Pneumonia Examination
Appearance
History
[edit | edit source]- cough
- productive?
- amount
- color
- odor/taste
- hemoptysis
- productive?
- fever, chills, rigors, SOB, chest pain (worse on inspiration), diaphoresis
- travel, infectious exposure, medications, EtOH
- underlying conditions: smoker, diabetes, cystic fibrosis, immunocomprimised, asthma, COPD, TB
Physical Exam
[edit | edit source]Inspection
[edit | edit source]- ill-looking
- SOB
- diaphoresis
- chills/rigors
- respiratory distress
cough
palpation
[edit | edit source]- decreased chest expansion or asymetry
- lymphadenopathy
- increased tactile fremitus
percussion
[edit | edit source]- dull
- decreased diaphragmatic excursion
auscultation
[edit | edit source]- bronchial breath sounds in periphery
- decreased air entry
- crepitations ( coarse crackles )
- bronchophony -voice heard abnormally clearly over consolidated lung
- egaphony - listen to patient's chest as they make "e" sound, if +'ve will hear an "a" sound
- whispering pectoriloquay - pt whispers "1, 2, 3, 4", if clear then extreme consolidation
Investigations to order
[edit | edit source]- CBC
- Blood cultures
- mantoux (TB)
- serology (mycoplasma, viruses)
- sputum
- gram stain, C&S
- CXR
- typical: discrete/lobar consolidation, air bronchograms
- atypical: diffuse/patchy/interstitial infiltrates
External link
[edit | edit source]- Lung Sounds Breath sound recordings, waveforms and lesson notes