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; furthermore:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye) rash with formation of vesicles (zoster vesicles; also possible without efflorescence) in the affected dermatome/skin area, which is autonomously supplied by the sensitive fibers of a spinal nerve root/spinal cord root; possible localizations are face and eyes (zoster ophthalmicus), auditory canal (zoster oticus), jaw (zoster maxillaris), genital area (zoster genitalis)]
- Examination of the lungs (due topossible secondary diseases).
- 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]
- Inspection (viewing).
- Neurological examination – including testing of sensitivity, motor and cranial nerve functions; also reflexes and coordination should be checked [due topossible sequelae:
- Acute neuritis (inflammation of the nerves).
- Ascending myelitis (inflammation of the spinal cord) with or without paralysis.
- Meningoencephalitis (combined inflammation of the brain (encephalitis) and meninges (meningitis)).
- Postherpetic neuralgia (nerve pain after herpes zoster disease).
- Sensory disturbances within the affected dermatome (segmental area of skin innervated by a spinal cord nerve)]
Square brackets [ ] indicate possible pathologic (pathological) physical findings.
