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, mucous membranes, and sclerae (white part of the eye) [accompanying symptom of chronic phase: night sweats].
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Inspection and palpation (palpation) of the lymph node stations (cervical, axillary, supraclavicular, inguinal).
- Auscultation (listening) of the heart [due topossible secondary disease: cardiomyopathy (heart muscle disease)].
- Auscultation of the lungs [due topossible sequelae: pulmonary insufficiency (inability of the lungs to perform adequate gas exchange)]
- Examination of the abdomen (abdomen)
- Percussion (tapping) of the abdomen
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
- Palpation (palpation) of the abdomen, etc., with an attempt to palpate the spleen.
- [Leading symptom of chronic phase: splenomegaly; accompanying symptom of chronic phase: upper abdominal pain]
- [Symptom of accelerated phase: increasing splenomegaly]
- Percussion (tapping) of the abdomen
- Inspection of the genital [due todifferential diagnosis: other forms of leukemia, e.g., acute lymphoblastic leukemia (ALL), which is associated with painless, usually unilateral, swelling of the testis].
- Inspection (viewing).
- If necessary, urological / nephrological examination [due topossible secondary disease: renal insufficiency / uremia (kidney weakness / kidney failure)]
- Health check (as an additional follow-up measure).
Square brackets [ ] indicate possible pathological (pathological) physical findings.