Pneumonia Examination

## History

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* 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

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### Inspection

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

cough

### palpation

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

### percussion

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*     * dull
* decreased diaphragmatic excursion

### auscultation

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*     * 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

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* 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

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* Lung Sounds  Breath sound recordings, waveforms and lesson notes

## Other OSCE modules

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* v
* t
* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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