Fever: 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; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes, and sclerae (white part of eye) [sweating (hot, severely red skin, glazed eyes in high fever); exanthema (rash)?, abscess (encapsulated collection of pus)?]
      • Foreign body search [including pacemaker?, venous access?, port?, dialysis shunt?, endoprostheses?]
      • Orienting dental status
    • Knocking pain paranasal sinuses?
    • Inspection and palpation (palpation) of the lymph node stations.
    • Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion); soft tissue swelling; pressure pain (localization!).
    • Auscultation (listening) of the heart [due todifferential diagnosis: infective endocarditis (endocarditis)].
    • Examination of the lungs
      • Auscultation of the lungs [due todifferential diagnoses: pneumonia (pneumonia), bronchitis].
      • 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 the lung tissue (e.g. 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]
      • Vocal fremitus (checking the conduction 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]
    • Palpation (palpation) of the abdomen (abdomen) including examination of the renal bearings (pressure pain?, knocking pain?, coughing pain?, defensive tension?, hernial ports?, renal bearing knocking pain?) [due todifferential diagnoses: appendicitis (appendicitis); pyelonephritis (inflammation of the renal pelvis)]
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation.
  • If necessary, gynecological examination
  • ENT medical examination [due todifferential diagnoses: otitis media (otitis media), sinusitis (sinusitis); tonsillitis (tonsillitis)].
  • Neurological examination [due todifferential diagnosis: meningitis (meningitis); headache?, changes in character?]

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