Which combination of physical exam findings is typical for lobar pneumonia?

Which combination of physical exam findings is typical for lobar pneumonia?

• A. Dullness to percussion, increased tactile fremitus, positive egophony, bronchial breath sounds
• B. Hyperresonance and decreased fremitus
• C. Clear lungs with wheezes
• D. Normal exam without abnormal sounds

Answer: (A)

Lobar pneumonia causes consolidation of a whole lobe, which changes how the chest sounds and how voice vibrations are transmitted. When the lung tissue is filled with inflammatory exudate, percussion becomes dull because the air has been replaced by denser material. The denser tissue also transmits vibrations more readily, so tactile fremitus is increased. Auscultation reveals bronchial breath sounds instead of the normal soft, low-pitched vesicular sounds, since airways are more directly involved in sound transmission. You may also hear egophony, where the voice sound changes from an “E” to an “A” over the affected area due to the consolidated tissue. Together, dullness to percussion, increased tactile fremitus, bronchial breath sounds, and egophony point to lobar pneumonia. Hyperresonance with decreased fremitus would suggest pneumothorax or emphysema; clear lungs with wheezes suggests reactive airways disease; a normal exam makes pneumonia unlikely.

Lobar pneumonia causes consolidation of a whole lobe, which changes how the chest sounds and how voice vibrations are transmitted. When the lung tissue is filled with inflammatory exudate, percussion becomes dull because the air has been replaced by denser material. The denser tissue also transmits vibrations more readily, so tactile fremitus is increased. Auscultation reveals bronchial breath sounds instead of the normal soft, low-pitched vesicular sounds, since airways are more directly involved in sound transmission. You may also hear egophony, where the voice sound changes from an “E” to an “A” over the affected area due to the consolidated tissue. Together, dullness to percussion, increased tactile fremitus, bronchial breath sounds, and egophony point to lobar pneumonia. Hyperresonance with decreased fremitus would suggest pneumothorax or emphysema; clear lungs with wheezes suggests reactive airways disease; a normal exam makes pneumonia unlikely.