Pneumonia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Priyamvada Singh, M.D. [3]

Overview

Physical examination may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. Patients who have difficulty breathing, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention. Auscultation findings include lack of normal breath sounds, the presence of crackling sounds (rales), or increased loudness of whispered speech (whispered pectoriloquy) with areas of the lung that are stiff and full of fluid, called consolidation. Vital signs are useful in determining the severity of illness and have predictive values. However, a high degree of suspicion should be kept in elderly as the presentation could be subtle in them.

Physical Examination

The physical exam findings for pneumonia are as follows:

• Physical examination of patients with pneumonia is usually remarkable for: shortness of breath, cough, fever, and difficulty breathing.

Appearance of the Patient

• Patients with pneumonia usually appear normal or in distress.

Vital Signs

Criteria for Tachypnea Age Breaths/min < 2 months > 60 2-12 months > 50 1- 5 years > 40 > 5 years > 20

• Decreased oxygen saturation
• Fever
• Hypotension < 90 mm Hg
• Tachycardia > 125 beats/min
• Tachypnea

Skin

• Skin examination of patients with pneumonia is usually normal.

HEENT

• HEENT examination of patients with pneumonia is usually normal.

Neck

• Neck examination of patients with pneumonia is usually normal.

Lungs

Palpation

• Increased tactile fremitus

Percussion

• Dullness on percussion

Auscultation

• Decreased breath sounds
• Bronchial breath sounds
• Rhonchi
• Crackles, Rales
• Increased vocal fremitus

Heart

• Cardiovascular examination of patients with pneumonia is usually normal.

Abdomen

Abdominal examination of patients with pneumonia is usually normal.

Back

• Back examination of patients with pneumonia is usually normal.

Genitourinary

• Genitourinary examination of patients with pneumonia is usually normal.

Neuromuscular

• Neuromuscular examination of patients with pneumonia is usually normal.

Extremities

• Extremities examination of patients with pneumonia is usually normal.