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; furthermore:
- Inspection (viewing).
- Skin, mucous membranes, and sclerae (white part of the eye) [diffuse erythematous maculopapular exanthema (rash with small papules); petechiae (flea-like hemorrhages)]
- Neck incl. palpation [meningismus (painful neck stiffness)/increased resistance to movement of the head in the cervical spine]
- Extremities
- Auscultation (listening) of the heart
- Examination of the lungs (due topossible secondary diseases).
- 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 the lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased 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]
- Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce 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/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated: e.g. atelectasis, pleural rind; strongly attenuated or absent: in case of pleural effusion, pneumothorax, pulmonary 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]
- 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)). [due todifferential diagnoses:
- Empyema – collection of pus in a body cavity; may occur in the skull subdurally (under the hard meninges) and epidurally (on the hard meninges).
- Encephalitis (inflammation of the brain).
- Brain abscess – accumulation of pus in the brain (headache, nausea, vomiting, epileptic seizures, clouding of consciousness).
- Meningeosis carcinomatosa – metastases of a cancer in the meninges.
- Subarachnoid hemorrhage (SAB) – bleeding in the spaces in the skull that carry cerebrospinal fluid (nervous fluid). This is accompanied by sudden headache and meningism, causes brief disturbances of consciousness, and may lead to permanent brain dysfunction)]
Note: Patients with impaired consciousness and/or focal deficit (e.g., limb paralysis) must first undergo computed tomography of the skull (cranial computed tomography; CCT).
- ENT medical examination – focus search (focal diagnosis): e.g., suspected mastoiditis – mastoid process inflammation; inflammation of the aerated bone cells of the mastoid process (mastoid process).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
