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; further:
- Inspection (viewing).
- Skin, mucous membranes, and sclerae (white part of the eye) [pruritus (itching), exanthema (skin redness), skin florescences (skin lesions), inflammation of the skin/crustations (larva migrans externa syndrome), petechiae (small skin bleedings), skin swelling, jaundice (yellowing), facial edema with swelling of the eyelids, localized bulging edema (water retention in the tissue) mostly on the forearms or face, conjunctivitis (conjunctivitis), elephantiasis (abnormal enlargement of a body part due to a lymphatic congestion), pigment disorders, keratitis (corneal inflammation), ulceration (ulceration), generalized urticaria (hives)]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Inspection and palpation of lymph node stations [lymphadenopathy (lymph node enlargement)].
- Auscultation (listening) of the heart [due tosymptom: myocarditis (inflammation of the heart muscle)]
- Examination of the lungs
- Auscultation (listening) of the lungs [irritable cough, bronchitis, hemoptysis (coughing up blood), dyspnea (shortness of breath), asthma attacks, acute respiratory distress attacks].
- 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 doctor 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 decreased 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 (checking the transmission of low frequencies; the patient is asked to say 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 (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]
- Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
- Digital rectal examination (DRU): examination of the rectum (rectal) [rectal bleeding].
- Inspection (viewing).
- Ophthalmological examination [due tosymptoms: visual disturbances, loss of visual acuity (visual acuity loss), chorioretinitis (inflammation of the choroid (choroid) with an involvement of the retina (retina)), onchocerciasis (river blindness): chronic disease caused by filariae of the species Onchocerca volvulus from the group of nematodes and leads to blindness in about 10% of sufferers]
- Neurological examination [due tosymptoms: epileptic seizures; paresis (paralysis), unspecified; meningismus (painful neck stiffness); neurological focal symptoms such as eye muscle paralysis; encephalitis (inflammation of the brain); meningitis (meningitis); severe headaches]
- Psychiatric examination [due tosymptoms: psychotic disorders]
- Urological examination [due tosymptoms: Dysuria (difficult (painful) urination), hematuria (blood in the urine), urinary tract infections]
- Male genital examination wg symptoms:
- Inspection and palpation of the genitals (penis and scrotum (scrotum); if necessary, the painfulness compared to the opposite side or where is the punctum maximum of pain) [orchitis (inflammation of the testis), funiculitis (inflammation of the spermatic cord)].
- Male genital examination wg symptoms:
Square brackets [ ] indicate possible pathological (pathological) physical findings.
