Vasculitides: 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, mucous membranes, and sclerae (white part of the eye) [eyelid, lower leg edema (water retention); exophthalmos (protrusion of the eye from the orbit); exanthem (rash); Skin changes such as palpable purpura (small-spot capillary bleeding in the skin, subcutis (subcutaneous tissue) or mucous membranes (skin hemorrhage)), petechial hemorrhage (pinpoint skin hemorrhage), necrosis (tissue breakdown), subcutaneous nodules; ulcers (ulcers); palmar erythema (redness of the palms); stomatitis (inflammation of the mouth) with a strawberry tongue]
      • Gait pattern [gait unsteadiness, arthralgia (joint pain), myalgia (muscle pain)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart.
    • Examination of the lungs
      • Auscultation (listening) of the lungs
      • 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]
      • Percussion (tapping) of the lungs [e.g., in emphysema; box tone in pneumothorax]
      • 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. 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). 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]
    • Examination of the abdomen (abdomen)
      • Auscultation of the abdomen [vascular or stenotic sounds?, bowel sounds?]
      • Percussion (tapping) of the abdomen.
        • [Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
      • Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?).
    • Palpation of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral musculature); soft tissue swelling; tenderness (localization! ; restricted mobility (spinal movement restrictions); “tapping signs” (testing painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain? ; compression pain, anterior, lateral or saggital; hyper- or hypomobility?
    • Palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; tenderness (localization!).
    • Palpation of lymph nodes [cervical lymphadenopathy (enlargement of the lymph nodes of the neck)]
  • Ophthalmological examination – in case of visual disturbances, red eye, etc.
  • ENT medical examination – because of possible symptoms: chronic otitis media (inflammation of the middle ear), chronic bloody-crusty nasal mucosa inflammation, inflammation of the throat/salivary glands, mastoiditis (mastoid process inflammation; purulent inflammation of the bone behind the ear), rhinitis (inflammation of the nasal mucosa), septal perforation (hole in the nasal septum), sinusitis (sinusitis), ulcerations (ulcers) in the oropharynx (oral pharynx).
  • Neurological examination – including reflex testing, verification of motor function, sensitivity.

Square brackets [ ] indicate possible pathological (pathological) physical findings. For disease-related information, see under the appropriate disease.