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).
- Skin, mucous membranes, and sclerae (white part of eye) [dry mucous membranes? visible or palpable edema/water retention of lower extremity? in bedridden patients of dorsal (back) pelvic region]
- Examination of the lungs (dyspnea (shortness of breath); if pulmonary edema/water retention in the lungs is suspected):
- Auscultation (listening) of the lungs [tachypnea (> 20 breaths/min); exacerbated breath sound; inspiratory: bds. moist rales (RGs)/coarse-bubble rales; in severe cases audible even without stethoscope (“bubbling of the lungs”); breath sound is attenuated].
- 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 (eg. 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 [the tapping sound is normal to muffled].
- 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., 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). 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]
- Palpation (palpation) of the abdomen (abdomen), etc. [due topossible causes: Ileus (intestinal obstruction); pancreatitis (pancreatitis)]
- Inspection (viewing).
- Neurologic examination [due topossible symptoms: cephalgia (headache); somnolence (impaired consciousness); convulsions]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
