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) [leading symptom: small-spot exanthema (rash) that begins on the face and spreads over the body – persists for one to three days; enanthema on the soft palate; conjunctivitis (inflammation of the conjunctiva), jaundice]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Inspection and palpation of lymph node stations [lymphadenopathy (lymph node enlargement)?]
- Examination of the lungs (symptom or possible sequelae).
- 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 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 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 several times in a low voice the word “99”, 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]
- Abdominal (stomach) examination [hepatosplenomegaly (liver and spleen enlargement?]
- 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).
- Ophthalmological examination [due topossible secondary diseases:
- Glaucoma (“green star”, intraocular pressure increase).
- Cataract (“cataract”, clouding of the lens of the eye).
- Myopia (nearsightedness)
- Retinopathy (diseases of the retina of the eye)]
- Gynecological examination in existing pregnancy [due topossible sequelae: (abortion (miscarriage), low birth weight].
- Neurological examination [due topossible sequelae:
- Mental retardation (mental developmental disorders).
- Autism (developmental disorders with perceptual and information processing disorder).
- Epilepsy (seizures)
- Paralysis
- Meningoencephalitis (combined inflammation of the brain (encephalitis) and meninges (meningitis)).
- Microcephalus (head that has a comparatively small size; the circumference of the head in this case is three standard deviations smaller than the mean for a person of the same age and sex)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
