During anamnesis (from ancient Greek. αναμνησις, anámnesis = memory) – taking a medical history – the history of a patient is carefully examined with reference to current symptoms. A detailed medical history includes biological, psychological, and social aspects. This gathered information often permits conclusions regarding risk factors and causal relationships. The anamnesis does not have a direct therapeutic goal, although talking about and clarifying the issues may have a salutary effect.

The history is usually taken before physical examination takes place, but in an emergency immediate treatment is required and taking the medical history is postponed. The goal of the accurate medical history is to narrow down the possible differential diagnoses. This process of elimination is based on key symptoms and exclusion criteria. Following the medical history, further investigations are often necessary to effectively diagnose a medical condition.

Even without technical instruments, an examiner is able to obtain orientation on individual organs and their projection onto the body surface of the patient through practice. Auscultation (to auscultate originates from the Latin word “auscultare” and means listening) is part of the physical examination and includes the listening to the sounds of the organs typically done with a stethoscope. Percussion (to percuss originates from the Latin word “percutare” and means to beat or shake) is performed for diagnostic purposes and involves tapping the body surface of the patient. Percussion induces vibrations of the tissue beneath the surface of the body. The resulting sounds provide information about the state of the tissue. Thus, the size and position of an organ (e.g. liver) or the air content of the tissue (e.g. lung) can be assessed.

Through knowledge of the projection of the internal organs onto the body surface, disease specific symptoms can already be linked to organs during physical examination. In addition to the patient’s history, first clues of the diseased organ(s) involved can be deduced. For example, appendicitis (inflammation of the appendix [Appendix vermiformis]) is usually accompanied by discomfort in the right lower abdomen.

The fracture of a bone leads to the formation of two or more fragments with or without dislocation. Apart from pain, true signs are abnormal mobility, grinding sounds with movement (crepitation), axis misalignment, an initial muscle stupor (lack of muscle activity), and corresponding radiograph findings. Ideally, healing of a fracture involves complete immobilization and weight-bearing restrictions. Successful healing of a fracture is achieved when the formerly injured bone regains its full weight-bearing capacity and long bones have reformed the medullary cavity. The primary fracture healing exclusively occurs with narrow, irritation-free fracture gaps and does not involve callus formation, as is achieved surgically by osteosynthesis with plates and screws for optimal alignment of fractured ends. As part of the primary fracture healing, the fracture gap is bridged by capillaries from opened HAVERS’ canals which are surrounded by osteons spanning the gap. The secondary fracture healing often forms a slightly thicker callus which is gradually converted into functional bone mass.

For treatment plans and the prognosis of orthopaedic diseases and deformities during childhood, the determination of skeletal age and any existing growth reserves are of great importance.

From a functional viewpoint, passive and active musculoskeletal systems can be distinguished:

In many parts of the body, large and medium-sized arteries run near the body surface. The pulse can be felt by pressing the artery against a harder underlying structure. The most distal palpable pulse and thus farthest from the heart is the pulse of the A. dorsalis pedis on the dorsum of the foot. The examination of the arterial pulse reveals many clues about the frequency of the heartbeat, differences of blood flow in the upper and lower extremity, and holds general clues about the circulation of the blood in a particular body section.

In patients with liver cirrhosis significantly less blood flows through the liver due to higher resistance of the liver and therefore increased portal vein pressure. Bypassing the liver, the remainder of the blood flows through portocaval anastomoses directly into the systemic circulation. However, the veins in the anastomosis region are structurally not well suited to accommodate the increased blood flow and will form varicose veins. This can lead to oesophageal varices in the region of the gastro-oesophageal junction, to the rare formation of a Caput medusae (Medusa head) in the region of para-umbilical veins, or it can result in the occurrence of varicose veins in the anal canal. Especially oesophageal varices can easily be injured during food uptake and cause life-threatening haemorrhages.

The examination of lymph nodes is an important aspect of the physical examination of a patient. The examination includes the palpable lymph nodes of the neck, the axilla, and the groin. The enlargement of lymph nodes can be a sign of inflammation (lymphadenitis) or malignant disease (e.g. metastasis of a malignant tumour or a generalized disorder of the lymphatic system such as HODGKIN’s disease).

Excessive alcohol consumption, Diabetes mellitus, vitamin B deficiency, intoxication with heavy metals and drugs as well as impaired blood perfusion can result in disturbances of peripheral nerves. This can lead to palsy or excessive excitation of nerve cells (neurons). Polyneuropathy resembles a clinical scenario in which many nerves are affected.

Disorders of the autonomic nervous system play a role in almost all medical disciplines. These disorders can present as separate diseases (e.g. hereditary autonomic neuropathy), as a consequence of other diseases (e.g. autonomic neuropathy in diabetes mellitus or PARKINSON’s disease), or in response to external conditions and other disorders (e.g. autonomic dysregulation due to stress, severe pain, or psychiatric disorders). Depending on the affected region of the autonomic nervous system, disorders of the circulatory system, digestion, sexual function, or other functions may prevail.

White spots under nails are due to defective fusion of the nail plate with the nail bed. Changes in light reflection at these points cause the nail plate to appear milky-white (similar to the Lunula). The lack of fusion may have different reasons, for example it occurs through physical trauma, it may result from certain medication, or it is linked to various diseases. Brittle nails signal lack of biotin (vitamin H). Biotin is required for the formation of keratin, the main component of the nail plate. Numerous systemic diseases are associated with nail changes. For example, psoriasis leads to the formation of small pits, oily spots and sometimes crumbly nails up to a complete nail dystrophy. Following skin and nail injuries, the nail can be colonized by fungi (onychomycosis). Treatment of fungal infections of the toenails is often lengthy.

The dermo-epidermal connection is ensured by a number of different proteins and structures which are responsible for the adhesion mechanisms between these two zones. Genetic defects of some of these proteins and structures lead to injuries inflicted by shear forces resulting in cracks which may be associated with the formation of blisters (Bullae) and, in some cases, involve large detachment of the epidermis. Detachment of epidermis can also be caused by auto-antibodies against components of adhesive structures (bullous pemphigoid, pemphigus).