A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, respiratory rate, body temperature, body weight, body height, and assessment of level of consciousness; further:
- Inspection (viewing).
- Skin and mucous membranes
- 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.
- Examination of the lungs
- Auscultation (listening) of the lungs [decreased breath sound, if necessary; inspiratory: fine-bubble rales (RG), unilateral or bilateral/no RGs in atypical pneumonia (lung inflammation); overall: low diagnostic sensitivity (percentage of diseased patients in whom the disease is detected by the examination method, ie. i.e., a positive finding occurs) 47-69% and specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy by the examination) 58-75%; note: MERS is often accompanied by unremarkable auscultation findings]
- Bronchophony (testing for conduction of high-frequency sounds; patient is asked to say 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) 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, pulmonary 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]
- 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 puts 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 reduced sound conduction (greatly attenuated or absent: in pleural effusion, 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) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
- Inspection (viewing).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
