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; [among other things, for gout/hyperuricemia:
- [acute gout: podagra – severe joint pain in the metatarsophalangeal joint of the big toe; other commonly affected joints are the knee and ankle, reddened, overheated.
- Chronic gout: tophi – gouty nodules made of uric acid crystals – in joints and soft tissues; predilection sites are: Ear cartilage (helix of the auricles, so-called gout pearls), eyelids, nostrils, bursa, extensor sides of the elbow joints; joint deformities]
- Exanthem (acute onset of skin rash)?
- Splinter hemorrhages in the nail folds? [due toendocarditis]
- Gait pattern (fluid, limping).
- Body or joint posture (upright, bent, gentle posture).
- Limb swelling (elbow joint, knee joint (“dancing” patella?), ankle).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); limited motion passive and active, capsular pattern?, instability?, evidence of injury such as hematoma formation, arthritic joint lumpiness) [monoarticular joint pain: joint is swollen, red].
- Skin and mucous membranes; [among other things, for gout/hyperuricemia:
- Palpation (palpation) of the joint [overheated and tender to pressure/extreme painfulness; palpate extremities – hands, feet, olecranon, knee joints – for soft tissue and bone tophi (due togout)]
- Auscultation of the heart [due toendocarditis: heart murmur: this can change its character (decrescendoform/become quieter; crescendoform/become louder)]
- Inspection (viewing).
- Ophthalmologic examination [ocular inflammation? (due toreactive arthritis (post-infectious arthritis)/Reiter’s disease)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
