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), and oropharynx (oral cavity and pharynx)
- [Enanthem (rash around mucous membranes); morbilliform exanthem (rash) occurring mainly on the arms and trunk of the body; usually papular?
- Palatal petechiae (fleabite-like bleeding in the area of the palate)?
- Grayish, greasy imposing coatings?
- Massively enlarged tonsils?/palatine tonsil]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Skin, mucous membranes and sclerae (white part of the eye), and oropharynx (oral cavity and pharynx)
- Inspection and palpation of lymph node stations [lymphadenopathy (lymph node enlargement), especially cervical (“belonging to the neck”) and axillary (belonging to the armpit)]
- Auscultation (listening) of the heart [due topossible secondary diseases:
- Myocarditis (inflammation of the heart muscle).
- Pericarditis (inflammation of the pericardium)
- Vasculitis (vascular inflammation)]
- Examination of the lungs (due topossible secondary diseases).
- 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 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 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 (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]
- Examination of the abdomen (abdomen) [splenomegaly (splenomegaly) ?]
- Percussion (tapping) of the abdomen.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
- Percussion (tapping) of the abdomen.
- Inspection (viewing).
- Cancer screening [due topossible secondary diseases:
- B-cell lymphoma
- Burkitt’s lymphoma (endemic in African and Latin American malarial areas and New Guinea) – special type of malignant tumor originating from the lymphatic system.
- Hodgkin’s lymphoma (malignant disease; emanates from the lymphatic system).
- Leiomyosarcoma (malignant tumor that usually originates from hair follicles).
- Lymphomas of the central nervous system
- Gastric carcinoma (stomach cancer)
- Nasopharyngeal carcinoma (malignant nasal tumor).
- Tonsillar carcinoma (cancer of the palatine tonsils)
- Thymoma (thymus tumor)
- T-cell lymphoma (disease belonging to the non-Hodgkin’s lymphomas; these originate in the lymphatic system)]
- Neurological examination [due tosymptoms:
- Meningitis (meningitis) – very rare.
- Myalgia (muscle pain)
- Neuritis (nerve inflammation)]
[due topossible secondary diseases:
- Encephalitis (inflammation of the brain).
- Meningitis (meningitis)
- Acute transverse myelitis (diffuse spinal cord inflammation).
- Facial nerve palsy (paralysis of the facial nerve; this supplies facial muscles, among others).
- Guillain-Barré syndrome (form of polyradiculitis; this refers to the inflammation of several nerve roots).
- Peripheral neuritis (inflammation of nerves at peripheral nerves)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
