A 49-year-old man comes to the hospital for a 10-day history of cough and worsening shortness of breath. He has sharp right-sided chest pain that worsens on inspiration and coughing. Two weeks ago, the patient was admitted to the hospital after passing out on the street from alcohol intoxication but he left against medical advice. He has coronary artery disease and hypertension. He takes no medications. He drinks 4 cans of beer daily and has smoked 2 packs of cigarettes daily for 20 years. His temperature is 38.5°C (101.3° F), pulse is 110/min, respirations are 29/min, and blood pressure is 110/65 mmHg. Examination shows poor dentition. Chest x-ray is shown below. Which of the following would be the expected physical examination finding over the right lower chest?

Question

A 49-year-old man comes to the hospital for a 10-day history of cough and worsening shortness of breath. He has sharp right-sided chest pain that worsens on inspiration and coughing. Two weeks ago, the patient was admitted to the hospital after passing out on the street from alcohol intoxication but he left against medical advice. He has coronary artery disease and hypertension. He takes no medications. He drinks 4 cans of beer daily and has smoked 2 packs of cigarettes daily for 20 years. His temperature is 38.5°C (101.3° F), pulse is 110/min, respirations are 29/min, and blood pressure is 110/65 mmHg. Examination shows poor dentition.   Chest x-ray is shown below.  Which of the following would be the expected physical examination finding over the right lower chest?

Quizplus · Accepted Answer

Eductional Objective: A pleural effusion is a collection of fluid between the visceral pleura that lines the lungs and the parietal pleura that lines the thoracic cavity.  The fluid acts to insulate vibrations and sounds that originate in the airways of the lung; therefore, tactile fremitus and breath sounds are decreased over a pleural effusion.  Dullness to percussion is also present.

A 49-Year-Old Man Comes to the Hospital for a 10-Day