Rosh Emergency Medicine Practice Test

In assessing a patient for pleural effusion, which physical finding is expected?

1. Decreased breath sounds

2. Increased tactile fremitus

3. Hyper-resonance on percussion

4. Equal breath sounds bilaterally

The correct answer is: Decreased breath sounds

Decreased breath sounds are an expected physical finding when assessing a patient for pleural effusion. This occurs because the presence of fluid in the pleural space can dampen the transmission of sounds from the lungs through the pleura to the chest wall. As the pleural effusion increases in size, it can further limit the movement of the lung, leading to diminished air movement in the affected area. Therefore, during auscultation, healthcare providers typically note decreased or absent breath sounds over regions where fluid has collected. In contrast, the other findings do not align with what is typically observed in pleural effusion. Increased tactile fremitus usually indicates denser lung tissue found in cases such as pneumonia, while hyper-resonance on percussion is more suggestive of conditions like pneumothorax, where there is excessive air. Equal breath sounds bilaterally would not be expected if there is a significant pleural effusion on one side; rather, you would expect diminished breath sounds on the side with the effusion.