4.   Description of body habitus re: wasting of extremities, protuberant abdomen, etc
5.  Calculation of weight as a percentage of ideal weight for height"  and classification of nutritional status completed annually by RD
6.  Description of findings suggestive of fat-soluble vitamin deficiencies leg, perleche,peeling of nailbeds, etc)
7.  Annual evaluation of Tanner stage in pediatric patients
B. Findings Relevant to Gastrointestinal Manifestations
1.  Abdominal examination, including bowel sounds, description of liver  and spleen size and texture, palpable masses, tenderness and distension
2.   Rectal examination for prolapse in pediatric population (if history is suggestive)
C. Findings Relevant to Respiratory Manifestations
1. Vital signs (resting - respiratory rate, pulse, blood pressure, temperature)
2.  Oxyhemoglobin saturation (SaO,) while resting as clinically indicated
3.  Chest examination, including anterior-posterior diameter, retractions,  use of accessory respiratory muscles, and auscultatory findings
4.  Upper respiratory tract examination, including presence of nasal polyps, rhinitis, otitis media, etc
5. Extremity findings, including clubbing, color, and joint examination