Coxsackie A/B: Examination

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, oral cavity, and sclera (white part of the eye) [maculopapular exanthema (rash) – patchy rash accompanied by papule (vesicle) formation; herpangina (vesicle on the palate), acute hemorrhagic conjunctivitis (conjunctivitis), acute lymphonodular pharyngitis (pharyngitis)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart [possible symptom or due topossible sequelae: Myocarditis (inflammation of the heart muscle), pericarditis (pericarditis)] [due todifferential diagnoses:
      • Valvular heart disease, unspecified
      • Cardiac arrhythmia
      • Hypertensive crisis (seizure-like increase in blood pressure to values > 200 mmHg).
      • Cardiomyopathy (heart muscle disease)
      • Coronary heart disease (CHD)
      • Myocardial infarction (heart attack)
      • Myocarditis (heart muscle inflammation)]
    • Inspection and palpation (palpation) of the thyroid gland.
    • Examination of the lungs
      • Auscultation (listening) of the lungs [possible symptom: bronchitis or differential diagnosis: pleurisy (pleurisy)].
      • 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 (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pneumothorax). 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, box sound in pneumothorax].
      • Voice fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice, while the doctor places his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of decreased sound conduction (severely attenuated or absent: in pneumothorax). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
    • Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
  • Neurological examination [due tosymptom: pseudoparalysis (paralysis) [virus type 7]; possible sequelae:

Square brackets [ ] indicate possible pathological (pathological) physical findings.