Tobacco Dependence: Examination

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).
      • Of the skin, mucous membranes, pharynx (throat) and sclerae (white part of the eye) [due topossible sequelae: pharyngitis (pharyngitis), tonsillitis (tonsillitis)].
      • Extremities [cold, in nicotine intoxication: muscle tremors].
    • Auscultation (listening) of the heart [tachycardia (too fast heartbeat: > 100 beats per minute)] [due topossible sequelae: Extrasystoles (heart stuttering; additional heartbeats), heart failure (heart failure), atrial fibrillation (VHF)]
    • Examination of the lungs (due topossible secondary diseases):
      • Auscultation (listening) of the lungs [bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD)].
      • 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, 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]
      • Voice fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice, 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 (e.g., 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, 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]
  • Cancer screening [due topossible secondary diseases:
    • Bronchial carcinoma (lung cancer).
    • Cervical carcinoma (cancer of the cervix)
    • Urinary bladder carcinoma (bladder cancer)
    • Hypernephroma (renal cell carcinoma).
    • Carcinoma of the oral cavity
    • Carcinoma of the paranasal sinuses
    • Colon carcinoma (cancer of the large intestine)
    • Laryngeal carcinoma (cancer of the larynx)
    • Leukemia – acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML).
    • Gastric carcinoma (stomach cancer)
    • Mammary carcinoma (breast cancer)
    • Esophageal carcinoma (cancer of the esophagus)
    • Pancreatic carcinoma (cancer of the pancreas)
    • Squamous cell carcinoma of the skin]
  • Ophthalmologic examination [due topossible sequelae:
    • Cataract (“cataract”)
    • Keratoconjunctivitis sicca (dry eyes)
    • Macular degeneration]
  • Dermatological examination [due topossible secondary diseases:
    • Alopecia (hair loss)
    • Cellulite
    • Nail psoriasis (nail psoriasis)
    • Psoriasis (psoriasis)
    • Premature aging of the skin]
  • ENT medical examination [due topossible secondary diseases:
    • Dysacusis (hearing disorder).
    • Hearing loss
    • Meniere’s disease (disease of the inner ear)
    • Otitis media (inflammation of the middle ear)]
  • Neurological examination [due tosymptom in nicotine poisoning: seizures][due topossible sequelae:
    • Dementia
    • Diabetic polyneuropathy – secondary disease of diabetes mellitus (diabetes), which leads to chronic disorders of peripheral nerves or parts of nerves. This results in sensory disturbances in the affected regions of the body.
    • Migraine
    • Alzheimer’s disease
    • Transient ischemic attack (TIA)]
  • Psychiatric examination [due topossible sequelae: insomnia (sleep disorders)]
  • Urological examination [due topossible sequelae: chronic renal insufficiency (kidney weakness)]
  • Health check

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