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).
- Congested jugular veins [= clinical sign of heart failure (cardiac insufficiency): sign of increased right ventricular filling pressure].
- Peripheral edema (praetibial edema?/water retention in the area of the lower leg/before the tibia, ankle; in supine patients: presacral/before the sacrum) [= clinical sign of heart failure (cardiac insufficiency)]
- Auscultation (listening) of the heart [acute pericarditis (pericarditis), right heart failure (right heart failure), left heart failure (left heart failure); present 3. Heart sound (time: early diastole (relaxation and filling phase of the heart); approx. 0.15 sec. after the 2nd heart sound; due to the impingement of the blood jet on the stiff wall of the (insufficient) ventricle/heart chamber); highly specific, but not very sensitive] (differential diagnoses)]
- Examination of the lungs
- Auscultation (listening) of the lungs [inspiratory and expiratory (on inhalation and exhalation): decreased breath sound/unilateral or bilateral basal decreased or absent breath sound or attenuation? ; appearance of the pleural abdomen at the onset of a parapneumonic effusion (occurring as a concomitant disease in the course of pneumonia)].
- 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 (differential diagnosis)) 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]
- Percussion (tapping) of the lungs [muffled; Notice. Pleural effusions are more common on the right side because the pleural area is larger on that side].
- Vocal fremitus (checking for low frequency conduction; patient is asked to say 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 (differential 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 (attenuated: e.g. in case of pleural rupture (possible secondary disease); strongly attenuated or absent: in case of pleural effusion. 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]
- Examination of the abdomen
- Percussion (tapping) of the abdomen
- [Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if one taps against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand on it (undulation phenomenon); flank attenuation [ascites in the presence of liver cirrhosis?].
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
- Palpation of the abdomen (tenderness?, tapping pain?, coughing pain?, guarding?, hernial orifices?, renal bed tenderness?).
- Percussion (tapping) of the abdomen
- Cancer screening
- Inspection (viewing).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
