A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; in children, additional percentile progression; furthermore:
- Inspection (viewing).
- Skin and mucous membranes [pallor?, cyanosis/bluish discoloration of skin, fingernails/mucous membranes, and lips?, sweating?]
- Sclerae (white part of the eye)
- Pharynx (throat) [obstructed nasal breathing?]
- Legs [edema/water retention?, thrombosis?]
- Knocking pain sinuses? [sinusitis/sinusitis?]
- Auscultation (listening) of the heart [heart failure?
- Examination of the lungs
- Auscultation of the lungs [due todifferential diagnoses (in bold possible dangerous courses):
- Bronchial asthma or status asthmaticus [expiratory (“occurring on exhalation”) wheezing, prolonged expiratory, dry rales (RGs); caveat: silent chest (greatly attenuated breath sound)]
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Exacerbation of chronic bronchitis – acute exacerbation of chronic bronchitis.
- Foreign body aspiration (inhalation of foreign substances); especially common in young children and the elderly [dyspnea (shortness of breath), inspiratory stridor (whistling breathing sound occurring on inhalation)]
- Flu infection
- Upper and lower respiratory tract infections, unspecified
- Influenza (flu)
- Pulmonary embolism (pulmonary artery embolism or pulmonary artery thromboembolism) – blockage of a pulmonary vessel by a blood clot (blood clot) called a thrombus [dyspnea (shortness of breath), tachypnea (> 20 breaths/min), tachycardia (heartbeat too fast: > 100 beats per minute), chest pain (chest pain)]
- Pulmonary edema (water retention in the lungs) [tachypnea (> 20 breaths/min), dyspnea (shortness of breath), exacerbated breath sounds, wet rales (RGs)]
- Pneumonia (pneumonia)
- Pneumothorax (collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura)) [asymmetric thoracic movement (chest motion), stabbing chest pain, unilateral attenuated breath sound, hypersonoric tapping sound]
- Etc.
- 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 [eg. E.g., in emphysema; Schachtelton (pronounced hypersonoric, hollow-sounding knocking sound) in pneumothorax]
- Vocal fremitus (checking the transmission 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]
- Auscultation of the lungs [due todifferential diagnoses (in bold possible dangerous courses):
- Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
- Inspection (viewing).
- ENT examination [due todifferential diagnoses: chronic sinusitis (sinusitis); sinubronchitis (simultaneous occurrence of sinusitis and bronchitis); foreign body or cerumen (earwax) in the external auditory canal].
Square brackets [ ] indicate possible pathological (pathological) physical findings.