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 and mucous membranes
- Auscultation (listening) of the heart [to exclude cardiac diseases differential diagnosis; pericarditis: friction sounds over the heart].
- Examination of the lungs (due topossible secondary diseases).
- Auscultation of the lungs [pleurisy: friction sounds over the lungs? (also possible in pneumonia and pulmonary embolism]
- Bronchophony (check 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. in pneumonia (differential diagnosis)) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated or absent: e.g. in pleural empyema (accumulation of pus in the pleural cavity; possible secondary disease), pleural effusion and pneumothorax (differential diagnosis). The result is, the number “66” is barely audible over the diseased lung area to absent, because the high-frequency sounds are strongly muffled]
- Percussion (tapping) of the lungs [e.g., nesting sound in pneumothorax (differential diagnosis)]
- 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. 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 pleural rash; strongly attenuated or absent: in pleural empyema (accumulation of pus in the pleural cavity; possible secondary disease), pleural effusion and pneumothorax (differential diagnosis). As a result, 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).
- Cancer screening
Square brackets [ ] indicate possible pathological (pathological) physical findings.
