COVID-19 physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Syed Hassan A. Kazmi BSc, MD [3]; Javaria Anwer M.D.[4]

Synonyms and keywords:COVID physical exam, SARS CoV2 physical exam, SARS CoV2 physical examination, COVID-19 physical findings.


COVID-19 is a rapidly evolving situation and a heterogenous disease entity. A suspected or confirmed CVOVID-19 patient can have as common finding as fever and as unique yet significant finding as anosmia. Although, the common physical examination findings among patients infected with coronavirus include fever, cough, and shortness of breath.[1] The patient may just have abdominal pain and tenderness on examination.[2] The general appearance of the patient infected with coronavirus-19 depends on the severity of the illness. High clinical suspicion and careful physical exam are they key to early diagnosis and treatment of COVID-19 infection.

The Cochrane Collaboration has reviewed both the History and Symptoms | Physical Examination[3].

Physical Examination

Physical exam of a suspected or confirmed case of COVID-19 patient should be conducted in a private room, preferably a negative pressure one. The examiner should have PPE that includes gloves, gowns or aprons, masks, or respirators covering the mouth and nose, goggles, and face shields.[4] Due to the risk of aerosol spread of the SARS-CoV-2 virus, CDC recommends that protective eyewear (such as goggles or a face shield) should cover the front and sides of the face with no gaps between glasses and the face.[5] If possible and the patient is in no respiratory distress, patient should wear a surgical mask.[6]

Appearance of the Patient

Vital Signs





Lung examination findings in COVID-19
Physical exam Mild-moderate infection (Pneumonia)[30] Severe infection (ARDS)[31]
Inspection Tachypnea

Maybe normal respiratory rate


Tachypnea [Respiratory rate (≥ 30 breaths/min) indicates severe disease]

Increased work of breathing using accessory muscles

lethargic and dehydrated patient

Palpation Increased vocal fremitus

Diminished chest expansion at the affected side

Decreased vocal fremitus (accompanying pneumothorax)

Diminished chest movements at the affected side

Percussion Dull percussion note Tympanic note if pneumothorax accompanies
Auscultation Decreased breath sounds if pleural effusion accompanies

Bronchial breath sounds (click here to listen)


Rales and Crackles

Decreased breath sounds over a lung may indicate a
pneumothorax or endotracheal tube down the right main bronchus


Rales may or may not be present






Chilblains in a COVID-19 patient commonly known as COVID toes- By Sapp - Own work, Public Domain,



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