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) [central cyanosis (blue coloration of skin and mucous membranes/tongue)]
- Skin and mucous membranes
- In children:
- Increase in sagittal thoracic diameter (chest diameter from front to back) with hyperinflation.
- Thoracic retractions (jugular, intercostal, epigastric) in acute respiratory distress
- Auscultation (listening) of the heart [tachycardia (heartbeat too fast: > 100 beats per minute)].
- Examination of the lungs
- Auscultation (listening) of the lungs [tachypnea, respiratory rate: > 20 breaths/min; expiratory (“on exhalation”) wheezing, prolonged expiratory; dry rales (RGs); inspiratory (“on inhalation“) free Cave: silent chest/silent lung (greatly attenuated breath sounds to no breath sounds) due to expiratory (“on exhalation”) collapse of the bronchioles (smallest branches of the bronchi) during the acute asthma attack. This causes the lungs to become hyperinflated (is also referred to as dynamic lung hyperinflation or “air trapping”) by the inhaled air trapped in the alveoli (small air sacs in the lungs). The lungs thus act as a “silencer.”]
- 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. in pneumonia (differential diagnosis)) 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 and pneumothorax (differential diagnoses), pulmonary emphysema (possible sequelae)). The result is, the number “66” is barely audible over the diseased lung area to absent, because the high-frequency sounds are strongly attenuated]
- Percussion (tapping) of the lungs [hypersonoric tapping sound: sound with very bright, full timbre; box tone in pneumothorax (differential diagnosis)]
- Vocal fremitus (testing of 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/compaction of lung tissue (e.g. e.g. in pneumonia (differential diagnosis)) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (strongly attenuated or absent: in pleural effusion and pneumothorax (differential diagnoses), pulmonary emphysema (possible sequelae)). 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) [central cyanosis (blue coloration of skin and mucous membranes/tongue)]
- Neurological examination [hyperventilation syndrome/dysfunction of breathing with ventilation of the lungs increased above the need, which occurs mainly in conflict situations (differential diagnosis)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
