Intensive Care Medicine (ICM) Practice Exam

If a patient presentation shows decreased breath sounds and dullness to percussion, what condition is likely?

1. Pneumothorax

2. Pleural effusion

3. Pneumonia

4. Listening to the patient's bowels instead of their lungs

The correct answer is: Pleural effusion

The presentation of decreased breath sounds alongside dullness to percussion is characteristic of pleural effusion. In this condition, excess fluid accumulates in the pleural space between the lungs and the chest wall. As a result, when a healthcare provider performs percussion over an area of pleural effusion, the fluid's density generates a dull sound compared to the resonant sound produced by normal lung tissue. When breath sounds are examined, the fluid interferes with the normal airflow in the lungs, leading to decreased or absent breath sounds in the corresponding area. This contrasts with conditions like pneumothorax, where breath sounds may be decreased on the affected side, but percussion typically reveals hyper-resonance rather than dullness due to the presence of air in the pleural space. Pneumonia often presents with increased breath sounds and may have a dull percussion note due to consolidation, but the typical pattern seen in pleural effusion is more indicative. The choice involving listening to the patient's bowels is unrelated to this respiratory assessment, emphasizing the importance of focused auscultation and examination techniques in identifying respiratory issues accurately.