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Difficulty: EasyPhysical Examination Findings

A 55-year-old man presents to the emergency department with a 4-day history of high fever, productive cough with rust-colored sputum, and right-sided pleuritic chest pain. Vital signs are temperature 38.9°C (102°F), blood pressure 120/80 mmHg, heart rate 110/min, and respiratory rate 24/min. Based on the highly suspected diagnosis of lobar consolidation secondary to bacterial pneumonia, which of the following physical examination findings are classically expected over the right lower lung field? (Select all that apply)

  1. Increased tactile fremitusAnswer
  2. Dullness to percussionAnswer
  3. C
    Hyperresonance to percussion
  4. D
    Decreased tactile fremitus
  5. E
    Tracheal deviation to the contralateral side

Answer

The correct findings expected in a patient with lobar consolidation are increased tactile fremitus and dullness to percussion.
In lobar consolidation (e.g., from bacterial pneumonia), the alveolar air spaces are filled with exudate. This solid and fluid medium transmits sound more effectively than air, leading to increased tactile fremitus. Furthermore, the absence of air in the affected lung tissue results in a dull note on percussion, differentiating it from the normal resonant sound of aerated lungs.

Step-by-Step Solution

1
Analyze the clinical presentation.
The patient has symptoms and signs classic for a lobar pneumonia (lobar consolidation), including fever, productive cough, and pleuritic chest pain.
Identifying the underlying pathology is necessary to predict the physical examination findings.
2
Correlate the pathology with physical signs.
Consolidation involves the replacement of alveolar air with fluid and exudate.
Understanding the physical properties of the diseased tissue explains the acoustic and tactile changes.
3
Determine the expected exam findings.
A solid or fluid medium enhances sound transmission (causing increased tactile fremitus) and decreases resonance (causing dullness to percussion).
This allows differentiation of consolidation from other pulmonary processes like pleural effusion or pneumothorax.

Key Concept

Physical examination findings in lobar consolidation include increased tactile fremitus and dullness to percussion due to the replacement of alveolar air with fluid or exudate, which enhances sound transmission but decreases resonance.
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Physical Examination Findings

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