History and exam

Key diagnostic factors

common

dyspnea

A localized symptom that can also have a long differential, so although it is present in most cases of HAP, other serious diagnoses (e.g., pulmonary embolism) should be considered.

productive cough

A localized symptom that can be relative to a patient's baseline cough status. For example, patients with COPD often have a baseline cough with a white sputum production.

HAP is often accompanied by a cough with thick yellow or green sputum.

fever

A systemic sign of a possible infection, but not specific for HAP. Fever has a low specificity and high sensitivity for HAP. Critically ill patients may actually present with hypothermia.

Other diagnostic factors

common

chest pain

A localized symptom that may be present as a result of pleural involvement of HAP, or secondary to intercostal muscle overuse after persistent coughing.

asymmetric expansion of the chest

This may be noted with a suppressed motion on the side of the pneumonia. This sign is less likely to be appreciated in bilateral pneumonia.

diminished resonance

Resonance, noted by palpating a patient's chest while he or she speaks "99", may also be diminished on the side of the pneumonia. This sign is less likely to be appreciated in bilateral pneumonia.

egophony

A localizing sign auscultated over the affected area of the lung. A change in the sound of a patient's voice. When asked to make "eee" sound, it is heard as "aaa."

whisper pectoriloquy

A localizing sign auscultated over the affected area of the lung. Referred to when a whisper is heard clearly and loudly while auscultating over the affected part of lung.

crackles or rhonchi

Localizing sign auscultated over the affected area of the lung.

tachycardia

Can be a localized or a systemic sign with a high specificity and low sensitivity for HAP. General fever can cause tachycardia, but if a pericardial effusion associated with HAP is present, tachycardia may be due to a more localized cause.

malaise/anorexia

Systemic symptoms that are common in HAP, but nonspecific.

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