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; further:
- Inspection (viewing).
- Skin, mucous membranes, sclerae (white part of the eye).
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Auscultation 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
- Vocal fremitus (checking the transmission 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.g. 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]
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
Clinical assessment by prognostic score
The CRB-65 and CURB-65 prognosis scores have proven useful for estimating prognosis.
In the CRB-65, 1 point is given for each of the following possible symptoms:
- Confusion.
- Respiratory rate > 30/min [see also on respiratory rate under sequelae/prognostic factors].
- Blood pressure (blood pressure) (below 90 mmHg systolic or below 60 mmHg diastolic and
- Age (age) > 65 years
From this, estimates of lethality can be derived.
Prognosis score CRB-65 score
| CRB-65 score | Lethality risk | Measure |
| 0 | 1-2 % | Outpatient therapy |
| 1-2 | 13 % | Weigh inpatient therapy, usually required |
| 3-4 | 31,2 % | Intensive medical therapy |
Further notes
