While palpating the thorax of a patient who repeats the words "ninety-nine," you note a localized area of decreased tactile fremitus on the lower right side. Which of the following could explain this finding?
1. Atelectasis on the right
2. Right-sided lower pneumothorax
3. Right-sided lower pleural effusion
4. Obstruction of a bronchus in the right lung
a. 2, 3, and 4 only
b. 1 and 3 only
c. 3 and 4 only
d. 1, 3, and 4 only
ANS: A
Tactile fremitus is reduced most often in patients who are obese or overly muscular. In addition, when the pleural space lining the lung becomes filled with air (pneumothorax) or fluid (pleural effusion), fremitus is significantly reduced or absent.
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