Archive: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

Physical Exam:

• inspection
  • ill-looking
  • SOB
  • diaphoresis
  • chills/rigors
  • respiratory distress
• palpation
  • decreased chest expansion or asymetry
  • lymphadenopathy
  • tactile fremitus
• percussion
  • dull
  • decreased diaphragmatic excursion
• auscultation
  • bronchial breath sounds in periphery
  • decreased air entry
  • crepitations
  • 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