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).
- Finger
- Drumstick fingers? [the end links of the fingers are distended like pistons].
- Watch glass nails? [the fingernails are strongly curved outward and have a roundish shape]
- Auscultation (listening) of the heart [due topossible sequelae: cor pulmonale (dilation (enlargement) and/or hypertrophy (enlargement) of the right ventricle (main chamber) of the heart due to pulmonary hypertension (increase in pressure in the pulmonary circulation)].
- Examination of the lungs
- [due topossible secondary diseases:
- Auscultation (listening) of the lungs
- [moist rales?
- Expiratory (“on exhalation”) wheezing?
- Humming on exhalation]
- 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/compaction of lung tissue (eg. 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]
- Percussion (tapping) of the lungs [e.g., in emphysema; box tone in pneumothorax]
- 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. e.g., pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; with decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: with 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]
- Inspection (viewing).
- Cancer screening [due topossible causative tumors leading to airway obstruction (narrowing)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.