Pneumonia Examination

History

 * cough
 * productive?
 * amount
 * color
 * odor/taste
 * hemoptysis
 * fever, chills, rigors, SOB, chest pain (worse on inspiration), diaphoresis
 * travel, infectious exposure, medications, EtOH
 * underlying conditions: smoker, diabetes, cystic fibrosis, immunocomprimised, asthma, COPD, TB

Inspection
cough
 * ill-looking
 * SOB
 * diaphoresis
 * chills/rigors
 * respiratory distress

palpation

 * decreased chest expansion or asymetry
 * lymphadenopathy
 * increased tactile fremitus

percussion

 * dull
 * decreased diaphragmatic excursion

auscultation

 * bronchial breath sounds in periphery
 * decreased air entry
 * crepitations ( coarse crackles )
 * bronchophony -voice heard abnormally clearly over consolidated lung
 * egaphony - listen to patient's chest as they make "e" sound, if +'ve will hear an "a" sound
 * whispering pectoriloquay - pt whispers "1, 2, 3, 4", if clear then extreme consolidation

Investigations to order

 * CBC
 * Blood cultures
 * mantoux (TB)
 * serology (mycoplasma, viruses)
 * sputum
 * gram stain, C&S
 * CXR
 * typical: discrete/lobar consolidation, air bronchograms
 * atypical: diffuse/patchy/interstitial infiltrates

External link

 * Lung Sounds Breath sound recordings, waveforms and lesson notes