Tetanus: Examination

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 and mucous membranes [hyperhidrosis (increased sweating)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Muscle assessment; increase in cramps with external influences?
      • [painful persistent muscle spasms (usually starting at the temporomandibular joint (TMJ).
      • Twitching muscle spasms
      • Rigidity (muscle stiffness, confined to one area or spreading from the shoulder region)]
    • Auscultation (listening) of the heart [tachycardia (heartbeat too fast: > 100 beats per minute); bradycardia (heartbeat too slow: < 60 beats per minute)); arrhythmias (cardiac arrhythmias)]
    • Examination of the lungs (due topossible secondary diseases).
      • Auscultation (listening) of the lungs [dyspnea (shortness of breath due to stiffening of the respiratory muscles)]
      • 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 doctor 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 (check 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]
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, tapping pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing tapping pain?) [acute abdomen (severe abdominal pain with unclear cause)]
  • Neurological examination – including checking motor and sensory function, testing for muscle rigidity [due todifferential diagnoses: encephalitides (brain inflammation); meningitides (meningitis)]

Square brackets [ ] indicate possible pathological (pathological) physical findings.