A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes [anemia (anemia), edema (water retention), pruritus (itching), yellowish skin color]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Auscultation of the heart [due todifferential diagnoses: heart failure (heart failure), myocardial infarction (heart attack) with heart failure (heart failure), myocarditis (heart muscle inflammation) with heart failure (heart failure)]
- Examination of the lungs
- Auscultation (listening) of the lungs [dyspnea (shortness of breath); pulmonary edema: attenuated breath sound; moist, coarse-bubble rales, which in severe cases can be heard without a stethoscope (“bubbling 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 doctor listens to the lungs) [increased sound conduction due to pulmonary infiltration (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Percussion (tapping) of the lungs [pulmonary edema: tapping sound normal to muffled]
- Vocal fremitus (checking for low frequency conduction; patient is asked to say the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back) [increased sound conduction due to pulmonary infiltration (e.g. in pneumonia/pulmonary inflammation) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: in pleural effusion, pneumothorax, emphysema). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- Examination of the abdomen (abdomen)
- Percussion (tapping) of the abdomen [attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?)
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?)
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of prostate size, shape and consistency [benign prostatic hyperplasia/benign prostatic enlargement].
- Inspection (viewing).
- Urologic/nephrologic examination [due todifferential diagnoses:
- Acute interstitial nephritis (inflammation of the kidneys).
- Benign prostatic hyperplasia
- Glomerulonephritis – kidney disease caused by inflammation of the renal corpuscles.
- Ureteral stenosis (narrowing of the ureter)
- Urethrastenosis (urethral narrowing)
- Urolithiasis (urinary stone disease)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.