Pneumonia physical examination

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:^[1]^[2]^[3]

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**^[4]
Age	Breaths/min

< 2 months	> 60
2-12 months	> 50
1- 5 years	> 40
> 5 years	> 20

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.

References

↑ Musher, Daniel M.; Thorner, Anna R. (2014). “Community-Acquired Pneumonia”. New England Journal of Medicine. 371 (17): 1619–1628. doi:10.1056/NEJMra1312885. ISSN 0028-4793.
↑ “WHO Pneumonia Fact Sheets”.
↑ Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). “Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults”. Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
↑ Russell, G. (2001). “Community acquired pneumonia”. Archives of Disease in Childhood. 85 (6): 445–446. doi:10.1136/adc.85.6.445. ISSN 0003-9888.

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[MusherThorner2014-1] Musher, Daniel M.; Thorner, Anna R. (2014). “Community-Acquired Pneumonia”. New England Journal of Medicine. 371 (17): 1619–1628. doi:10.1056/NEJMra1312885. ISSN 0028-4793.

[2] “WHO Pneumonia Fact Sheets”.

[MandellWunderink2007-3] Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). “Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults”. Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.

[Russell2001-4] Russell, G. (2001). “Community acquired pneumonia”. Archives of Disease in Childhood. 85 (6): 445–446. doi:10.1136/adc.85.6.445. ISSN 0003-9888.

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