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).
- Inspection and palpation (palpation) of the thyroid gland [due topossible cause: hypothyroidism (hypothyroidism)?]
- Auscultation (listening) of the heart.
- Examination of the lungs
- Auscultation (listening) of the lungs [due topossible cause: chronic obstructive pulmonary disease (COPD)?]
- Bronchophony (checking the conduction 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. e.g. in pneumonia) [due todifferential diagnosis] 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) [due todifferential diagnosis]. 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]
- Vocal fremitus (testing of low frequency transmission; 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 transmission due to pulmonary infiltration/compaction of lung tissue (e. e.g. in pneumonia) [due todifferential diagnosis] the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (strongly attenuated or absent: in pleural effusion) [due todifferential diagnosis]. 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]
- Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
- Inspection (viewing).
- Gynecological examination in existing pregnancy and peripartum depression [due topossible sequelae: Prematurity, intrauterine growth retardation]
- Neurological examination – to exclude a somatic cause with examination of motor and sensory function, testing of reflexes Reflexes (especially the biceps tendon reflex (BSR), triceps tendon reflex (TSR), radius periosteal reflex (RPR), patellar tendon reflex (PSR) and the Achilles tendon reflex (ASR, also triceps surae reflex)). [due todifferential diagnoses:
- Dementia, unspecified
- Brain organic changes, unspecified]
- Psychiatric examination [due todifferential diagnoses:
- Alcohol dependence
- Drug addiction
- Schizophrenia – severe psychiatric disorder; belongs to the endogenous psychoses and is characterized by disturbances of thinking, perception and affectivity].
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
