Delirium: Examination

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).
      • Skin, mucous membranes, and sclerae (white part of the eye) [symptoms of delirium tremens (alcohol withdrawal delirium): sweating, tremor (shaking; assessing fluid balance (e.g., signs of desiccosis (dehydration))
    • 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:
    • Epilepsy with long postictal stage.
    • Encephalitis (inflammation of the brain)
    • Brain abscess (encapsulated collection of pus in the brain).
    • Meningitis (meningitis)
    • Nonconvulsive status epilepticus (form of sustained epileptic seizure that is not notable for twitching/convulsions)]
  • 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.