Tuberculosis: 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 [weight loss!]; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes, and sclerae (white part of eye) [pallor, drumstick fingers (distension of finger end links); sweaty/increased sweating; anemia (anemia)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Examination of the lungs
      • Auscultation (listening) of the lungs [dyspnea (shortness of breath)]
      • 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 transmission due to pulmonary infiltration/compaction of lung tissue (e.g. in pneumonia) (differential diagnosis/possible sequelae) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated or absent): e.g. in pleural effusion (differential diagnosis/possible sequelae), pulmonary emphysema (differential diagnosis). The result is, the number “66” is barely audible over the diseased lung area to absent, because the high-frequency sounds are strongly attenuated]
      • Percussion (tapping) of the lungs [e.g., in emphysema (differential diagnosis)]
      • Vocal fremitus (checking the transmission 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. in pneumonia) (differential diagnosis/possible sequelae) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (strongly attenuated or absent: in pleural effusion (differential diagnosis/possible sequelae), pulmonary emphysema (differential diagnosis). 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]
    • Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)

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