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).
- Auscultation (listening) of the heart [symptoms of delirium tremens (alcohol withdrawal delirium): tachycardia (heartbeat too fast: > 100 beats per minute)]
- Examination of the lungs [due todifferential diagnoses: pulmonary insufficiency with hypoxemia (decreased blood oxygen content) and hypercapnia (increased blood carbon dioxide content), pneumonia (pneumonia)]:
- Auscultation (listening) of the lungs.
- 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 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 pleural effusion). 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]
- Voice fremitus (check the transmission of low frequencies; the patient is asked to say several times in a low voice the word “99”, while the doctor puts his hands on the chest or back of the patient) [increased sound conduction due to pulmonary infiltration / compaction of lung tissue (eg, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). 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]
- Neurological examination – including level of consciousness, sensory/motor testing, test for painful neck stiffness (meningismus) [due topossible cause: dementia?] [due todifferential diagnoses:
- Urological examination [due todifferential diagnoses:
- Urinary tract infections, unspecified
- Renal insufficiency (kidney weakness)
- Uremia (occurrence of urinary substances in the blood above normal values)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.