A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
- Inspection (viewing).
- Skin and mucous membranes
- Throat
- Eyes including the sclerae (white part of the eye) [conjunctivitis (inflammation of the conjunctiva)].
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Examination of the lungs
- Auscultation (listening) of the lungs
- Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. in pneumonia/lung inflammation) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated or absent: e.g. in case of pleural effusion/fluid accumulation between the chest wall and the lung). As a result, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Voice fremitus (checking the transmission of low frequencies; the patient is asked to say the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration (for example, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
- Neurological examination – including checking if the symptom of painful neck stiffness (meningismus) is present, testing of motor and sensory function with checking of reflexes (especially biceps tendon reflex (BSR), triceps tendon reflex (TSR), radius periosteal reflex (RPR), patellar tendon reflex (PSR) and Achilles tendon reflex (ASR, also triceps surae reflex)).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
