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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
[[Physical examination]] may reveal [[fever]] or sometimes [[hypothermia|low body temperature]], an [[tachypnea|increased respiratory rate]], [[hypotension|low blood pressure]], a [[tachycardia|fast heart rate]], or a low [[oxygen saturation]], which is the amount of oxygen in the blood as indicated by either [[pulse oximetry]] or [[arterial blood gas|blood gas analysis]]. Patients who have difficulty breathing, who are confused, or who have [[cyanosis]] (blue-tinged skin) require immediate attention. [[Auscultation]] findings include lack of normal breath sounds, the presence of crackling sounds ([[rales]]), or increased loudness of whispered speech (whispered pectoriloquy) with areas of the lung that are stiff and full of fluid, called consolidation. Vital signs are useful in determining the severity of illness and have predictive values. However, a high degree of suspicion should be kept in elderly as the presentation could be subtle in them.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].


OR
The physical exam findings for pneumonia are as follows:<ref name="MusherThorner2014">{{cite journal|last1=Musher|first1=Daniel M.|last2=Thorner|first2=Anna R.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=371|issue=17|year=2014|pages=1619–1628|issn=0028-4793|doi=10.1056/NEJMra1312885}}</ref><ref>{{cite web|url=http://www.who.int/mediacentre/factsheets/fs331/en/|title= WHO Pneumonia Fact Sheets}}</ref><ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=L. A.|last2=Wunderink|first2=R. G.|last3=Anzueto|first3=A.|last4=Bartlett|first4=J. G.|last5=Campbell|first5=G. D.|last6=Dean|first6=N. C.|last7=Dowell|first7=S. F.|last8=File|first8=T. M.|last9=Musher|first9=D. M.|last10=Niederman|first10=M. S.|last11=Torres|first11=A.|last12=Whitney|first12=C. G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement 2|year=2007|pages=S27–S72|issn=1058-4838|doi=10.1086/511159}}</ref>


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Physical examination of patients with pneumonia is usually remarkable for: shortness of breath, cough, fever, and difficulty breathing.
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with pneumonia usually appear normal or in distress.  


===Vital Signs===
===Vital Signs===
 
{|style="float:right"
*High-grade / low-grade fever
|
*[[Hypothermia]] / hyperthermia may be present
{| style="border: 0px; font-size: 85%; margin: 3px; width:200px;" align=center
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
|valign=top|
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
|+ '''Criteria for Tachypnea'''<ref name="Russell2001">{{cite journal|last1=Russell|first1=G.|title=Community acquired pneumonia|journal=Archives of Disease in Childhood|volume=85|issue=6|year=2001|pages=445–446|issn=00039888|doi=10.1136/adc.85.6.445}}</ref>
*Tachypnea / bradypnea
! style="background: #4479BA; color:#FFF;  width: 100px;" | Age
*Kussmal respirations may be present in _____ (advanced disease state)
! style="background: #4479BA; color:#FFF;  width: 100px;" | Breaths/min
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
|-
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  < 2 months
| style="padding: 5px 5px; background: #F5F5F5;" | > 60
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  2-12 months
| style="padding: 5px 5px; background: #F5F5F5;" | > 50
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  1- 5 years
| style="padding: 5px 5px; background: #F5F5F5;" | > 40
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  > 5 years
| style="padding: 5px 5px; background: #F5F5F5;" | > 20
|}
|style="width: 600px"|         
|}
* [[Decreased oxygen saturation]]
* [[Fever]]
* [[Hypotension]] < 90 mm Hg
* [[Tachycardia]] > 125 beats/min
* [[Tachypnea]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with pneumonia is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with pneumonia is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with pneumonia is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
====Palpation====
OR
* Increased tactile fremitus
* Asymmetric chest expansion OR decreased chest expansion
 
*Lungs are hyporesonant OR hyperresonant
====Percussion====
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Dullness on percussion
*Rhonchi
 
*Vesicular breath sounds OR distant breath sounds
====Auscultation====
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
* Decreased breath sounds
*[[Wheezing]] may be present
* Bronchial breath sounds
*[[Egophony]] present/absent
* [[Rhonchi]]
*[[Bronchophony]] present/absent
* Crackles, [[Rales]]
*Normal/reduced [[tactile fremitus]]
* Increased [[vocal fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with pneumonia is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
Abdominal examination of patients with pneumonia is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with pneumonia is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with pneumonia is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with pneumonia is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with pneumonia is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{reflist|2}}
 
[[Category:Pneumonia]]
[[Category:Pulmonology]]


{{WH}}
[[Category:Emergency medicine]]
{{WS}}
[[Category:Pediatrics]]
[[Category: (name of the system)]]
[[Category:Disease]]
[[Category:primary care]]

Revision as of 07:38, 18 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Physical examination may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. Patients who have difficulty breathing, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention. Auscultation findings include lack of normal breath sounds, the presence of crackling sounds (rales), or increased loudness of whispered speech (whispered pectoriloquy) with areas of the lung that are stiff and full of fluid, called consolidation. Vital signs are useful in determining the severity of illness and have predictive values. However, a high degree of suspicion should be kept in elderly as the presentation could be subtle in them.

Physical Examination

The physical exam findings for pneumonia are as follows:[1][2][3]

  • Physical examination of patients with pneumonia is usually remarkable for: shortness of breath, cough, fever, and difficulty breathing.

Appearance of the Patient

  • Patients with pneumonia usually appear normal or in distress.

Vital Signs

Criteria for Tachypnea[4]
Age Breaths/min
< 2 months > 60
2-12 months > 50
1- 5 years > 40
> 5 years > 20

Skin

  • Skin examination of patients with pneumonia is usually normal.

HEENT

  • HEENT examination of patients with pneumonia is usually normal.

Neck

  • Neck examination of patients with pneumonia is usually normal.

Lungs

Palpation

  • Increased tactile fremitus

Percussion

  • Dullness on percussion

Auscultation

Heart

  • Cardiovascular examination of patients with pneumonia is usually normal.

Abdomen

Abdominal examination of patients with pneumonia is usually normal.

Back

  • Back examination of patients with pneumonia is usually normal.

Genitourinary

  • Genitourinary examination of patients with pneumonia is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with pneumonia is usually normal.

Extremities

  • Extremities examination of patients with pneumonia is usually normal.

References

  1. ↑ Musher, Daniel M.; Thorner, Anna R. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 371 (17): 1619–1628. doi:10.1056/NEJMra1312885. ISSN 0028-4793.
  2. ↑ "WHO Pneumonia Fact Sheets".
  3. ↑ Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
  4. ↑ Russell, G. (2001). "Community acquired pneumonia". Archives of Disease in Childhood. 85 (6): 445–446. doi:10.1136/adc.85.6.445. ISSN 0003-9888.
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