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) [barrel thorax (shape of chest resembles a barrel), drumstick fingers (conspicuous thickening of terminal phalanges), watch glass nails (bulging nails), central cyanosis (bluish discoloration of skin and central mucous membranes, e.g., tongue)]
- Auscultation (listening) of the heart [barely audible heart murmurs; heart failure (cardiac insufficiency) (differential diagnosis)]
- Examination of the lungs (due topossible secondary diseases).
- Auscultation (listening) of the lungs [in- and expiratory (during inhalation and exhalation): decreased breathing sound/attenuated breathing sound; the so called “silent lung”
- Pink buffer (see symptoms below for definition): quiet breath sounds, silent chest.
- Blue Bloater: distance gieing, moist rales]
- 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 (eg. 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 case of pulmonary emphysema, pleural effusion, pneumothorax). 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 [in pulmonary emphysema hypersonoric tapping sound; low-pitched diaphragm]
- 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. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (strongly attenuated or absent: in case of pulmonary emphysema, pleural effusion, pneumothorax). 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]
- Auscultation (listening) of the lungs [in- and expiratory (during inhalation and exhalation): decreased breathing sound/attenuated breathing sound; the so called “silent lung”
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
