A 44-year-old man comes to the emergency department with a 3-day history of fever, chills, malaise, dyspnea, and a cough productive of "greenish" sputum. The patient has no prior medical problems and has never been hospitalized. He has a 25-pack-year smoking history and drinks 4-5 beers a week. His temperature is 39.4 C (103 F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 20/min. On examination, dullness to percussion, crackles, and higher clarity and intensity sound when he recites "toy-boat" are present at the right lung base. The remainder of the examination is normal. Chest x-ray shows a dense infiltrate occupying the entire right lower lobe. Which of the following is the most likely cause of these findings?

Question

A 44-year-old man comes to the emergency department with a 3-day history of fever, chills, malaise, dyspnea, and a cough productive of "greenish" sputum.  The patient has no prior medical problems and has never been hospitalized.  He has a 25-pack-year smoking history and drinks 4-5 beers a week.  His temperature is 39.4 C (103 F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 20/min.  On examination, dullness to percussion, crackles, and higher clarity and intensity sound when he recites "toy-boat" are present at the right lung base.  The remainder of the examination is normal.  Chest x-ray shows a dense infiltrate occupying the entire right lower lobe. Which of the following is the most likely cause of these findings?

Quizplus · Accepted Answer

Eductional Objective: Alveolar consolidation occurs when the alveoli become filled with fluid (eg, inflammatory exudate in bacterial pneumonia).  The increased compactness of the alveolar fluid (compared to air) causes sound to travel faster and more efficiently, resulting in bronchophony, increased tactile fremitus (vibration), and increased intensity of breath sounds over the affected area.  Dullness to percussion is also present.

A 44-Year-Old Man Comes to the Emergency Department with a 3-Day