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 (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes [hematoma or ecchymosis/small patchy hemorrhage at site of force, if applicable].
- Body or joint posture (upright, bent, relieving posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation).
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Palpation (palpation) of the vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of the paraverebral muscles); soft tissue swelling; tenderness (localization! ; restricted mobility (movement restrictions of the spine); “tapping signs” (testing the painfulness of the spinous processes, transverse processes, as well as the costotransverse joints (vertebral-rib joints) and the back muscles) [pressure and compression pain in the affected thoracic segment; possibly also crepitation / audible and palpable crackling sounds when friction of fragments during movement].
- Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion?); soft tissue swelling; pressure pain (localization!).
- Examination of the lungs
- Auscultation (listening) of the lungs [dyspnea/breathlessness, if necessary].
- 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 physician 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 case of decreased sound conduction (attenuated or absent): e.g., in pleural effusion, pneumothorax, emphysema). 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 [e.g., in emphysema; box tone in pneumothorax]
- Vocal fremitus (checking the transmission of low frequencies; the 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., in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: in pleural effusion, pneumothorax, emphysema). 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]
- Palpation of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
