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) of the skin, mucous membranes, and sclerae (white part of the eye).
- [Erythema nodosum (nodular erythema), localization: both extensor sides of the lower leg, on the knee and ankle joints; less commonly on the arms or buttocks
- Red-brownish papules (from Latin papula “vesicle” or nodule).
- Lupus pernio (large nodular form of sarcoidosis; extensive, livid infiltration of nose, cheeks, earlobes).
- Cicatricial sarcoidosis (yellow-brownish changes on scars).
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)]
- Inspection and palpation (palpation) of the lymph node stations (biopsy/tissue collection if necessary; especially the hilar lymph nodes).
- Auscultation (listening) of the heart
- Examination of the lungs
- Auscultation (listening) of the lungs
- Bronchophony (checking the conduction 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. 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 [eg. E.g. hypersonoric tapping sound in bronchial asthma, emphysema; box tone in pneumothorax]
- Vocal fremitus (testing of 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., pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; with decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: with 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]
- Examination of the abdomen
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers.
- [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]
- Palpation of the abdomen (tenderness?, tapping pain?, coughing pain?, guarding tension?, hernial orifices?, renal bearing tapping pain?).
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers.
- Inspection (viewing) of the skin, mucous membranes, and sclerae (white part of the eye).
- Ophthalmological examination – if eye involvement is suspected.
- Dermatological examination – in case of skin involvement
- Neurological examination – in case of suspected involvement of the central nervous system.
- Orthopedic examination – in case of joint inflammation.
Square brackets [ ] indicate possible pathological (pathological) physical findings.
