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 and sclerae (white part of the eye).
- Auscultation (listening) of the heart.
- Examination of the lungs
- Auscultation (listening) of the lungs [due tocauses: Bronchial asthma?; Chronic obstructive pulmonary disease (COPD)?]
- Bronchophony (checking the transmission 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 transmission due to pulmonary infiltration/compaction of lung tissue (e.g. in pneumonia) (differential diagnosis) 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 (differential diagnosis), emphysema (possible sequelae)). The result is, the number “66” is barely audible over the diseased lung area to absent, because the high-frequency sounds are strongly attenuated]
- Percussion (tapping) of the lungs [e.g., in emphysema (possible sequelae)]
- 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. in pneumonia) (differential diagnosis) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (strongly attenuated or absent: in case of pleural effusion (differential diagnosis), pulmonary emphysema (possible sequelae)). 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 (abdomen) (tenderness?, tapping pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing tapping pain?) [abdominal pain (abdominal pain)?] [differential diagnosis: appendicitis (appendicitis)]
- Inspection (viewing).
- ENT medical examination – if sinusitis (sinusitis) or otitis media (otitis media) is suspected.
- Neurological examination – with testing of motor function and sensitivity in suspected meningitis (meningitis) or brain abscess (encapsulated collection of pus in the area of the brain).
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 (breathing 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
- Regardless of the outcome of the above prognostic score, patients with severe concomitant disease should be hospitalized at the onset of pneumonia because worsening of the underlying disease is expected.
