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 and mucous membranes
- Inspection and palpation (palpation) of the neck [due topossible differential diagnosis: goiter (thyroid enlargement); tumors of the thyroid].
- Examination of the lungs
- Auscultation (listening) of the lungs [whistling breath sound occurring on inspiration and/or expiration (inspiratory/expiratory stridor); acute airway obstruction in the extrathoracic (outside the chest) region; bronchial asthma; chronic airway obstruction in the extrathoracic (outside the chest) region; tracheal stenosis (tracheal narrowing); foreign body aspiration]
- 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]
- 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.g. 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 (attenuated: e.g. atelectasis, pleural rind; strongly attenuated or absent: in case of pleural effusion, pneumothorax, pulmonary emphysema). As a result, 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).
- ENT medical examination [due topossible differential diagnoses:
- Diphtheria (true croup)
- Epiglottitis (inflammation of the epiglottis)
- Glottic edema – swelling of the voice-forming laryngeal portion.
- Laryngospasm (glottis spasm) – spasmodic closure of the larynx, leading to acute respiratory distress.
- Pseudocroup – laryngitis caused by viruses.
- Vocal cord paralysis (recurrent paresis), unspecified]
Square brackets [ ] indicate possible pathologic (pathological) physical findings.
