Pneumonia: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, respiratory rate, body temperature, body weight, body height, and assessment of level of consciousness; furthermore:
  • Inspection (viewing).
    • Skin and mucous membranes [profuse sweating; central cyanosis (possible/blue-red coloration of skin and central mucous membranes/tongue due to lack of oxygen in blood)]
    • Abdomen (abdomen)
      • Shape of the abdomen?
      • Skin color? Skin texture?
      • Efflorescences (skin changes)?
      • Pulsations? Bowel movements?
      • Visible vessels?
      • Scars? Hernias (fractures)?
  • Auscultation (listening) of the heart [due topossibly accompanying myocarditis (inflammation of the heart muscle)].
  • Examination of the lungs
    • Auscultation (listening) of the lungs [decreased breath sound; inspiratory: fine-bubble rales (RG), unilateral or bilateral/no RGs in atypical pneumonia; overall: low diagnostic sensitivity (percentage of diseased patients in whom the disease is detected by the examination method, ie. i.e., a positive finding occurs) 47-69% and specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy by the examination) 58-75%]
    • Bronchophony (testing of 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. 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, pulmonary 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 [e.g., in emphysema].
    • Voice fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the doctor places his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of decreased sound conduction (severely attenuated or absent: in pleural effusion, 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 (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
• Neurological examination [due topossible sequelae: meningitis (meningitis)]

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
• Blood pressure (blood pressure less than 90 mmHg systolic or less than 60 mmHg diastolic and
• Age (age) > 65 years

From this, estimates of lethality can be derived. Prognosis score CRB-65 score

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.
• Regarding the “risk of needing intensive medical therapy for community-acquired pneumonia,” see Pneumonia/Consequelae below.