Intensive Care Medicine (ICM) Practice Exam

Fluid accumulation in the lung could lead to which of the following during a pulmonary exam?

1. Increased fremitus

2. Decreased breath sounds

3. Hyperresonance

4. Painful chest expansion

The correct answer is: Decreased breath sounds

Fluid accumulation in the lungs, such as in the case of pleural effusion or pulmonary edema, results in specific findings during a pulmonary examination. The presence of fluid can create a barrier that dampens the transmission of sound through the lung tissue. As a result, breath sounds over the area of fluid are typically decreased. This is because the normal air-filled lung, which allows for better sound conduction, is replaced by fluid that absorbs and reflects sound waves differently. In contrast to fluid accumulation, conditions like hyperresonance are associated with the presence of air in the pleural space, such as a pneumothorax, and not fluid. Increased fremitus is usually indicative of consolidation in lung tissue, as sound vibrations are enhanced when lung density increases, whereas decreased fremitus is noted in cases of fluid or air in the pleural space. Painful chest expansion often suggests other issues, possibly related to musculoskeletal problems or pleuritis rather than fluid accumulation specifically. Thus, the finding of decreased breath sounds is the most consistent and appropriate outcome when assessing a pulmonary exam with fluid present in the lungs.